Antibiotics for colds in children: who are the high prescribers?

Abstract

Objective: To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs).

Design and setting: Analysis of 34624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996.

Participants: Primary care physicians with at least 25 episodes of care (n=205). The proportion of patients with URIs receiving antibiotics stratified the sample into low (< or =25th percentile) and high (> or =75th percentile) antibiotic prescribers.

Main outcome measures: Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty.

Results: The high prescriber group (n=52) included data from 11899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n=55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P<.001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians.

Conclusion: With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums.