Antibiotics for upper respiratory tract infections in ambulatory practice in the United States, 1997-1999: does physician specialty matter?
BACKGROUND
The dangers of overuse of antibiotics for upper respiratory infections (URIs) has been widely recognized, but the rate of change in prescribing patterns in recent years is unknown.


METHODS
Data on the use of antibiotics for URIs was extracted from the 1997 to 1999 National Ambulatory Medical Care Survey (a national multistage probability sample survey of patients' office visits to office-based physicians). Adult patients (>/=18 years) with a primary diagnosis of URI (bronchitis, common colds, and other acute upper respiratory infections) were included. The decision to prescribe antibiotics was modeled as a function of patient, physician, and practice characteristics using logistic regression.


RESULTS
The rate of antibiotic prescription for URIs decreased from 52.1% in 1997 to 41.5% in 1999. In a multivariate logistic regression model, treatment by general internal medicine physicians [odds ratio (OR), 0.37; 95% confidence interval (CI), 0.18 to 0.76] was associated with lower prescription rates. Of patients visiting general internal medicine physicians for URIs, 36.2% received antibiotics compared with 42.9% of those seeing a general/family medicine physician. Patients treated by their primary care physicians had a higher risk of receiving antibiotics (OR, 1.70; 95% CI, 1.08 to 2.68).


CONCLUSIONS
Despite a downward trend in antibiotic prescribing over the years, overprescription of antibiotics for upper respiratory infections persists. General internal medicine physicians are less likely than general/family physicians to prescribe antibiotics, but this gap seems to be narrowing. Specific interventions must be designed to address these disparities.
Rutschmann
Olivier T
OT
Duke Center for Clinical Health Policy Research, Duke University Medical Center, Durham, North Carolina, USA. olivier.rutschmann@hcuge.edu
Domino
Marisa Elena
ME
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine / Q000592:standards*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013038:Specialization; D014481:United States
D000900:Anti-Bacterial Agents