NATIONAL TRENDS IN THE USE OF ANTIBIOTICS BY PRIMARY-CARE PHYSICIANS FOR ADULT PATIENTS WITH COUGH

Background: Increased antibiotic use for outpatient illnesses has been identified as an important determinant of the recent rise in antibiot ic resistance among common respiratory pathogens. Efforts to reduce th e inappropriate use will need to be evaluated against current trends i n the outpatient use of antibiotics. Objectives: To examine national t rends in the use of antibiotics by primary care physicians in the care of adult patients with cough and identify patient factors that may in fluence antibiotic use for these patients. Methods: This study was bas ed on a serial analysis of results from all National Ambulatory Medica l Care Surveys beginning in 1980 (when therapeutic drug use was first recorded) to 1994 (the most recent survey year available). These surve ys are a random sampling of visits to US office-based physicians in 19 80, 1981, 1985, and annually from 1989-1994. Eligible visits included those by adults presenting to general internists, family practitioners , or general practitioners with a chief complaint of cough. A total of 3416 visits for cough were identified over the survey years. Survey r esults were extrapolated, based on sampling weights in each year, to p roject national rates of antibiotic use for patients with cough. Addit ional analyses examined the rates of antibiotic use stratified by pati ent age, race, and clinical diagnosis. Results: Overall, an antibiotic was prescribed 66% of the time during office visits for patients with cough: 59% of patient visits in 1980 rising to 70% of visits in 1994 (P = .002 for trend). In every study year, white, non-Hispanic patient s and patients younger than 65 years were more likely to receive antib iotics compared with nonwhite patients and patients 65 years or older, respectively. Conclusions: The rate of antibiotic use by primary care physicians for patients with cough remained high from 1980 to 1994, a nd was influenced by nonclinical characteristics of patients.