Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics

Kozyrskyj, Anita L.; Dahl, Matthew E.; Chateau, Dan G.; Mazowita, Garey B.; Klassen, Terry P.; Law, Barbara J.
July 2004
CMAJ: Canadian Medical Association Journal;7/20/2004, Vol. 171 Issue 2, p139
Academic Journal
Background: Evidence-based guidelines for antibiotic use are well established, but nonadherence to these guidelines continues. This study was undertaken to determine child, household and physician factors predictive of nonadherence to evidence-based antibiotic prescribing in children. Methods: The prescription and health care records of 20 000 Manitoba children were assessed for 2 criteria of nonadher-ence to evidence-based antibiotic prescribing during the pe-riod from fiscal year 1996 (April 1996 to March 1997) to fis-cal year 2000: receipt of an antibiotic for a viral respiratory tract infection (VRTI) and initial use of a second-line agent for acute otitis media, pharyngitis, pneumonia, urinary tract infection or cellulitis. The likelihood of nonadherence to evi-dence- based prescribing, according to child demographic characteristics, physician factors (specialty and place of training) and household income, was determined from hier-archical linear modelling. Child visits were nested within physicians, and the most parsimonious model was selected at p< 0.05. Results: During the study period, 45% of physician visits for VRTI resulted in an antibiotic prescription, and 20% of antibiotic prescriptions were for second-line antibiotics. Relative to gen-eral practitioners, the odds ratio for antibiotic prescription for a VRTI was 0.51 (95% confidence interval [CI] 0.42--0.62) for pediatricians and 1.58 (95% CI 1.03--2.42) for other special-ists. The likelihood that an antibiotic would be prescribed for a VRTI was 0.99 for each successive $10 000 increase in house-hold income. Pediatricians and other specialists were more likely than general practitioners to prescribe second-line anti-biotics for initial therapy. Both criteria for nonadherence to ev-idence- based prescribing were 40% less likely among physi-cians trained in Canada or the United States than among physicians trained elsewhere. Interpretation: The links that we...


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