title: Antibiotic prescribing for upper respiratory tract infection: the importance of diagnostic uncertainty.
abstract: OBJECTIVE
  Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI.
  
  
  METHODS
  We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada. The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis.
  
  
  RESULTS
  A total of 257 physicians responded (48%). Poor appearance (OR, 6.50; 95% CI, 5.06 to 3.84), fever above 38.5 degrees C (OR, 1.48; 95% CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95% CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not. Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95% CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95% CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95% CI, 1.11 to 1.24, 5-year increments).
  
  
  CONCLUSIONS
  Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Arnold
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Warren J
authors.initials: WJ
authors.lastname: McIsaac
authors.forename: Elaine E L
authors.initials: EE
authors.lastname: Wang
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario; D010372:Pediatrics; D011177:Postal Service; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D019037:Urban Health Services
chemical_list: D000900:Anti-Bacterial Agents