Received from the Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School (JAL), and the General Medicine Division, Massachusetts General Hospital (DES), Boston, Mass.
Desire for Antibiotics and Antibiotic Prescribing for Adults with Upper Respiratory Tract Infections
Article first published online: 3 OCT 2003
Journal of General Internal Medicine
Volume 18, Issue 10, pages 795–801, October 2003
How to Cite
Linder, J. A. and Singer, D. E. (2003), Desire for Antibiotics and Antibiotic Prescribing for Adults with Upper Respiratory Tract Infections. Journal of General Internal Medicine, 18: 795–801. doi: 10.1046/j.1525-1497.2003.21101.x
Presented in part at the Annual Meeting of the Society of General Internal Medicine, Atlanta, GA, May 3, 2002 and presented at the Annual Meeting of the Society of General Internal Medicine, Vancouver, BC, May 2, 2003.
- Issue published online: 3 OCT 2003
- Article first published online: 3 OCT 2003
- respiratory tract diseases;
- physician's practice patterns
OBJECTIVE: Prior studies have shown that 60% to 75% of adults with upper respiratory tract infections want antibiotics. More recent research indicates declines in antibiotic prescribing for upper respiratory tract infections. To investigate whether there has been a comparable decrease in patients’ desire for antibiotics, we measured the proportion of adults with upper respiratory tract infections who wanted antibiotics in the winter of 2001–2002. We also sought to identify factors independently associated with wanting antibiotics and antibiotic prescribing.
DESIGN: Prospective survey of adults with upper respiratory tract infections prior to visiting an acute care clinic from November 2001 to February 2002.
MEASUREMENTS AND MAIN RESULTS: Thirty-nine percent of 310 patients wanted antibiotics. Many patients wanted relief from symptoms (43%) or pain (24%) and many patients expected to receive a diagnosis (49%) or reassurance during the visit (13%). In multivariable modeling, independent predictors of wanting antibiotics were prior antibiotic use (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.3 to 4.7) and current smoking (OR, 3.1; 95% CI, 1.3 to 7.3). Physicians prescribed antibiotics to 46% of patients who wanted antibiotics and 29% of patients who did not want antibiotics (P= .01). In multivariable modeling, wanting antibiotics was an independent predictor of antibiotic prescribing (OR, 2.1; 95% CI, 1.1 to 4.4).
CONCLUSIONS: Only 39% of adults seeking care for upper respiratory tract infections wanted antibiotics, less than in previous studies. In continuing efforts to break the cycle of inappropriate antibiotic use, physicians should not assume that most patients with upper respiratory tract infections want antibiotics.