Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
Research ArticleResearch

Antibiotic prescribing for pediatric respiratory infections

What explains a large variation among physicians?

Rachel McKay, David M. Patrick, Kimberlyn McGrail and Michael R. Law
Canadian Family Physician June 2019; 65 (6) e278-e291;
Rachel McKay
Postdoctoral fellow in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, Que.
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: rachel.mckay@mail.mcgill.ca
David M. Patrick
Professor in the School of Population and Public Health and Medical Epidemiology Lead for Antimicrobial Resistance in the British Columbia Centre for Disease Control at the University of British Columbia in Vancouver.
MD FRCPC MHSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kimberlyn McGrail
Associate Professor in the School of Population and Public Health and in the Centre for Health Services and Policy Research at the University of British Columbia.
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael R. Law
Associate Professor in the School of Population and Public Health and in the Centre for Health Services and Policy Research at the University of British Columbia.
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure 1.
    • Download figure
    • Open in new tab
    Figure 1.

    Monthly number of visits and visits with antibiotic prescriptions, and monthly proportions of visits with antibiotic prescriptions, from 2005 to 2011 in British Columbia: The spike in RTI visits at the end of 2009, and related decrease in proportion of visits associated with a prescription, is likely attributable to the H1N1 influenza pandemic.

    RTI—respiratory tract infection.

  • Figure 2.
    • Download figure
    • Open in new tab
    Figure 2.

    Histogram of proportion of pediatric RTI visits associated with an antibiotic prescription, per physician, between 2005 and 2011: Frequencies are weighted by the total number of RTI visits.

    RTI—respiratory tract infection.

Tables

  • Figures
    • View popup
    Table 1.

    Distribution of variables by antibiotic prescription for RTI visits in children

    VARIABLEFULL DATA SET*SAMPLE OF 1 VISIT PER CHILD*
    ALL VISITS (N = 2 996 186)†ASSOCIATED WITH AN ANTIBIOTIC PRESCRIPTION (N = 834 673)‡NOT ASSOCIATED WITH AN ANTIBIOTIC PRESCRIPTION (N = 2 161 513)‡ALL VISITS (N = 671 342)†ASSOCIATED WITH AN ANTIBIOTIC PRESCRIPTION (N = 183 118)‡NOT ASSOCIATED WITH AN ANTIBIOTIC PRESCRIPTION (N = 488 224)‡
    Overall population, %100.027.972.1100.027.372.7
    Year, %
      • 200511.330.369.713.231.668.4
      • 200615.429.470.616.230.669.4
      • 200714.728.571.613.728.971.1
      • 200814.128.871.212.628.471.6
      • 200916.922.977.216.121.278.9
      • 201013.128.072.012.225.874.3
      • 201114.628.671.516.125.474.6
    Patient-level factors
    Patient sex
      • Female, %47.527.972.148.927.372.7
      • Male, %52.527.872.251.227.372.7
      • Missing, n2NANA1NANA
    Median (IQR) patient age, y4 (2–9)6 (3–10)4 (1–8)6 (2–11)8 (4–12)5 (1–10)
      • Missing, n2NANA2NANA
    Follow-up RTI visit,§ %14.024.675.57.924.375.8
    QAIPPE
      • 1 (lowest), %22.228.671.420.427.672.4
      • 2, %22.728.771.320.927.872.2
      • 3, %20.027.672.420.527.372.7
      • 4, %18.226.973.12026.973.1
      • 5 (highest), %15.727.172.918.226.773.3
      • Missing, n38 224NANA9157NANA
    Diabetes, %0.233.166.90.233.366.7
    Asthma, %12.431.568.58.131.168.9
    Cystic fibrosis, %0.218.681.40.117.782.3
    Immune deficiency, %0.230.269.80.228.771.3
    Chronic liver disease, %< 0.127.872.20.026.473.6
    Congestive heart failure, %< 0.127.272.80.022.977.1
    COPD, %0.531.568.50.331.468.7
    Chronic kidney disease, %0.128.771.40.128.571.6
    Recent antibiotic use,‖ %9.124.575.59.424.175.9
    Median (IQR) ADG sum4 (2–5)4 (2–5)4 (2–5)3 (2–5)3 (2–4)3 (2–5)
      • Missing, n9NANA2NANA
    Visits in past 3 y with this physician, %
      • 036.628.671.446.828.771.3
      • ≤ 30 (but > 0)30.228.671.425.527.972.1
      • > 3033.226.373.727.824.475.6
    Median (IQR) no. of different GPs seen in past 3 y5 (3–7)5 (3–8)5 (3–7)4 (2–6)4 (2–6)4 (2–6)
    Season, %
      • Mar–May24.229.170.924.529.071.0
      • Jun–Aug15.029.570.514.529.770.3
      • Sep–Nov29.325.474.628.824.076.0
      • Dec–Feb31.528.471.632.327.872.3
    Physician-level factors
    Physicians, n6404NANA6148NANA
    Physician sex
      • Female, %27.723.576.628.323.077.0
      • Male, %72.329.570.571.728.971.1
      • Missing, n10 398NANA1910NANA
    Specialty, %
      • Emergency medicine physician0.625.174.90.725.274.8
      • Pediatrician2.911.288.82.412.887.2
      • Other0.841.858.20.740.759.3
      • GP95.728.371.796.227.672.5
    Visits for RTIs in the past 30 d, %
      • None0.620.479.60.721.079.0
      • ≤ 2.55.721.778.36.922.177.9
      • > 2.5–514.724.475.616.824.775.3
      • > 5–7.516.526.074.017.826.273.8
      • > 7.5–1014.827.972.214.827.472.6
      • > 10–1522.129.970.120.629.370.7
      • > 15–2014.031.968.112.230.969.1
      • > 2011.729.470.610.228.771.3
    Medical school graduation location
      • Canada, %62.124.375.864.123.876.2
      • International, %37.933.866.236.033.466.6
      • Missing, n70 648NANA15 683NANA
    Daily patient volume,¶ %
      • 1st quartile (< 28 visits)22.823.276.925.323.376.7
      • 2nd quartile (28–37 visits)24.926.473.626.626.273.8
      • 3rd quartile (38–48 visits)26.028.971.125.728.771.3
      • 4th quartile (> 48 visits)26.332.367.722.431.468.6
    Years since medical school graduation
      • 0–5, %4.621.878.25.220.879.3
      • 6–10, %9.322.177.99.822.477.6
      • 11–15, %13.024.076.013.424.375.7
      • 16–20, %18.526.973.118.227.073.1
      • 21–25, %16.828.771.316.527.772.3
      • 26–30, %13.930.070.013.729.370.7
      • 31–35, %11.930.769.311.629.770.3
      • 36–40, %7.430.769.37.229.770.3
      • > 40, %4.739.160.94.537.962.1
      • Missing, n4032NANA1050NANA
    No. of RTIs seen in the past y, %
      • 1st quartile (≤ 248)20.420.879.224.821.578.5
      • 2nd quartile (249–490)22.225.674.525.125.974.1
      • 3rd quartile (491–972)25.228.271.825.028.571.5
      • 4th quartile (≥ 973)32.233.766.425.033.266.8
    Regional-level factors
    Median (IQR) proportion of LHA population aged > 65 y0.13 (0.10–10.15)0.13 (0.10–0.15)0.13 (0.11–0.15)0.13 (0.11–0.16)0.13 (0.10–0.16)0.13 (0.11–0.16)
    Median (IQR) proportion of LHA population aged < 15 y0.18 (0.16–0.21)0.19 (0.17–0.22)0.18 (0.16–0.21)0.18 (0.16–0.21)0.19 (0.16–0.21)0.18 (0.16–0.21)
    Median (IQR) age of LHA population, y39 (36–41)38 (35–41)39 (37–41)39 (37–42)39 (37–41)39 (37–42)
    Health authority
      • Interior, %11.827.872.214.528.072.1
      • Fraser, %46.329.670.441.328.571.5
      • Vancouver Coastal, %23.222.477.622.321.978.1
      • Vancouver Island, %12.226.473.614.326.573.5
      • Northern, %6.537.562.57.536.663.4
      • Missing, n4689NANA1251NANA
    Median (IQR) 28-d moving average apparent temperature, °C4.73 (0.57–11.76)4.62 (0.33–12.14)4.77 (0.66–11.57)4.49 (0.36–11.50)4.42 (0.17–12.14)4.52 (0.43–11.24)
    • ADG—aggregated diagnosis group, COPD—chronic obstructive pulmonary disease, IQR—interquartile range, LHA—local health area, NA—not applicable, QAIPPE—Quintile of Annual Income Per Person Equivalent, RTI—respiratory tract infection.

    • ↵* Not all percentages add to 100 owing to rounding.

    • ↵† Overall values.

    • ↵‡ Within-category values.

    • ↵§ A follow-up visit is any visit within 14 d of another RTI visit.

    • ↵‖ Recent antibiotic use is any antibiotic prescription within the past 6 mo.

    • ↵¶ Daily patient volume is the total number of claims billed on the RTI visit day.

    • View popup
    Table 2.

    Generalized linear mixed model of antibiotic prescription for pediatric RTIs: A) Effect estimates and B) measures of model fit and variance.

    A)
    EFFECTEMPTY MODELBASIC MODEL WITH YEAR ONLYWITH PATIENT COVARIATESWITH PATIENT AND PHYSICIAN COVARIATESWITH PATIENT, PHYSICIAN, AND REGIONAL COVARIATES
    Random effect, variance (SE)
    Physician0.96 (0.023)0.95 (0.022)0.91 (0.011)0.78 (0.019)0.76 (0.019)
    Fixed effects, OR (95% CI)
    Constant term0.27 (0.26–0.27)0.35 (0.34–0.36)0.18 (0.17–0.18)0.10 (0.09–0.11)0.10 (0.08–0.12)
    Year (reference: 2005)
      • 20060.93 (0.91–0.95)0.94 (0.92–0.96)0.91 (0.88–0.93)0.90 (0.88–0.92)
      • 20070.89 (0.87–0.91)0.93 (0.91–0.95)0.88 (0.86–0.90)0.87 (0.85–0.89)
      • 20080.85 (0.83–0.87)0.92 (0.90–0.94)0.87 (0.85–0.89)0.86 (0.84–0.88)
      • 20090.58 (0.57–0.60)0.61 (0.60–0.63)0.58 (0.56–0.59)0.57 (0.56–0.59)
      • 20100.76 (0.74–0.78)0.92 (0.90–0.94)0.83 (0.81–0.86)0.83 (0.81–0.85)
      • 20110.75 (0.73–0.77)0.94 (0.92–0.96)0.86 (0.83–0.88)0.85 (0.82–0.87)
    Season (reference: Jun–Aug)
      • Mar–May0.98 (0.97–1.00)0.99 (0.97–1.00)1.05 (1.03–1.07)0.99 (0.97–1.02)
      • Sep–Nov0.80 (0.79–0.82)0.80 (0.79–0.82)0.86 (0.85–0.88)0.80 (0.77–0.82)
      • Dec–Feb0.99 (0.97–1.00)0.96 (0.94–0.98)1.06 (1.04–1.09)0.95 (0.92–0.98)
    Patient sex (reference: male)
      • Female0.97 (0.96–0.98)0.97 (0.96–0.98)0.97 (0.96–0.98)
    Patient age (per y increase)1.08 (1.08–1.08)1.08 (1.08–1.08)1.08 (1.08–1.08)
    Follow-up RTI visit0.98 (0.96–1.01)0.97 (0.95–1.00)0.97 (0.95–1.00)
    QAIPPE (reference: 1)
      • 21.00 (0.98–1.02)1.00 (0.98–1.02)1.00 (0.98–1.02)
      • 31.01 (0.99–1.03)1.01 (0.99–1.03)1.01 (0.99–1.03)
      • 41.02 (1.00–1.04)1.02 (1.00–1.05)1.02 (1.00–1.04)
      • 51.03 (1.01–1.05)1.04 (1.02–1.06)1.04 (1.02–1.06)
    Diabetes1.08 (0.95–1.22)1.05 (0.93–1.19)1.05 (0.93–1.19)
    Asthma1.06 (1.04–1.08)1.06 (1.04–1.08)1.06 (1.04–1.08)
    Cystic fibrosis0.96 (0.80–1.16)0.97 (0.80–1.18)0.97 (0.80–1.18)
    Immune deficiency0.92 (0.80–1.07)0.92 (0.79–1.06)0.92 (0.79–1.06)
    Chronic liver disease1.07 (0.74–1.56)1.03 (0.70–1.52)1.00 (0.68–1.48)
    Congestive heart failure1.30 (0.88–1.92)1.12 (0.75–1.69)1.12 (0.74–1.68)
    COPD0.87 (0.78–0.98)1.14 (1.02–1.29)1.15 (1.02–1.29)
    Chronic kidney disease0.90 (0.72–1.13)1.12 (0.89–1.40)1.12 (0.90–1.40)
    Recent antibiotic use0.85 (0.83–0.87)0.86 (0.84–0.88)0.86 (0.84–0.88)
    ADG sum0.97 (0.97–0.97)0.97 (0.97–0.97)0.97 (0.97–0.97)
    Visits in past 3 y with this physician, % (reference: > 30)
      • 01.20 (1.18–1.22)1.21 (1.19–1.24)1.21 (1.19–1.24)
      • ≤ 30 (but > 0)1.07 (1.05–1.09)1.07 (1.05–1.09)1.07 (1.05–1.09)
    No. of different GPs seen in past 3 y1.02 (1.02–1.02)1.02 (1.02–1.02)1.02 (1.02–1.02)
    Physician sex (reference: male)
      • Female0.89 (0.84–0.94)0.91 (0.86–0.96)
    Specialty (reference: GP)
      • Emergency medicine physician0.79 (0.61–1.02)0.79 (0.62–1.02)
      • Pediatrician0.47 (0.41–0.55)0.48 (0.42–0.56)
      • Other0.88 (0.72–1.06)0.89 (0.73–1.07)
    Visits for RTIs in the past 30 d, % (reference: > 20)
      • None1.34 (1.21–1.49)1.36 (1.23–1.51)
      • ≤ 2.51.42 (1.35–1.49)1.45 (1.38–1.52)
      • > 2.5–51.40 (1.34–1.45)1.42 (1.36–1.48)
      • > 5–7.51.32 (1.27–1.37)1.33 (1.29–1.38)
      • > 7.5–101.25 (1.21–1.30)1.26 (1.22–1.31)
      • > 10–151.21 (1.17–1.25)1.22 (1.18–1.25)
      • > 15–201.13 (1.10–1.16)1.13 (1.10–1.16)
    Medical school graduation location (reference: Canada)
      • International1.77 (1.68–1.88)1.73 (1.63–1.83)
    Daily patient volume (reference: 1st quartile [< 28 visits])
      • 2nd quartile (28–37 visits)0.99 (0.97–1.01)0.99 (0.98–1.01)
      • 3rd quartile (38–48 visits)0.97 (0.95–0.99)0.97 (0.95–0.99)
      • 4th quartile (> 48 visits)0.94 (0.92–0.96)0.94 (0.92–0.97)
    Years since medical school graduation (reference: 0–5)
      • 6–100.98 (0.93–1.03)0.99 (0.94–1.04)
      • 11–151.07 (1.01–1.14)1.08 (1.02–1.15)
      • 16–201.15 (1.08–1.22)1.16 (1.09–1.24)
      • 21–251.21 (1.13–1.29)1.23 (1.15–1.31)
      • 26–301.29 (1.21–1.39)1.32 (1.23–1.41)
      • 31–351.32 (1.23–1.42)1.35 (1.26–1.46)
      • 36–401.36 (1.25–1.47)1.39 (1.29–1.51)
      • > 401.41 (1.28–1.56)1.46 (1.33–1.61)
    No. of RTIs seen in the past y (reference: 1st quartile [≤ 248])
      • 2nd quartile (249–490)1.10 (1.07–1.13)1.11 (1.08–1.14)
      • 3rd quartile (491–972)1.17 (1.12–1.21)1.19 (1.15–1.23)
      • 4th quartile (≥ 973)1.27 (1.21–1.33)1.31 (1.25–1.37)
    LHA population aged > 65 y (per 10%)0.99 (0.98–1.00)
    LHA population aged < 15 y (per 10%)1.12 (1.06–1.17)
    Median age of LHA population (centred on mean)1.19 (1.11–1.27)
    Health authority (reference: Vancouver Coastal)
      • Interior1.07 (1.02–1.13)
      • Fraser1.00 (0.97–1.03)
      • Vancouver Island1.03 (0.98–1.08)
      • Northern1.20 (1.13–1.28)
    28-d moving average apparent temperature0.99 (0.99–0.99)
    B)
    MEASUREEMPTY MODELBASIC MODEL WITH YEAR ONLYWITH PATIENT COVARIATESWITH PATIENT AND PHYSICIAN COVARIATESWITH PATIENT, PHYSICIAN, AND REGIONAL COVARIATES
    Observations used, n671 342671 342662 202645 815645 094
    AIC616 216.2692 274.7666 759.5648 692.3647 788.8
    ICC,* %22.622.421.619.218.8
    MOR2.552.532.482.332.30
    PCV (relative to intercept-only model) at level of physician, %NA1.495.8618.5520.82
    PCV (relative to previous model) at level of physician, %NA1.494.4413.482.78
    • ADG—aggregated diagnosis group, AIC—Akaike information criterion, COPD—chronic obstructive pulmonary disease, ICC—intraclass correlation, IQR—interquartile range, LHA—local health area, MOR—median odds ratio, NA—not applicable, OR—odds ratio, PCV—percent change in variance, QAIPPE—Quintile of Annual Income Per Person Equivalent, RTI—respiratory tract infection.

    • ↵* ICC is the proportion of total variance attributable to between-physician differences.

PreviousNext
Back to top

In this issue

Canadian Family Physician: 65 (6)
Canadian Family Physician
Vol. 65, Issue 6
1 Jun 2019
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Antibiotic prescribing for pediatric respiratory infections
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Antibiotic prescribing for pediatric respiratory infections
Rachel McKay, David M. Patrick, Kimberlyn McGrail, Michael R. Law
Canadian Family Physician Jun 2019, 65 (6) e278-e291;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Antibiotic prescribing for pediatric respiratory infections
Rachel McKay, David M. Patrick, Kimberlyn McGrail, Michael R. Law
Canadian Family Physician Jun 2019, 65 (6) e278-e291;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Notes
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy
  • Google Scholar

More in this TOC Section

  • Primary care reform in Alberta
  • Administrative burden in primary care
  • Burden of administrative responsibilities in primary care
Show more Research

Similar Articles

Subjects

  • Collection française
    • Résumés de recherche

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire