Duration of illness strongly influences practitioners to prescribe antibiotics in treating acute respiratory tract infections

Clinical Decisionmaking
Duration of illness strongly influences practitioners to prescribe antibiotics in treating acute respiratory tract infections
May 01, 2009.-

Antibiotics offer no help for acute respiratory tract infections (ARI) that are caused by viruses. Distinguishing which ARIs are caused by viruses and bacteria is primarily based on clinical examination, rather than a diagnostic test result. Practice guidelines have been developed by a variety of organizations to help clinicians distinguish viral vs. bacterial ARIs. According to a new study, the duration of illness appears to influence practitioners the most in deciding when to use antibiotics for ARI, particularly when the patient also has a fever or productive cough.

Researchers presented 101 primary care physicians, nurse practitioners, and physician assistants with a set of 20 patient vignettes describing patients with ARI symptoms. Practitioners indicated they would prescribe antibiotics in 44.5 percent of the cases presented to them. On a scale from 0 to 100, their comfort level in making this decision was 78. When asked how strongly they would urge the patient to take antibiotics, their rating was 24. Among the variables in deciding when to use an antibiotic, duration of illness was deemed most important by 72 percent of the practitioners. This was the strongest decisionmaker for antibiotic use when it was accompanied by fever or productive cough.

The researchers also asked 8 internal medicine faculty to review published expert-panel guidelines from the CDC on managing ARI and then rate the same 20 cases. These clinicians prescribed antibiotics in only 20 percent of the cases, believing that 19.4 percent of them were bacterial in nature. The researchers indicate that eliminating the effect of a productive cough in the first set of practitioners studied would bring their prescription rate close to that of the faculty members. Educational programs that target the use of antibiotics in relation to specific symptoms may help practitioners avoid overprescribing. The study was supported by the Agency for Healthcare Research and Quality (HS13001).

See "How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections?" by Robert S. Wigton, M.D., M.S., Carol A. Darr, Ph.D., Kitty K. Corbett, Ph.D., M.P.H., and others, in the October 2008 Journal of General Internal Medicine 23(10), pp. 1615-1620.