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Antibiotic prescribing for upper respiratory tract infection: the importance of diagnostic uncertainty

Sandra R Arnold1, Teresa To, Warren J McIsaac

  • 1Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

The Journal of Pediatrics
|February 4, 2005
PubMed

Insights

Physicians are more likely to prescribe antibiotics for children with upper respiratory tract infections (URI) if the child appears unwell, has a high fever, or is over two years old. These clinical factors influence antibiotic prescribing for pediatric URI.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Practice

Background:

  • Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant global health concern.
  • Over-prescription contributes to antibiotic resistance and adverse effects.

Purpose of the Study:

  • To determine the influence of specific clinical features on antibiotic prescribing for pediatric URI.
  • To investigate factors that may increase physician concern about bacterial infection in children with URI.

Main Methods:

  • A mail survey with 16 clinical scenarios of children with URI was distributed to 540 pediatricians and family practitioners in Ontario, Canada.
  • Logistic regression analysis was used to assess the association between clinical features, parental pressure, and physician characteristics with antibiotic prescribing.

Main Results:

  • Poor appearance (OR, 6.50), fever >38.5°C (OR, 1.48), and age >2 years (OR, 2.27) were significantly associated with antibiotic prescribing.
  • Parental pressure was not associated with antibiotic prescribing.
  • Physician factors like being a family practitioner (OR, 1.54), seeing more patients weekly, and older physician age were linked to higher antibiotic use.

Conclusions:

  • Clinical indicators of potential bacterial infection in children with URI are associated with increased antibiotic prescribing.
  • Understanding these physician decision-making factors is crucial for developing targeted interventions to reduce antibiotic misuse.
Abstract

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