Journal of General Internal Medicine

, Volume 17, Issue 2, pp 87–94

Tensions in antibiotic prescribing

Pitting social concerns against the interests of individual patients
  • Joshua P. Metlay
  • Judy A. Shea
  • Linda B. Crossette
  • David A. Asch
Original Articles

DOI: 10.1046/j.1525-1497.2002.10711.x

Cite this article as:
Metlay, J.P., Shea, J.A., Crossette, L.B. et al. J GEN INTERN MED (2002) 17: 87. doi:10.1046/j.1525-1497.2002.10711.x

Abstract

BACKGROUND: To reduce the prevalence of antibioticresistant bacteria in the community, physicians must optimize their use of antibiotics. However, optimal use from the perspective of the community (reserving newer agents for future use) is not always consistent with optimal use from the perspective of the individual patient (prescribing newer, broader agents).

OBJECTIVES: To identify preferred patterns of antibiotic prescribing for patients with community-acquired pneumonia (CAP), measure explicit attitudes toward antibiotics and antibiotic resistance, and determine the relationship between these prescribing patterns and attitudes.

DESIGN: Cross-sectional anonymous mail survey.

PARTICIPANTS: National random sample of 400 generalist physicians (general internal medicine and family practice) and 429 infectious diseases specialists.

MEASUREMENTS: Rank ordering of antibiotic preferences for a hypothetical outpatient with CAP and reasons for antibiotic selection. Endorsement of attitudes regarding antibiotic prescribing decisions and resistance.

RESULTS: Both generalists and infectious diseases specialists were more likely to prefer newer, broader drugs for the treatment of CAP compared to older agents still recommended by national guidelines. Physicians rated the issue of contributing to antibiotic resistance lowest among 7 determinants of their choices.

CONCLUSIONS: Despite national guidelines and increasing public awareness, the public health concern of contributing to the problem of antibiotic resistance does not exert a strong impact on physician prescribing decisions for CAP. Future efforts to optimize antibiotic prescribing decisions will need to consider options for increasing the impact of public health issues on the patient-oriented decisions of individual physicians.

Key words

antibioticsdrug utilizationphysician’s practice patternsdrug resistancemicrobialpneumonia

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Joshua P. Metlay
    • 1
    • 2
    • 3
    • 4
    • 5
  • Judy A. Shea
    • 2
    • 3
    • 5
  • Linda B. Crossette
    • 3
  • David A. Asch
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.the Philadelphia Veterans Affairs Medical CenterUniversity of PennsylvaniaPhiladelphia
  2. 2.the Division of General Internal Medicine, Department of MedicineUniversity of PennsylvaniaPhiladelphia
  3. 3.the Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphia
  4. 4.the Center for Education and Research on TherapeuticsUniversity of PennsylvaniaPhiladelphia
  5. 5.the Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphia
  6. 6.University of Pennsylvania School of MedicinePhiladelphia