Self-reported prescribing of antibiotics for children with undifferentiated acute respiratory tract infections with cough.

Abstract

Physicians are often called on to manage children with acute respiratory tract infections with cough when the clinical presentation may not allow a differentiation between viral and bacterial etiology. To develop guidelines for appropriate antibiotic use, it is necessary to understand the present prescribing patterns of physicians who manage children presenting with such an undifferentiated acute respiratory tract infection with cough (UARTIC). To determine the variability of self-reported prescribing habits for antibiotics for children with UARTIC. In this cross-sectional survey by a modified Dillman's Total Design Method, a mail-out questionnaire was administered to a random sample of 181 primary care family physicians and pediatricians (Toronto, Ontario, Canada) to assess perceptions of their own antibiotic-prescribing habit. Completed questionnaires were received from 136 (75%) eligible physicians; 32% reported that > 10% of their office visits were for UARTIC. For a 3-day history of UARTIC 24% reported prescribing antibiotics or antibiotics in reserve (i.e. a prescription to be filled if the patient's condition does not improve) always or most times. This increased to 45% when UARTIC had worsened in the 24 h before the office visit (P < 0.001). When a pediatric patient presented with UARTIC, antibiotics or antibiotics in reserve were prescribed in the absence of clear indicators of bacterial infection. Research- and evidence-based guidelines are needed to support rational antibiotic use for UARTIC.