Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians

R. Gonzales, J. F. Steiner and M. A. Sande
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver 80262, USA. Ralph.Gonzales@uchsc.edu

CONTEXT: Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of all antibiotic prescribing by ambulatory care physicians. How frequently antibiotics are prescribed for these conditions and for and by whom is not known. OBJECTIVES: To measure antibiotic prescription rates and to identify predictors of antibiotic use for adults diagnosed as having colds, upper respiratory tract infections, and bronchitis in the United States. DESIGN: Sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1992. SETTING: Office-based physician practices. SUBJECTS: Physicians (n=1529) completing patient record forms for adult office visits (n=28787). MAIN OUTCOME MEASURES: Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. RESULTS: Office visits for colds, upper respiratory tract infections, and bronchitis resulted in approximately 12 million antibiotic prescriptions, accounting for 21% of all antibiotic prescriptions to adults in 1992. A total of 51 % of patients diagnosed as having colds, 52% of patients diagnosed as having upper respiratory tract infections, and 66% of patients diagnosed as having bronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibiotic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower antibiotic prescription rates. Patient age, Hispanic ethnicity, geographic region, physician specialty, and payment sources were not associated with antibiotic prescription rates in the bivariate analysis. Multivariate logistic regression analysis identified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to be independently associated with more frequent antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. CONCLUSION: Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States. Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?
Bont et al.
Fam Pract 2007;24:317-322.
ABSTRACT | FULL TEXT  

Diagnosing streptococcal sore throat in adults: Randomized controlled trial of in-office aids
Worrall et al.
cfp 2007;53:666-671.
ABSTRACT | FULL TEXT  

Ruling out the need for antibiotics: are we sending the right message?
Mangione-Smith et al.
Arch Pediatr Adolesc Med 2006;160:945-952.
ABSTRACT | FULL TEXT  

The Changing Fate of Pneumonia as a Public Health Concern in 20th-Century America and Beyond
Podolsky
Am. J. Public Health 2005;95:2144-2154.
ABSTRACT | FULL TEXT  

Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial
Samore et al.
JAMA 2005;294:2305-2314.
ABSTRACT | FULL TEXT  

Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count
Takemura et al.
J. Clin. Pathol. 2005;58:729-733.
ABSTRACT | FULL TEXT  

Antibiotic Prescribing for Cough and Symptoms of Respiratory Tract Infection: Do the Right Thing
Ebell
JAMA 2005;293:3062-3064.
FULL TEXT  

Antibiotic prescription in primary health care: clinical and economic perspectives (Catalonia, Spain)
Caminal and Rovira
Eur J Public Health 2005;15:276-281.
ABSTRACT | FULL TEXT  

Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis, URIs, and acute bronchitis in Taiwan: a multi-level modeling approach
Huang et al.
Fam Pract 2005;22:160-167.
ABSTRACT | FULL TEXT  

Provider and Practice Characteristics Associated With Antibiotic Use in Children With Presumed Viral Respiratory Tract Infections
Gaur et al.
Pediatrics 2005;115:635-641.
ABSTRACT | FULL TEXT  

National Trends in Cyclooxygenase-2 Inhibitor Use Since Market Release: Nonselective Diffusion of a Selectively Cost-effective Innovation
Dai et al.
Arch Intern Med 2005;165:171-177.
ABSTRACT | FULL TEXT  

Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities
Akkerman et al.
J Antimicrob Chemother 2004;54:1116-1121.
ABSTRACT | FULL TEXT  

Strategies to Diagnose and Treat Group A Streptococcal Pharyngitis
Gonzales et al.
JAMA 2004;292:167-167.
FULL TEXT  

Antibiotics for Upper Respiratory Tract Infections in Ambulatory Practice in the United States, 1997-1999: Does Physician Specialty Matter?
Rutschmann and Domino
J Am Board Fam Med 2004;17:196-200.
ABSTRACT | FULL TEXT  

Initial and Follow-up Costs by Treatment Outcome for Children With Respiratory Infections
Howard and McGowan
Pediatrics 2004;113:1352-1356.
ABSTRACT | FULL TEXT  

VP1 Sequencing of All Human Rhinovirus Serotypes: Insights into Genus Phylogeny and Susceptibility to Antiviral Capsid-Binding Compounds
Ledford et al.
J. Virol. 2004;78:3663-3674.
ABSTRACT | FULL TEXT  

Community-Level Predictors of Pneumococcal Carriage and Resistance in Young Children
Huang et al.
Am J Epidemiol 2004;159:645-654.
ABSTRACT | FULL TEXT  

Modelling of escalating outpatient antibiotic expenditures
Zintzaras and Ioannidis
J Antimicrob Chemother 2003;52:1001-1004.
ABSTRACT | FULL TEXT  

Trends in Antimicrobial Prescribing for Bronchitis and Upper Respiratory Infections Among Adults and Children
Mainous et al.
Am. J. Public Health 2003;93:1910-1914.
ABSTRACT | FULL TEXT  

Keeping the doctor away
Hueston
BMJ 2003;327:E102-103.
FULL TEXT  

Diagnosis and Management of Adults with Pharyngitis: A Cost-Effectiveness Analysis
Neuner et al.
ANN INTERN MED 2003;139:113-122.
ABSTRACT | FULL TEXT  

Health Care in America: Lost Opportunities Amid Plenty
Whalen
Qual Health Res 2003;13:857-870.
ABSTRACT  

A 65-Year-Old Woman With Acute Cough Illness and an Important Engagement
Gonzales
JAMA 2003;289:2701-2708.
FULL TEXT  

Diagnosis and Treatment of Rhinovirus Respiratory Infections
Anzueto and Niederman
Chest 2003;123:1664-1672.
ABSTRACT | FULL TEXT  

Potential Impact of Increased Use of Biocides in Consumer Products on Prevalence of Antibiotic Resistance
Gilbert and McBain
Clin. Microbiol. Rev. 2003;16:189-208.
ABSTRACT | FULL TEXT  

Quality or financing: what drives design of the health care system?
McLoughlin and Leatherman
Qual Saf Health Care 2003;12:136-142.
ABSTRACT | FULL TEXT  

The Economic Burden of Non-Influenza-Related Viral Respiratory Tract Infection in the United States
Fendrick et al.
Arch Intern Med 2003;163:487-494.
ABSTRACT | FULL TEXT  

Predictors of Broad-Spectrum Antibiotic Prescribing for Acute Respiratory Tract Infections in Adult Primary Care
Steinman et al.
JAMA 2003;289:719-725.
ABSTRACT | FULL TEXT  

Respiratory Consequences of Rhinovirus Infection
Greenberg
Arch Intern Med 2003;163:278-284.
ABSTRACT | FULL TEXT  

Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis
Hickman et al.
The Annals of Pharmacotherapy 2003;37:187-191.
ABSTRACT | FULL TEXT  

Misconceptions About Colds and Predictors of Health Service Utilization
Lee et al.
Pediatrics 2003;111:231-236.
ABSTRACT | FULL TEXT  

Medicine and Professionalism
Barondess
Arch Intern Med 2003;163:145-149.
FULL TEXT  

Antibiotic Prescribing by Primary Care Physicians for Children With Upper Respiratory Tract Infections
Nash et al.
Arch Pediatr Adolesc Med 2002;156:1114-1119.
ABSTRACT | FULL TEXT  

Treatment of community-acquired lower respiratory tract infections in adults
Ortqvist
Eur Respir J 2002;20:40S-53s.
ABSTRACT | FULL TEXT  

Trends in Antimicrobial Prescribing Rates for Children and Adolescents
McCaig et al.
JAMA 2002;287:3096-3102.
ABSTRACT | FULL TEXT  

Prescribing Behaviour of Physicians
Sharma et al.
Journal of Health Management 2002;4:55-71.
ABSTRACT  

The Impact of Empirical Management of Acute Cystitis on Unnecessary Antibiotic Use
McIsaac et al.
Arch Intern Med 2002;162:600-605.
ABSTRACT | FULL TEXT  

Antibiotics for Common Respiratory Tract Infections in Adults
Hirschmann
Arch Intern Med 2002;162:256-264.
ABSTRACT | FULL TEXT  

National Patterns in the Treatment of Urinary Tract Infections in Women by Ambulatory Care Physicians
Huang and Stafford
Arch Intern Med 2002;162:41-47.
ABSTRACT | FULL TEXT  

Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence
Ball et al.
J Antimicrob Chemother 2002;49:31-40.
ABSTRACT | FULL TEXT  

President's page: "The Great End Of Life Is Not Knowledge But Action."--Thomas Henry Huxley (1825-95)
Zipes
J Am Coll Cardiol 2001;38:2088-2090.
FULL TEXT  

The incidence, natural history and associated outcomes of influenza-like illness and clinical influenza in Italy
Sessa et al.
Fam Pract 2001;18:629-634.
ABSTRACT | FULL TEXT  

Antimicrobial Resistance: Guidelines for the Practicing Orthopaedic Surgeon
Osmon
JBJS 2001;83:1891-1901.
FULL TEXT  

Relationship Between Asthma Medication and Antibiotic Use
Glauber et al.
Chest 2001;120:1485-1492.
ABSTRACT | FULL TEXT  

Antibiotic Treatment of Adults With Sore Throat by Community Primary Care Physicians: A National Survey, 1989-1999
Linder and Stafford
JAMA 2001;286:1181-1186.
ABSTRACT | FULL TEXT  

The Ethics Of Pharmaceutical Benefit Management
Burton et al.
Health Aff (Millwood) 2001;20:150-163.
ABSTRACT | FULL TEXT  

Improving Quality, Minimizing Error: Making It Happen
Becher and Chassin
Health Aff (Millwood) 2001;20:68-81.
ABSTRACT | FULL TEXT  

The Diagnosis and Treatment of Cough
Irwin and Madison
NEJM 2000;343:1715-1721.
FULL TEXT  

Picornavirus Infections: A Primer for the Practitioner
Rotbart and Hayden
Arch Fam Med 2000;9:913-920.
ABSTRACT | FULL TEXT  

Cultural and Economic Factors That (Mis)Shape Antibiotic Use: The Nonpharmacologic Basis of Therapeutics
Avorn and Solomon
ANN INTERN MED 2000;133:128-135.
ABSTRACT | FULL TEXT  

Characteristics and Experiences of Parents and Adults Who Want Antibiotics for Cold Symptoms
Braun and Fowles
Arch Fam Med 2000;9:589-595.
ABSTRACT | FULL TEXT  

A matter of perspective
Enkin and Jadad
CMAJ 2000;162:1839-1841.
FULL TEXT  

Review: penicillin V is better than placebo and equal to non-penicillins for acute maxillary sinusitis
Anderer
Evid. Based Nurs. 2000;3:49-49.
FULL TEXT  

Outcomes After Judicious Antibiotic Use for Respiratory Tract Infections Seen in a Private Pediatric Practice
Pichichero et al.
Pediatrics 2000;105:753-759.
ABSTRACT | FULL TEXT  

The Drug-Resistant Pneumococcus: Clinical Relevance, Therapy, and Prevention
Harwell and Brown
Chest 2000;117:530-541.
ABSTRACT | FULL TEXT  

Does Clinical Error Contribute to Unnecessary Antibiotic Use?
McIsaac and Butler
Med Decis Making 2000;20:33-38.
ABSTRACT  

Understanding Antibiotic Overuse for Respiratory Tract Infections in Children
Pichichero
Pediatrics 1999;104:1384-1388.
FULL TEXT  

Antibiotics for Upper Respiratory Tract Infections: Follow-up Utilization and Antibiotic Use
Hueston et al.
Arch Fam Med 1999;8:426-430.
ABSTRACT | FULL TEXT  

Effectiveness of Live, Attenuated Intranasal Influenza Virus Vaccine in Healthy, Working Adults: A Randomized Controlled Trial
Nichol et al.
JAMA 1999;282:137-144.
ABSTRACT | FULL TEXT  

Pneumococcal macrolide resistance—myth or reality?
Amsden
J Antimicrob Chemother 1999;44:1-6.
FULL TEXT  

Medical leadership and the future of health care
Shore
Ann. Thorac. Surg. 1999;67:1219-1226.
ABSTRACT | FULL TEXT  

Decreasing Antibiotic Use in Ambulatory Practice: Impact of a Multidimensional Intervention on the Treatment of Uncomplicated Acute Bronchitis in Adults
Gonzales et al.
JAMA 1999;281:1512-1519.
ABSTRACT | FULL TEXT  

The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior
Mangione-Smith et al.
Pediatrics 1999;103:711-718.
ABSTRACT | FULL TEXT  

Parents, Physicians, and Antibiotic Use
Bauchner et al.
Pediatrics 1999;103:395-401.
ABSTRACT | FULL TEXT  

Antibiotics for Children With Upper Respiratory Tract Infections
Chen et al.
JAMA 1998;280:1399-1402.
FULL TEXT  

The Urgent Need to Improve Health Care Quality: Institute of Medicine National Roundtable on Health Care Quality
Chassin et al.
JAMA 1998;280:1000-1005.
ABSTRACT | FULL TEXT  

National Trends in the Use of Antibiotics by Primary Care Physicians for Adult Patients With Cough
Metlay et al.
Arch Intern Med 1998;158:1813-1818.
ABSTRACT | FULL TEXT  

Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats
Butler et al.
BMJ 1998;317:637-642.
ABSTRACT | FULL TEXT  

Strategies for promoting judicious use of antibiotics by doctors and patients
Belongia and Schwartz
BMJ 1998;317:668-671.
FULL TEXT  

Fortnightly review: Treatment of the common cold
Mossad
BMJ 1998;317:33-36.
FULL TEXT  

Reducing Inappropriate Oral Antibiotic Use: A Prescription for Change
Bauchner and Philipp
Pediatrics 1998;102:142-144.
FULL TEXT  

Antibiotics for Colds in Children: Who Are the High Prescribers?
Mainous III et al.
Arch Pediatr Adolesc Med 1998;152:349-352.
ABSTRACT | FULL TEXT  

Antibiotic Prescribing for Children With Colds, Upper Respiratory Tract Infections, and Bronchitis
Nyquist et al.
JAMA 1998;279:875-877.
ABSTRACT | FULL TEXT  

Why Do Physicians Prescribe Antibiotics for Children With Upper Respiratory Tract Infections?
Schwartz et al.
JAMA 1998;279:881-882.
FULL TEXT  

Strategies for Stemming the Tide of Antimicrobial Resistance
Low and Scheld
JAMA 1998;279:394-395.
FULL TEXT  

Antibiotic Prescribing and Respiratory Tract Infections
Jacques et al.
JAMA 1998;279:271-273.
FULL TEXT  

Expert Advice and Patient Expectations: Laboratory Testing and Antibiotics for Lyme Disease
Barbour
JAMA 1998;279:239-240.
FULL TEXT  

Antibiotic Overuse in URIs
JWatch Emergency Med. 1997;1997:19-19.
FULL TEXT  

OVERPRESCRIBING ANTIBIOTICS FOR RESPIRATORY INFECTIONS
JWatch General 1997;1997:1-1.
FULL TEXT