Original Article

Knowledge of the Principles of Judicious Antibiotic Use for Upper Respiratory Infections: A Survey of Senior Medical Students

Authors: Ekopimo Ibia, MD, Michael Sheridan, SCD, Richard Schwartz, MD

Abstract

Objective: Senior medical students (n = 2,433) from 21 accredited medical schools in New England and the mid-Atlantic states were surveyed to evaluate their knowledge of and compliance with principles of judicious antimicrobial use, as defined by the Centers for Disease Control and others.


Materials and Methods: A self-administered questionnaire with six vignettes on the clinical management of different upper respiratory tract infections was used. Compliance was calculated by using an ordinal response scale (1 to 4) for each question on the six vignettes.


Results: The adjusted response rate was 46%. More than 47% of the respondents had read none of the principles, and only 2.9% had read all six. Approximately 36% of the respondents would start antibiotics within 2 days of an 18-month-old presenting with purulent rhinitis, whereas 55.9% would immediately prescribe antibiotics if the child had wheezy bronchitis. For a 4-year-old with pharyngitis, 29.5% of respondents would either give an antibiotic office sample to start that night and a prescription for continuation of treatment at home, would give an antibiotic prescription with instructions to discontinue treatment with a negative throat culture, or would treat without a throat culture. Almost all of the respondents (99%) were informed regarding the problems of antibiotic resistance, usually from multiple sources. The number of sources of knowledge about problems of antibiotic resistance was the only predictor of compliance (P = 0.02). The number of principles read was not correlated with compliance.


Conclusions: Among students surveyed, large gaps remain regarding the appropriate use of antimicrobial agents for the treatment of upper respiratory infections.


Key Points


* Most senior medical students in New England and the mid-Atlantic states are informed about the problem of antibiotic resistance.


* Given a clinical scenario, many of these same students would use antibiotics inappropriately.


* Instructions about judicious antibiotic use need to be further reinforced in medical schools, using multiple learning modules.

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References

1. Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 1998;279:875–877.
 
2. Cantrell R, Young AF, Martin BC. Antibiotic prescribing in ambulatory care settings for adults with colds, upper respiratory tract infections, and bronchitis. Clin Ther 2002;24:170–182.
 
3. Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:163–165.
 
4. Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Otitis media: principles of judicious use of antimicrobial agents. Pediatrics 1998;101:165–171.
 
5. Schwartz B, Marcy SM, Phillips WR, Gerber MA, Dowell SF. Pharyngitis: principles of judicious use of antimicrobial agents. Pediatrics 1998;101:171–174.
 
6. O’Brien KL, Dowell SF, Schwartz B, S Marcy SM, Phillips WR, Gerber MA. Acute sinusitis-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:174–177.
 
7. O’Brien KL, Dowell SF, Schwartz B, S Marcy SM, Phillips WR, Gerber MA. Cough illness/bronchitis-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:178–181.
 
8. Rosenstein N, Phillips WR, Gerber MA, Marcy SM, Schwartz B, Dowell SF. The common cold-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:181–184.
 
9. Nambiar S, Schwartz RH, Sheridan MJ. Are pediatricians adhering to principles of judicious antibiotic use for upper respiratory tract infections? South Med J 2002;95:1163–1167.
 
10. Halasa NB, Griffin MR, Zhu Y, Edwards KM. Decreased number of antibiotic prescriptions in office-based settings from 1993 to 1999 in children less than five years of age. Pediatr Infect Dis J2002;21:1023–1028.
 
11. Nambiar S, Schwartz RH, Sheridan MJ. Antibiotic use for upper respiratory tract infections: how well do pediatric residents do? Arch Pediatr Adolesc Med. 2002;156:621–624.
 
12. Finkelstein JA, Stille C, Nordin J, et al. Reduction in antibiotic use among US children, 1996-2000.Pediatrics 2003;112:620–627.
 
13. Fakih MG, Hilu RC, Savoy-Moore RT, Saravolatz LD. Do resident physicians use antibiotics appropriately in treating upper respiratory infections? A survey of 11 programs. Clin Infect Dis.2003;37:853–856.
 
14. Metlay JP, Shea JA, Crossette LB, Asch DA. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients. J Gen Intern Med 2002;17:87–94.