Child/Adolescent Health

Doctors tend to overprescribe antibiotics for children with upper respiratory infections

Studies of antibiotic overuse often rely on physicians' reports of patients' diagnoses. However, physicians tend to overdiagnose children's upper respiratory infections (URIs) caused by bacteria, reveals a new study. It found that, given clinical criteria for bacterial URIs, antibiotic overuse occurred three times more often than suggested by physician diagnosis, and was particularly obvious for sinus infections.

Targeting physician overdiagnosis may reduce antibiotic overuse, suggest Elizabeth D. Cox, M.D., Ph.D., and Saurabh Saluja, B.A., of the University of Wisconsin School of Medicine and Public Health. They analyzed the videotapes of 66 visits for upper respiratory symptoms to determine children's diagnoses based on clinical criteria (symptoms, physician description of physical examination findings, and diagnostic tests), physician diagnosis, and prescribing. They then looked for agreement between the physician's diagnosis and the criteria-based diagnosis.

The criteria-based diagnoses agreed with 100 percent of physicians' diagnoses of streptococcal pharyngitis and 73 percent of physicians' acute otitis media (ear infection) diagnoses, but with only 17 percent of physicians' sinusitis diagnoses. Antibiotic overuse occurred in 11 percent of visits based on physicians' diagnoses of nonbacterial infections (viral infections are not treatable with antibiotics), but in three times as many (32 percent) visits when criteria-based diagnoses were considered. Thus, relying on physician-reported diagnoses may mask many instances of antibiotic overuse, especially for sinusitis diagnoses, conclude the researchers. Their study was funded by the Agency for Healthcare Research and Quality (HS13183).

See "Criteria-based diagnosis and antibiotic overuse for upper respiratory infections," by Dr. Cox and Mr. Saurabh Saluja in the July-August 2008 Ambulatory Pediatrics 8, pp. 250-254.

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