E-DRUG: Indiscriminate antibiotic prescribing
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According to a study published in today's issue of the Journal of
the American Medical Association (JAMA) antibiotic prescribing for
conditions where there is little or no benefit is very common.
Abstract follows below. JAMA website: http://www.ama-assn.org.
Thanks.
Syed Rizwanuddin Ahmad
Email: ra@usp.org
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Antibiotic Prescribing for Adults With Colds, Upper Respiratory
Tract Infections, and Bronchitis by Ambulatory Care Physicians
Ralph Gonzales,MD,MSPH; John F. Steiner,MD,MPH; Merle A. Sande,MD
JAMA. 1997;278:901-904
Context._Antibiotic use is associated with increased rates of
antibiotic-resistant organisms. A previous study has shown
that colds, upper respiratory tract infections, and bronchitis
account for nearly one third of all antibiotic prescribing by
ambulatory care physicians. How frequently antibiotics are
prescribed for these conditions and for and by whom is not known.
Objectives._To measure antibiotic prescription rates and to
identify predictors of antibiotic use for adults diagnosed as
having colds, upper respiratory tract infections, and bronchitis
in the United States.
Design._Sample survey of practicing physicians participating in the
National Ambulatory Medical Care Survey, 1992.
Setting._Office-based physician practices.
Subjects._Physicians (n=1529) completing patient record forms for
adult office visits (n=28 787).
Main Outcome Measures._Antibiotic prescriptions for colds, upper
respiratory tract infections, and bronchitis.
Results._Office visits for colds, upper respiratory tract
infections, and bronchitis resulted in approximately 12 million
antibiotic prescriptions, accounting for 21% of all antibiotic
prescriptions to adults in 1992. A total of 51% of patients
diagnosed as having colds, 52% of patients diagnosed as having
upper respiratory tract infections, and 66% of patients diagnosed
as having bronchitis were treated with antibiotics. Female sex
(odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62)
and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were
associated with greater antibiotic prescription rates, whereas
black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower
antibiotic prescription rates. Patient age, Hispanic ethnicity,
geographic region, physician specialty, and payment sources were
not associated with antibiotic prescription rates in the bivariate
analysis. Multivariate logistic regression analysis identified only
rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to
be independently associated with more frequent antibiotic
prescriptions for colds, upper respiratory tract infections, and
bronchitis.
Conclusion._Although antibiotics have little or no benefit for colds,
upper respiratory tract infections, or bronchitis, these conditions
account for a sizable proportion of total antibiotic prescriptions
for adults by office-based physicians in the United States. Overuse
of antibiotics is widespread across geographical areas, medical
specialties, and payment sources. Therefore, effective strategies for
changing prescribing behavior for these conditions will need to be
broad based.
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