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David R. Nash, MD; Jeffrey Harman, PhD; Ellen R. Wald, MD; Kelly J. Kelleher, MD

Arch Pediatr Adolesc Med. 2002;156:1114-1119.

Objectives  To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy.

Design  The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998.

Setting  Office-based physician practices.

Participants  Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years.

Main Outcome Measure  The appropriate use of antibiotics for upper respiratory tract infections.

Results  Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995.

Conclusions  Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.

From the Department of Pediatrics (Drs Nash, Wald, and Kelleher) and the Child Services Research and Development Program (Drs Harman and Kelleher), University of Pittsburgh School of Medicine, Pittsburgh, Pa. Dr Harman is currently located at the Department of Health Services Administration, University of Florida, Gainesville.

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