Antibiotic prescriptions for Upper Respiratory Tract Infections in Children

The objective of the study is to describe antibiotic prescribing patterns for upper respiratory infections (URIs) in the pediatric population, stratified by physician and nurse practitioners. The use of midlevel providers is increasing in specialty and subspecialty aspects of medicine, and there is a paucity of data regarding differences in treatment of otolaryngologic infections. At the same time, growing concern regarding antibiotic resistance has lead to greater scrutiny of antibiotic usage. This study will utilize the National Ambulatory Medical Care Survey (NAMCS) and National Hospitalist Ambulatory Care Survey (NHACS), which are a nationally representative sample of outpatient visits and include data on ICD-9 diagnoses and medications prescribed. Statistical analysis, particularly logistic regression, will be used to identify variation in antibiotic prescribing by patient and clinician characteristics. Preliminary results from 2006-2009 show that antibiotics were prescribed at 53.6% of pediatric office visits for URIs. Adjusting for specialty, age, sex, race and total number of chronic diseases, NP visits for any type of URI were associated with higher rates of antibiotic prescription compared to MD visits, OR 1.85 (1.04-3.30), P <0.05. The increased rates of antibiotic prescribing was also seen specifically for acute rhinosinusitis (OR 22.5, 1.3-386.4, P=0.03) and acute tonsillitis (OR 12.8, 1.15-142.3, p=0.04). Further investigation is necessary to broaden the years of analysis to include 2002-2011 in order to increase sample size and examine temporal trends in prescribing practices, and to appropriately adjust analyses for other covariants such as geographic region.