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01.10.2008 | Original Article | Ausgabe 10/2008

Journal of General Internal Medicine 10/2008

How Do Community Practitioners Decide Whether to Prescribe Antibiotics for Acute Respiratory Tract Infections?

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 10/2008
Autoren:
MD, MS Robert S. Wigton, PhD Carol A. Darr, PhD, MPH Kitty K. Corbett, MD Devin R. Nickol, MD, MSPH Ralph Gonzales

Abstract

BACKGROUND

Overuse of antibiotics in the treatment of acute respiratory tract infection (ARI) contributes to the growing problem of antibiotic-resistant infections.

OBJECTIVE

To identify factors that influence community practitioners to prescribe antibiotics and examine how they differ from the recommendations of the Centers for Disease Control and Prevention (CDC) guideline for treatment of ARI.

DESIGN

Paper case vignette study using a fractional factorial design.

PARTICIPANTS

One hundred one community practitioners and eight faculty members.

MAIN MEASUREMENTS

We asked community practitioners to estimate how likely they would be to prescribe antibiotics in each of 20 cases of ARI and then used multiple regression to infer the importance weights of each of nine clinical findings. We then compared practitioners’ weights with those of a panel of eight faculty physicians who evaluated the cases following the CDC guidelines rather than their own judgments.

MAIN RESULTS

Practitioners prescribed antibiotics in 44.5% of cases, over twice the percentage treated by the panel using the CDC guidelines (20%). In deciding to prescribe antibiotic treatment, practitioners gave little or no weight to patient factors such as whether the patients wanted antibiotics. Although weighting patterns differed among practitioners, the majority (72%) gave the greatest weight to duration of illness. When illness duration was short, the rate of prescribing (20.1%) was the same as the rate of the faculty panel (20%).

CONCLUSIONS

Based on hypothetical cases of ARI, community practitioners prescribed antibiotics at twice the rate of faculty following CDC practice guidelines. Practitioners were most strongly influenced by duration of illness. The effect of duration was strongest when accompanied by fever or productive cough, suggesting that these situations would be important areas for practitioner education and further clinical studies.

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