Antibiotic Prescribing by Pediatricians for Respiratory Tract Infection in

To examine antimicrobial prescribing rates for viral respiratory tract infections by primary care pediatricians in the greater Toronto area, charts were reviewed for the week of 17–21 February 1997 at 61 pediatricians ’ offices. Antibiotics were considered appropriate if the diagnosis was compatible with bacterial infection. A total of 3,585 patient visits were reviewed. The common cold was the most common respiratory tract syndrome leading to an office visit (1,317 visits). The overall rate of appropriate antibiotic prescribing was 89.5%. There was no significant difference in prescribing when physicians were compared by year of graduation from medical school, sex, or location of training. Diagnostic codes (ICD-9 [International Classification of Diseases, 9th edition] codes) did not match the chart diagnosis in 41 % of cases. Toronto primary care pediatricians appear to have a lower rate of inappropriate antibiotic prescribing than do primary care physicians in other regions of Canada and the United States. Drug resistance in community-acquired bacterial pathogens has hampered the safe and simple management of common infections, particularly in the recent past [1]. As the incidence of severe invasive disease due to Haemophilus influenzae type b has dramatically decreased with the introduction of conjugate vaccine, Streptococcus pneumoniae has emerged as the most significant community-acquired pathogen causing meningitis and bacteremia in young children [2, 3] and otitis media [4]. Unfortunately, during the 1990s, there has been a dramatic increase in the frequency of penicillin-resistant S. pneumoniae worldwide. The increased resistance has been clearly associ-ated with recent antibiotic use [5]. See editorial response by Gerber and Marcy on pages 318–20. Antibiotics are the second leading class of drugs prescribed according to the National Ambulatory Medical Care Surveys [6], with the majority of such prescriptions being for respira-tory tract infections. Studies of antibiotic prescribing have previously shown inappropriate overprescribing of antibiotics for viral respiratory tract infections. In a pediatric practice i