Journal of General Internal Medicine

, Volume 18, Issue 10, pp 795–801 | Cite as

Desire for antibiotics and antibiotic prescribing for adults with upper respiratory tract infections

  • Jeffrey A. Linder
  • Daniel E. Singer
Original Articles


OBJECTIVE: Prior studies have shown that 60% to 75% of adults with upper respiratory tract infections want antibiotics. More recent research indicates declines in antibiotic prescribing for upper respiratory tract infections. To investigate whether there has been a comparable decrease in patients’ desire for antibiotics, we measured the proportion of adults with upper respiratory tract infections who wanted antibiotics in the winter of 2001–2002. We also sought to identify factors independently associated with wanting antibiotics and antibiotic prescribing.

DESIGN: Prospective survey of adults with upper respiratory tract infections prior to visiting an acute care clinic from November 2001 to February 2002.

MEASUREMENTS AND MAIN RESULTS: Thirty-nine percent of 310 patients wanted antibiotics. Many patients wanted relief from symptoms (43%) or pain (24%) and many patients expected to receive a diagnosis (49%) or reassurance during the visit (13%). In multivariable modeling, independent predictors of wanting antibiotics were prior antibiotic use (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.3 to 4.7) and current smoking (OR, 3.1; 95% CI, 1.3 to 7.3). Physicians prescribed antibiotics to 46% of patients who wanted antibiotics and 29% of patients who did not want antibiotics (P=.01). In multivariable modeling, wanting antibiotics was an independent predictor of antibiotic prescribing (OR, 2.1; 95% CI, 1.1 to 4.4).

CONCLUSIONS: Only 39% of adults seeking care for upper respiratory tract infections wanted antibiotics, less than in previous studies. In continuing efforts to break the cycle of inappropriate antibiotic use, physicians should not assume that most patients with upper respiratory tract infections want antibiotics.

Key words

antibiotics respiratory tract diseases physician’s practice patterns 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 1999 Summary Advance Data from Vital and Health Statistics No 322. Hyattsville, Md: National Center for Health Statistics; 2001.Google Scholar
  2. 2.
    Hughes JM, McCaig LF. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 1995;273:214–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Mainous AG, III, Hueston WJ, Clark JR. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold. J Fam Prac. 1996;42:357–61.Google Scholar
  4. 4.
    Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279:875–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Metlay JP, Stafford RS, Singer DE. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Arch Intern Med. 1998;158:1813–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Hirschmann JV. Antibiotics for common respiratory tract infections in adults. Arch Intern Med. 2002;162:256–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Seppala H, Klaukka T, Vuopio-Varkila J, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997;337:441–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998;317:637–42.PubMedGoogle Scholar
  10. 10.
    Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Prac. 1993;37:23–7.Google Scholar
  11. 11.
    Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.PubMedGoogle Scholar
  12. 12.
    Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Prac. 1996;43:56–62.Google Scholar
  13. 13.
    Dosh SA, Hickner JM, Mainous AG, III, Ebel MH. Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis. An UPRNet study. Upper Peninsula Research Network. J Fam Prac. 2000;49:407–14.Google Scholar
  14. 14.
    Ray DA, Rohren CH. Characteristics of patients with upper respiratory tract infection presenting to a walk-in clinic. Mayo Clinic Proc. 2001;76:169–73.CrossRefGoogle Scholar
  15. 15.
    Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108:1–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Linder JA, Stafford RS. Antibiotic treatment of adults with sor e throat by community primary care physicians: a national survey 1989–99. JAMA. 2001;286:1181–6.PubMedCrossRefGoogle Scholar
  17. 17.
    McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002;287:3096–102.PubMedCrossRefGoogle Scholar
  18. 18.
    Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth AL. Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997;314:722–7.PubMedGoogle Scholar
  19. 19.
    Hong JS, Philbrick JT, Schorling JB. Treatment of upper respiratory infections: do patients really want antibiotics? Am J Med. 1999;107:511–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Sanchez-Menegay C, Hudes ES, Cummings SR. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med. 2001;134:479–86.PubMedGoogle Scholar
  23. 23.
    Scott JG. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Prac. 2001;50:853–8.Google Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  1. 1.the Division of General MedicineBrigham and Women’s Hospital and Harvard Medical SchoolUSA
  2. 2.the General Medicine DivisionMassachusetts General HospitalBoston

Personalised recommendations