How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections?
BACKGROUND
Overuse of antibiotics in the treatment of acute respiratory tract infection (ARI) contributes to the growing problem of antibiotic-resistant infections.


OBJECTIVE
To identify factors that influence community practitioners to prescribe antibiotics and examine how they differ from the recommendations of the Centers for Disease Control and Prevention (CDC) guideline for treatment of ARI.


METHODS
Paper case vignette study using a fractional factorial design.


METHODS
One hundred one community practitioners and eight faculty members.


METHODS
We asked community practitioners to estimate how likely they would be to prescribe antibiotics in each of 20 cases of ARI and then used multiple regression to infer the importance weights of each of nine clinical findings. We then compared practitioners' weights with those of a panel of eight faculty physicians who evaluated the cases following the CDC guidelines rather than their own judgments.


RESULTS
Practitioners prescribed antibiotics in 44.5% of cases, over twice the percentage treated by the panel using the CDC guidelines (20%). In deciding to prescribe antibiotic treatment, practitioners gave little or no weight to patient factors such as whether the patients wanted antibiotics. Although weighting patterns differed among practitioners, the majority (72%) gave the greatest weight to duration of illness. When illness duration was short, the rate of prescribing (20.1%) was the same as the rate of the faculty panel (20%).


CONCLUSIONS
Based on hypothetical cases of ARI, community practitioners prescribed antibiotics at twice the rate of faculty following CDC practice guidelines. Practitioners were most strongly influenced by duration of illness. The effect of duration was strongest when accompanied by fever or productive cough, suggesting that these situations would be important areas for practitioner education and further clinical studies.
Wigton
Robert S
RS
University of Nebraska Medical Center College of Medicine, Omaha, NE 68198-4285, USA. wigton@unmc.edu
Darr
Carol A
CA
Corbett
Kitty K
KK
Nickol
Devin R
DR
Gonzales
Ralph
R
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003657:Decision Making; D011307:Drug Prescriptions / Q000592:standards; D005194:Family Practice / Q000379:methods* / Q000639:trends; D005260:Female; D006282:Health Personnel / Q000639:trends; D006801:Humans; D008297:Male; D010821:Physicians, Family / Q000639:trends; D017410:Practice Guidelines as Topic / Q000592:standards; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents