ANTIBIOTIC PRESCRIBING FOR ADULTS WITH COLDS, UPPER RESPIRATORY-TRACTINFECTIONS, AND BRONCHITIS BY AMBULATORY CARE PHYSICIANS

Contex.-Antibiotic use is associated with increased rates of antibioti c-resistant organisms. A previous study has shown that colds, upper re spiratory tract infections, and bronchitis account for nearly one thir d of all antibiotic prescribing by ambulatory care physicians. How fre quently antibiotics are prescribed for these conditions and for and by whom is not known. Objectives.-To measure antibiotic prescription rat es and to identify predictors of antibiotic use for adults diagnosed a s having colds, upper respiratory tract infections, and bronchitis in the United States. Design.-Sample survey of practicing physicians part icipating in the National Ambulatory Medical Care Survey, 1992. Settin g.-Office-based physician practices. Subjects.-Physicians (n=1529) com pleting patient record forms for adult office visits (n=28787). Main O utcome Measures.-Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. Results.-Office visits for colds, u pper respiratory tract infections, and bronchitis resulted in approxim ately 12 million antibiotic prescriptions, accounting for 21% of all a ntibiotic prescriptions to adults in 1992. A total of 51% of patients diagnosed as having colds, 52% of patients diagnosed as having upper r espiratory tract infections, and 66% of patients diagnosed as having b ronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice loca tion (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibi otic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0. 93) was associated with lower antibiotic prescription rates. Patient a ge, Hispanic ethnicity, geographic region, physician specialty, and pa yment sources were not associated with antibiotic prescription rates i n the bivariate analysis. Multivariate logistic regression analysis id entified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39 -4.76) to be independently associated with more frequent antibiotic pr escriptions for colds, upper respiratory tract infections, and bronchi tis. Conclusion.-Although antibiotics have little or no benefit for co lds, upper respiratory tract infections, or bronchitis, these conditio ns account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States.; Overuse o f antibiotics is widespread across geographical areas, medical special ties, and payment sources. Therefore, effective strategies for changin g prescribing behavior for these conditions will need to be broad base d.