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Antibiotics for colds in children: who are the high prescribers?
A G Mainous1, W J Hueston, M M Love
1Department of Family Practice, University of Kentucky, Lexington, USA. mainouag@musc.edu
Insights
Physicians further from medical school graduation and family practitioners were more likely to be high antibiotic prescribers for pediatric upper respiratory infections (URIs). This highlights a need for targeted antibiotic stewardship education.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Antibiotic overuse for pediatric upper respiratory infections (URIs) contributes to antibiotic resistance.
- Understanding physician prescribing patterns is crucial for developing effective interventions.
Purpose of the Study:
- To identify physician characteristics associated with high antibiotic prescribing rates for pediatric URIs.
- To inform targeted educational strategies for antibiotic stewardship.
Main Methods:
- Analysis of 34,624 pediatric URI episodes from the Kentucky Medicaid program (1995-1996).
- Stratification of primary care physicians (n=205) into low (<25th percentile) and high (>75th percentile) antibiotic prescribers.
- Logistic regression to identify predictors of high antibiotic prescribing.
Main Results:
- High prescribers (80% rate) were significantly further from medical school graduation (27 vs. 19 years) and managed more URI episodes compared to low prescribers (16% rate).
- Family practitioners (OR 409) and other primary care physicians (OR 318) had significantly higher odds of being high prescribers compared to pediatricians.
Conclusions:
- Physician experience (years since graduation) and specialty are associated with antibiotic prescribing intensity for pediatric URIs.
- Enhanced antibiotic stewardship training during residency and continuing medical education is recommended to address high prescribing rates.
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.