, Volume 17, Issue 2, pp 87-94

Tensions in antibiotic prescribing

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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.

Portions of these study results were presented at the national meeting of the Society of General Internal Medicine, May 2–5, 2001, San Diego, Calif.
This work was supported by the Robert Wood Johnson Foundzation through a Generalist Physician Faculty Scholar Award to Dr. Metlay. Dr. Metlay is also supported by the Department of Veterans Affairs through a Research Career Development Award.