Antibiotic prescribing in a family medicine residency program

A total of 227 ambulatory patients who received prescriptions for antibiotics in a family practice residency program was studied. The common infections treated were urinary tract infections, upper respiratory tract infections, impetigo, nonspecific vaginitis, and bronchitis. Cultures obtained in 21.1 percent of the patients were usually considered to be appropriate. Urinary tract infections were usually treated with co-trimoxazole or other drugs containing sulfonamides; upper respiratory tract infections with amoxicillin, ampicillin, or penicillin; impetigo with penicillin; nonspecific vaginitis with vaginal creams; and bronchitis with ampicillin or erythromycin. Most prescriptions (86 percent) were written generically at an approximate savings of $2 per prescription. A review panel audited the prescribing practices and often (32.2 percent) disagreed among themselves, yet they did determine 65.4 percent of the prescriptions to be appropriate. The rate of appropriate antibiotic prescribing practices among the residents was found to decrease as the level of supervision decreased (P less than 0.01).