a SLACK Incorporated newspaper
November 1998
"Overall, the pediatric residents appeared to do the best on the questionnaire," said lead author Archana Chatterjee, MD, PhD, a fellow in pediatric infectious diseases at Creighton University in Omaha, Neb. "These doctors are still in training, so their answers probably reflect what they are being taught. They have yet to pick up `bad' practice habits."
Pediatricians came in second and family practitioners was the group least likely to follow guidelines especially among infrequently treated conditions.
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Participants were asked to choose from a list of answers, including whether they would prescribe antibiotics for the proposed infection, what type of antibiotic they would prescribe, for how long, and, in some scenarios, the reason for their choice. Answers were then compared to the published guidelines for antibiotic use by the American Academy of Pediatrics.
For a common ailment like otitis media, "the answers didn't vary much between the pediatricians and family practitioners," Chatterjee said. But for some of the less common problems, such as a UTI or bloody diarrhea, "there was quite a significant difference between the answers given by family practitioners and pediatricians. We felt this reflected the family practitioners' adult practice. Many have told me informally that this is how they treat adults. They simply don't see enough children to vary management."
For example, for a UTI, the recommended length of antibiotic use in adults is three days. "Many of the family practitioners also responded three days, although for children that should probably extend to seven days," said Chatterjee. Likewise, for upper respiratory infection, "they really shouldn't have chosen an antibiotic."
In addition, for a throat infection, significantly more family practitioners chose to prescribe antibiotics without first conducting diagnostic tests, and they most frequently chose responses outside the guidelines for recurrent throat infections.
When the findings on a chest X-ray were included with the symptoms and signs of wheezing in a 6-year-old with no prior history of asthma, a higher percentage of all three physician groups chose to prescribe antibiotics, "but the pediatric residents were the group with the lowest number of antibiotic prescriptions," said Chatterjee. For this vignette, 96% of family practitioners chose antibiotics, compared to 60% of pediatricians and only 47% of pediatric residents.
The survey project is ongoing, with questionnaires currently being mailed to practicing family physicians in Omaha. "People need to be aware that there are some guidelines and some recommendations for antibiotic use in children," Chatterjee said. "These are not just off the top of someone's head, but are based on good clinical research."
That said, practitioners still need to use their clinical judgment when consulting the guidelines. "Not everything is black and white in medicine," Chatterjee said. She noted the importance of being aware of antibiotic resistance patterns for a particular geographic area. "Once you know the resistance patterns, then you have a good idea of what kinds of antibiotics to prescribe, but try to follow the recommendations whenever possible."
For your information:
- Chatterjee A, Harrison CJ. Antibiotic prescribing practices among primary care physicians: a pilot study. Presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. Sept. 24-27. San Diego.
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