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This paper makes a useful contribution to the debate surrounding the prescription of antibiotics for non-pneumonic acute respiratory tract infections (RTIs). Using a US community based outpatient physician database, the authors assessed frequency of prescription of antibiotics, use of broad spectrum antibiotics, and factors predicting their use. They found that, despite little evidence of therapeutic benefit, 63% of patients with an acute RTI were prescribed antibacterial agents and 54% of the antibiotics given were broad spectrum. The rate of prescription varied significantly between geographical regions and with type of physician, race, and ownership of insurance.
Although the methodology of the study means that factors arguably important in determining whether antibacterial drugs should be prescribed cannot be fully determined—in particular, the presence of significant co-morbidity and severity of illness—the data are still compelling. Approximately half of the subjects presenting with a common cold or non-specific upper respiratory tract infection were given antibiotics and these were broad spectrum in half of the cases. The authors discuss the multiple, often interacting, factors which determine whether an antibiotic is prescribed at the time of a consultation and further comment on ways to impact on the prescription rate. This paper is timely in light of the increasing rates of antimicrobial resistance and complications related to broad spectrum antibiotic prescription.