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Ann-Christine Nyquist, MD, MSPH; Ralph Gonzales, MD, MSPH; John F. Steiner, MD, MPH; Merle A. Sande, MD

JAMA. 1998;279:875-877.

Context.— The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use.

Objective.— To evaluate antibiotic-prescribing practices for children younger than 18 years who had received a diagnosis of cold, upper respiratory tract infection (URI), or bronchitis in the United States.

Design.— Representative national survey of practicing physicians participating in the National Ambulatory Medical Care Survey conducted in 1992 with a response rate of 73%.

Setting.— Office-based physician practices.

Participants.— Physicians completing patient record forms for patients younger than 18 years.

Main Outcome Measures.— Principal diagnoses and antibiotic prescriptions.

Results.— A total of 531 pediatric office visits were recorded that included a principal diagnosis of cold, URI, or bronchitis. Antibiotics were prescribed to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis. Extrapolating to the United States, 6.5 million prescriptions (12% of all prescriptions for children) were written for children diagnosed as having a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions for children) were written for children diagnosed as having bronchitis. After controlling for confounding factors, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92). Children aged 0 to 4 years received 53% of all antibiotic prescriptions, and otitis media was the most frequent diagnosis for which antibiotics were prescribed (30% of all prescriptions).

Conclusions.— Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.

From the Division of Infectious Diseases, Department of Pediatrics (Dr Nyquist), Division of General Internal Medicine (Drs Gonzales and Steiner), and the Department of Preventive Medicine and Biometrics (Drs Nyquist, Gonzales, and Steiner), University of Colorado Health Sciences Center, Denver; and the Department of Medicine, University of Utah, Salt Lake City (Dr Sande).

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RELATED LETTER

Antibiotics for Children With Upper Respiratory Tract Infections
Raymond F. Chen, John M. Westfall, Tom Fahey, Nigel Stocks, Steven H. Woolf, Neil Brooks, Ann-Christine Nyquist, Ralph Gonzales, John F. Steiner, Merle A. Sande, Benjamin Schwartz, and Arch G. Mainous III
JAMA. 1998;280(16):1399-1402.
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RELATED ARTICLE

Why Do Physicians Prescribe Antibiotics for Children With Upper Respiratory Tract Infections?
Benjamin Schwartz, Arch G. Mainous III, and S. Michael Marcy
JAMA. 1998;279(11):881-882.
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