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How Do Community Practitioners Decide Whether to Prescribe Antibiotics for Acute Respiratory Tract Infections?

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Abstract

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.

DESIGN

Paper case vignette study using a fractional factorial design.

PARTICIPANTS

One hundred one community practitioners and eight faculty members.

MAIN MEASUREMENTS

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.

MAIN 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.

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Acknowledgments

Parts of this study were presented at the 2002 Annual Meeting of the Society of General Internal Medicine.

The study was funded through grants and contracts from the Agency for Health Care Research and Quality. Minimizing Antibiotic Resistance in Colorado (MARC) Project (AHRQ R01 HS13001–01), a study testing different types of community educational campaigns to improve appropriate antibiotic use for ARIs18.

The funding source had no role in the design, conduct, and analysis of the study or in the decision to submit the manuscript for publication. Drs. Gonzales, Darr, Corbett, and Nickol had full access to the data.

The authors would like to thank Thomas Tape, MD, for his review and comments on this manuscript.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. University of Nebraska Medical Center College of Medicine, Omaha, NE, USA

    Robert S. Wigton MD, MS & Devin R. Nickol MD

  2. University of Colorado at Denver and Health Sciences Center, Denver, CO, USA

    Carol A. Darr PhD

  3. Simon Fraser University, Burnaby, BC, Canada

    Kitty K. Corbett PhD, MPH

  4. University of California, San Francisco, CA, USA

    Ralph Gonzales MD, MSPH

Authors
  1. Robert S. Wigton MD, MS
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  2. Carol A. Darr PhD
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  3. Kitty K. Corbett PhD, MPH
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  4. Devin R. Nickol MD
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  5. Ralph Gonzales MD, MSPH
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Corresponding author

Correspondence to Robert S. Wigton MD, MS.

Appendix

Appendix

Sample Case

This patient has the following history:

  • colored nasal drainage

  • no cough

  • no sinus symptoms

  • The patient has had this illness for 14 days

  • Feels this illness is so severe that treatment is needed

Examination:

  • temperature = 99° F

The patient has come in specifically to get antibiotic treatment

Patient is leaving on vacation soon and worries about the illness getting worse

No prior antibiotics for this sort of illness

  1. 1.

    Mark an “x” on the line below to indicate how likely you are to prescribe an antibiotic in this case

  2. 2.

    In your practice, would you prescribe an antibiotic for this patient? (Circle one) Yes No

  3. 3.

    Mark an “x” on the line to indicate how comfortable you are with your decision about antibiotics?

  4. 4.

    Imagine this same patient does not want to take antibiotics: Mark an “x” on the line to indicate how strongly you would urge the patient to start antibiotics right away.

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Wigton, R.S., Darr, C.A., Corbett, K.K. et al. How Do Community Practitioners Decide Whether to Prescribe Antibiotics for Acute Respiratory Tract Infections?. J GEN INTERN MED 23, 1615–1620 (2008). https://doi.org/10.1007/s11606-008-0707-9

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  • DOI: https://doi.org/10.1007/s11606-008-0707-9

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