Antibiotics for colds in children: who are the high prescribers?
OBJECTIVE
To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs).


METHODS
Analysis of 34624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996.


METHODS
Primary care physicians with at least 25 episodes of care (n=205). The proportion of patients with URIs receiving antibiotics stratified the sample into low (< or =25th percentile) and high (> or =75th percentile) antibiotic prescribers.


METHODS
Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty.


RESULTS
The high prescriber group (n=52) included data from 11899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n=55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P<.001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians.


CONCLUSIONS
With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums.
Mainous
A G
AG
Department of Family Practice, University of Kentucky, Lexington, USA. mainouag@musc.edu
Hueston
W J
WJ
Love
M M
MM
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000188:drug therapy* / Q000209:etiology; D016001:Confidence Intervals; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D017050:Episode of Care; D005260:Female; D006801:Humans; D007223:Infant; D007629:Kentucky / Q000453:epidemiology; D016013:Likelihood Functions; D008297:Male; D010348:Patient Care Team / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000209:etiology
D000900:Anti-Bacterial Agents