WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys.
Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists.
They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.
Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.
When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.
Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way.
Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%), Dr. Fakih reported.
Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.
“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.
A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.
He could not explain the regional variances in prescribing, but suggested that differences in physician education or in patient populations might be involved; one region studied included the Detroit area, while the northern region is more rural.
There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas.
But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.
The conference was sponsored by the American Society for Microbiology.