Correlates of parental antibiotic knowledge, demand, and reported use.
BACKGROUND
Clinicians cite parental misconceptions and requests for antibiotics as reasons for inappropriate prescribing.


OBJECTIVE
To identify misconceptions regarding antibiotics and predictors of parental demand for antibiotics and to determine if parental knowledge and attitudes are associated with use.


METHODS
Survey of parents in 16 Massachusetts communities. Domains included antibiotic-related knowledge, attitudes about antibiotics, antibiotic use during a 12-month period, demographics, and access to health information. Bivariate and multivariate analyses evaluated predictors of knowledge and proclivity to demand antibiotics. A multivariate model evaluated the associations of knowledge, demand, and demographic factors with parent-reported antibiotic use.


RESULTS
A total of 1106 surveys were returned (response rates: 54% and 32% for commercially-insured and Medicaid-insured families). Misconceptions were common regarding bronchitis (92%) and green nasal discharge (78%). Two hundred sixty-five (24%) gave responses suggesting a proclivity to demand antibiotics. Antibiotic knowledge was associated with increased parental age and education, having more than 1 child, white race, and receipt of media information on resistance. Factors associated with a proclivity to demand antibiotics included decreased knowledge, pressure from day-care settings, lack of alternatives offered by clinicians, and lack of access to media information. Among all respondents, reported antibiotic use was associated with younger child age and day-care attendance. Among Medicaid-insured children only, less antibiotic knowledge and tendency to demand antibiotics were associated with higher rates of antibiotic use.


CONCLUSIONS
Misconceptions regarding antibiotic use are widespread and potentially modifiable by clinicians and media sources. Particular attention should be paid to Medicaid-insured patients in whom such misconceptions may contribute to inappropriate prescribing.
Kuzujanakis
Marianne
M
Harvard Pediatric Health Sevices Research Fellowship, the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass 02215, USA.
Kleinman
Ken
K
Rifas-Shiman
Sheryl
S
Finkelstein
Jonathan A
JA
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D004522:Educational Status; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D016014:Linear Models; D008404:Massachusetts; D008484:Medicaid; D008875:Middle Aged; D010031:Otitis / Q000188:drug therapy*; D010290:Parents / Q000193:education* / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents