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How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections?
Robert S Wigton1, Carol A Darr, Kitty K Corbett
1University of Nebraska Medical Center College of Medicine, Omaha, NE 68198-4285, USA. wigton@unmc.edu
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.
Insights
Community practitioners frequently overprescribe antibiotics for acute respiratory tract infections (ARIs), often influenced by illness duration rather than evidence-based guidelines. This contributes to antibiotic resistance, highlighting a need for targeted education.
Area of Science:
- Infectious Diseases
- Public Health
- Medical Education
Background:
- Antibiotic overuse for acute respiratory tract infections (ARIs) fuels antibiotic resistance.
- Understanding factors influencing prescribing decisions is crucial for antimicrobial stewardship.
Purpose of the Study:
- To identify factors influencing community practitioners' antibiotic prescribing for ARIs.
- To compare practitioners' prescribing patterns with Centers for Disease Control and Prevention (CDC) guidelines.
Main Methods:
- A paper case vignette study with a fractional factorial design was employed.
- 101 community practitioners evaluated 20 ARI cases, with antibiotic prescribing likelihood assessed.
- Multiple regression analyzed the weight given to nine clinical findings, compared against faculty adhering to CDC guidelines.
Main Results:
- Practitioners prescribed antibiotics in 44.5% of cases, more than double the CDC guideline rate (20%).
- Patient preference for antibiotics received minimal weight; duration of illness was the primary factor (72%).
- Prescribing rates aligned with the faculty panel when illness duration was short.
Conclusions:
- Community practitioners prescribed antibiotics at twice the rate of faculty following CDC guidelines for ARIs.
- Illness duration significantly influenced prescribing, particularly when combined with fever or productive cough.
- These findings indicate key areas for practitioner education and further clinical research to improve antibiotic use.
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