Original ArticleAntibiotic prescribing for upper respiratory tract infection: The importance of diagnostic uncertainty
Section snippets
Participants
We distributed a self-administered mail survey to a quasi-randomized sample (obtained from a medical list provider, Southam Medical Lists) of English-speaking family physicians (n = 270) and pediatricians (n = 270) in Ontario, Canada. Pediatricians in Ontario consist of a mix of primary care physicians, consultant general pediatricians, and pediatric specialists. Most family practitioners provide primary care. The cover letter indicated that the survey was directed at physicians providing primary
Results
There were 257 completed surveys returned of 540 mailed, 47.6% from family practitioners and 52.4% from pediatricians. There were 419 simulations for which there was a missing value for either the response variable or a demographic variable, leaving 3693 cases of a potential 4112 (89.8%) for analysis.
Table I displays the categoric demographic characteristics of the survey respondents. In addition, pediatricians reported spending more hours on continuing medical education each year (80.0 vs
Discussion
The results of this study suggest that patient clinical characteristics, which may lead to diagnostic uncertainty, are a more important determinant of antibiotic overuse than parental pressure.7, 8, 9, 10 Physicians were more likely to prescribe antibiotics to a child with URI if the child had a temperature greater than 38.5°C or appeared unwell, regardless of age. This may be due to diagnostic uncertainty and resultant concern about missing an evolving or occult invasive bacterial infection.16
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Cited by (0)
Supported by a research fellowship funded through the Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada (Dr Arnold) and by the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care through an Investigator Award (Dr To).
The results and conclusions are those of the authors; no official endorsement by the Ministry is intended or should be inferred.