Antibiotic prescribing for upper respiratory tract infection

The importance of diagnostic uncertainty

Sandra Arnold, Teresa To, Warren J. McIsaac, Elaine E.L. Wang

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objectives: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. Study design: We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI. We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada. The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis. Results: A total of 257 physicians responded (48%). Poor appearance (OR, 6.50; 95% CI, 5.06 to 3.84), fever above 38.5°C (OR, 1.48; 95% CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95% CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not. Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95% CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95% CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95% CI, 1.11 to 1.24, 5-year increments). Conclusions: Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.

Original languageEnglish (US)
Pages (from-to)222-226
Number of pages5
JournalJournal of Pediatrics
Volume146
Issue number2
DOIs
StatePublished - Jan 1 2005

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Respiratory Tract Infections
Uncertainty
Anti-Bacterial Agents
Physicians
Bacterial Infections
Fever
Pressure
Postal Service
Ontario
Canada
Logistic Models
Regression Analysis
Pediatrics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Antibiotic prescribing for upper respiratory tract infection : The importance of diagnostic uncertainty. / Arnold, Sandra; To, Teresa; McIsaac, Warren J.; Wang, Elaine E.L.

In: Journal of Pediatrics, Vol. 146, No. 2, 01.01.2005, p. 222-226.

Research output: Contribution to journalArticle

Arnold, Sandra ; To, Teresa ; McIsaac, Warren J. ; Wang, Elaine E.L. / Antibiotic prescribing for upper respiratory tract infection : The importance of diagnostic uncertainty. In: Journal of Pediatrics. 2005 ; Vol. 146, No. 2. pp. 222-226.
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