ANTIBIOTIC PRESCRIBING FOR CHILDREN WITH COLDS, UPPER RESPIRATORY-TRACT INFECTIONS, AND BRONCHITIS

Context.-The spread of antibiotic-resistant bacteria is associated wit h antibiotic use. Children receive a significant proportion of the ant ibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use. Objective.-T o 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.-Represen tative national survey of practicing physicians participating in the N ational Ambulatory Medical Care Survey conducted in 1992 with a respon se rate of 73%. Setting.-Office-based physician practices. Participant s.-Physicians completing patient record forms for patients younger tha n 18 years. Main Outcome Measures.-Principal diagnoses and antibiotic prescriptions. Results.-A total of 531 pediatric office visits were re corded 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 Stat es, 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 contr olling 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 l ower 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 pr escriptions, and otitis media was the most frequent diagnosis for whic h 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 antibiot ics, represents a substantial proportion of total antibiotic prescript ions to children in the United States each year.