Skip to main content

Advertisement

SpringerLink
Log in

Desire for antibiotics and antibiotic prescribing for adults with upper respiratory tract infections

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 1999 Summary Advance Data from Vital and Health Statistics No 322. Hyattsville, Md: National Center for Health Statistics; 2001.

    Google Scholar 

  2. Hughes JM, McCaig LF. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 1995;273:214–9.

    Article  PubMed  Google Scholar 

  3. Mainous AG, III, Hueston WJ, Clark JR. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold. J Fam Prac. 1996;42:357–61.

    Google Scholar 

  4. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–4.

    Article  PubMed  CAS  Google Scholar 

  5. Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279:875–7.

    Article  PubMed  CAS  Google Scholar 

  6. Metlay JP, Stafford RS, Singer DE. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Arch Intern Med. 1998;158:1813–8.

    Article  PubMed  CAS  Google Scholar 

  7. Hirschmann JV. Antibiotics for common respiratory tract infections in adults. Arch Intern Med. 2002;162:256–64.

    Article  PubMed  CAS  Google Scholar 

  8. Seppala H, Klaukka T, Vuopio-Varkila J, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997;337:441–6.

    Article  PubMed  CAS  Google Scholar 

  9. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998;317:637–42.

    PubMed  CAS  Google Scholar 

  10. Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Prac. 1993;37:23–7.

    CAS  Google Scholar 

  11. Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.

    PubMed  CAS  Google Scholar 

  12. Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Prac. 1996;43:56–62.

    CAS  Google Scholar 

  13. Dosh SA, Hickner JM, Mainous AG, III, Ebel MH. Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis. An UPRNet study. Upper Peninsula Research Network. J Fam Prac. 2000;49:407–14.

    CAS  Google Scholar 

  14. Ray DA, Rohren CH. Characteristics of patients with upper respiratory tract infection presenting to a walk-in clinic. Mayo Clinic Proc. 2001;76:169–73.

    Article  CAS  Google Scholar 

  15. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108:1–7.

    Article  PubMed  CAS  Google Scholar 

  16. Linder JA, Stafford RS. Antibiotic treatment of adults with sor e throat by community primary care physicians: a national survey 1989–99. JAMA. 2001;286:1181–6.

    Article  PubMed  CAS  Google Scholar 

  17. McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002;287:3096–102.

    Article  PubMed  Google Scholar 

  18. Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth AL. Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997;314:722–7.

    PubMed  CAS  Google Scholar 

  19. Hong JS, Philbrick JT, Schorling JB. Treatment of upper respiratory infections: do patients really want antibiotics? Am J Med. 1999;107:511–5.

    Article  PubMed  CAS  Google Scholar 

  20. Sanchez-Menegay C, Hudes ES, Cummings SR. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.

    Article  PubMed  CAS  Google Scholar 

  21. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.

    Article  PubMed  CAS  Google Scholar 

  22. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med. 2001;134:479–86.

    PubMed  CAS  Google Scholar 

  23. Scott JG. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Prac. 2001;50:853–8.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, USA

    Jeffrey A. Linder MD, MPH

  2. the General Medicine Division, Massachusetts General Hospital, Boston, Mass

    Daniel E. Singer MD

Authors
  1. Jeffrey A. Linder MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel E. Singer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey A. Linder MD, MPH.

Additional information

Funding sources: Dr. Linder was supported in part by National Research Service Award 5T32PE11001-12.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Linder, J.A., Singer, D.E. Desire for antibiotics and antibiotic prescribing for adults with upper respiratory tract infections. J GEN INTERN MED 18, 795–801 (2003). https://doi.org/10.1046/j.1525-1497.2003.21101.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2003.21101.x

Key words

Search

Navigation