title: Decline in inappropriate antibiotic use over a decade by pediatricians in a Tennessee community.
abstract: OBJECTIVE
  Published data indicates that antibiotic use for pediatric respiratory tract infections has declined across the United States. We reviewed antibiotic use in 2 pediatrics practices in Memphis, Tennessee, to determine whether there has been a reduction in inappropriate antibiotic use in this region.
  
  
  METHODS
  Randomly selected charts in 7 offices of 2 practices were reviewed for respiratory tract infection visits during alternate years between 1992 and 2002. Antibiotics were considered inappropriate for viral respiratory tract and other viral syndromes, asthma, allergic rhinitis, and otitis media with effusion. Changes in inappropriate prescribing were evaluated by generalized estimating equations with year of visit as the explanatory variable and visits clustered by practice.
  
  
  RESULTS
  There were 1504 unique patient visits reviewed. The number of visits with an antibiotic prescription fell from 85% in 1992 to 67% in 2002. The likelihood of inappropriately prescribing an antibiotic declined between 1992 and 2002 (odds ratio 0.28, 95% confidence interval 0.20-0.38). Use of amoxicillin-clavulanic acid and azithromycin increased, and amoxicillin use decreased.
  
  
  CONCLUSIONS
  There has been a marked decline in inappropriate antibiotic use in this region with high prescribing rates. Pediatricians have increased their use of broad-spectrum antibiotic agents for respiratory tract infections. Continuing education of physicians regarding appropriate use should continue to maintain and improve on the gains achieved in the last decade.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN 38103, USA. sarnold5@utmem.edu
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Arnold
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bush
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D010034:Otitis Media with Effusion / Q000188:drug therapy; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012220:Rhinitis / Q000188:drug therapy; D013714:Tennessee
chemical_list: D000900:Anti-Bacterial Agents