Context.— The spread of antibiotic-resistant bacteria is associated with antibiotic
use. Children receive a significant proportion of the antibiotics prescribed
each year and represent an important target group for efforts aimed at reducing
unnecessary antibiotic use.
Objective.— To evaluate antibiotic-prescribing practices for children younger than
18 years who had received a diagnosis of cold, upper respiratory tract infection
(URI), or bronchitis in the United States.
Design.— Representative national survey of practicing physicians participating
in the National Ambulatory Medical Care Survey conducted in 1992 with a response
rate of 73%.
Setting.— Office-based physician practices.
Participants.— Physicians completing patient record forms for patients younger than
Main Outcome Measures.— Principal diagnoses and antibiotic prescriptions.
Results.— A total of 531 pediatric office visits were recorded that included a
principal diagnosis of cold, URI, or bronchitis. Antibiotics were prescribed
to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis.
Extrapolating to the United States, 6.5 million prescriptions (12% of all
prescriptions for children) were written for children diagnosed as having
a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions
for children) were written for children diagnosed as having bronchitis. After
controlling for confounding factors, antibiotics were prescribed more often
for children aged 5 to 11 years than for younger children (odds ratio [OR],
1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians
than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92). Children aged 0 to
4 years received 53% of all antibiotic prescriptions, and otitis media was
the most frequent diagnosis for which antibiotics were prescribed (30% of
Conclusions.— Antibiotic prescribing for children diagnosed as having colds, URIs,
and bronchitis, conditions that typically do not benefit from antibiotics,
represents a substantial proportion of total antibiotic prescriptions to children
in the United States each year.