Recent published data have indicated a decline in inappropriate antibiotic use for pediatric respiratory tract infections across the United States; however, the southeast experienced a decline but to a lesser degree compared with other regions. A review of antibiotic prescribing practices was undertaken in two large Memphis area general pediatrics practices to determine if these nationally collected data are truly representative of this region. Randomly selected charts in the seven offices of these two practices were reviewed for respiratory tract infection visits for every other year starting in 1992 and finishing in 2002. Approximately 2750 visits were reviewed. Antibiotics were considered inappropriate for viral respiratory tract syndromes including episodes of pharyngitis with a negative throat swab or no swab for group A streptococcus. Overall, the common cold/viral pharyngitis accounted for 40% of all visits, with 43% of these visits resulting in an antibiotic prescription. Acute otitis media accounted for 28% of visits and sinusitis for 11%, which remained constant over the study period. The proportion of patients receiving an inappropriate antibiotic for any condition fell from 34% in 1992 to 15% in 2002 (p < .0001), mirroring the decline across the US. The proportion of visits with a prescription fell but remained quite high over the study period (82% in 1992 falling to 67% in 2002, p < .0001)). The data demonstrate that prescribing for patients diagnosed with viral syndromes has declined. However, high overall prescribing rates persist, suggesting overdiagnosis of bacterial syndromes occurs. Ongoing interventions to reduce unnecessary antibiotic use should focus on teaching appropriate diagnosis of otitis media and sinusitis.
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