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February 11, 2003 — Adult patients may be given prescriptions for antibiotics when they might not need them depending on the physician they see and where they live, according to a study in the February 12 issue of The Journal of the American Medical Association.
Michael A. Steinman, M.D., from the VA Medical Center, San Francisco, and colleagues identified factors associated with the prescribing of broad-spectrum antibiotics (antibiotics that cover a wide range of bacteria, including drugs such as quinolones, amoxicillin/clavulanate, and clarithromycin) by physicians caring for patients with acute respiratory tract infections (ARTIs), such as common cold, sinus infections, sore throat or bronchitis.
The authors write that antibiotics are commonly prescribed for ARTIs, even when these drugs are not always necessary for conditions like the common cold and uncomplicated acute bronchitis. They point out in background information that many experts have previously expressed concern about the overuse of the newer broad-spectrum antibiotics.
"These agents, while providing little therapeutic benefit for most patients, add substantially to health care costs," the authors note. "More importantly, frequent use of these agents promotes bacterial resistance. As a result, future patients may face high levels of resistance to some of today's most powerful therapies."
Data from the National Ambulatory Medical Care Survey (NAMCS) between 1997 and 1999 was analyzed for this study. This survey is conducted annually by the National Center for Health Statistics. Information was collected on a national sample of 1,981 adults seen by physicians for the common cold and other upper respiratory tract infections, including sinusitis, bronchitis, earaches and sore throats. Patients diagnosed with pneumonia were not included in the study.
"Antibiotics were prescribed to 63 percent of patients with an ARTI, ranging from 46 percent of patients with the common cold or nonspecific upper respiratory tract infection to 69 percent of patients with sinusitis and 83 percent of patients with more than one ARTI," the authors report. "Overall, broad-spectrum therapy was ordered for more than half of patients prescribed an antibiotic for each type of ARTI except pharyngitis, laryngitis, or tracheitis [inflammation of the trachea (windpipe)]."
The researchers note that "other independent predictors of choosing a broad-spectrum agent included black race, lack of health insurance, and health maintenance organization membership, each of which was associated with lower rates of broad-spectrum prescribing."
"These high rates of prescribing, wide variations in practice patterns, and the strong association of non-clinical factors with antibiotic choice suggest opportunities to improve prescribing patterns," the authors conclude.