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Inappropriate Antibiotic Use in Respiratory Infections Is Improving (Sort Of)

But, in 1999, 10%-20% of children and adults with URIs still received broad-spectrum antibiotics.

Concern about inappropriate antibiotic use for presumed viral upper respiratory tract infections (URIs) resulted in the dissemination of clinical practice guidelines and professional association recommendations in the late 1990s. However, results from the National Ambulatory Medical Care Surveys (NAMCS), which were conducted in 1993, 1995, 1997, and 1999, suggest that physician behavior was changing even before these guidelines were issued.

The sampled number of visits (mostly to primary care physicians) for viral respiratory infections ranged from 495 in 1999 to 1222 in 1995. Overall, antibiotic use in children with URIs dropped from about 40% in 1993 and 1995 to about 10% in 1997 and 1999; however, broad-spectrum antibiotics, which are of special concern because of increasing antibiotic resistance, were prescribed for about 10% of children in all years (and therefore constituted almost all antibiotic use in children with URIs in later years). Similar results were found for adults with URIs, with overall antibiotic prescriptions dropping from about 50% to 20% but with broad-spectrum antibiotic use persisting at about 18%.

Comment: Many physicians have changed their prescribing practices in response to initial research on inappropriate antibiotic use, but a floor seems to persist for the inappropriate use of broad-spectrum antibiotics.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine December 9, 2003

Citation(s):

Mainous AG III et al. Trends in antimicrobial prescribing for bronchitis and upper respiratory infections among adults and children. Am J Public Health 2003 Nov; 93:1910-4.

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