How many people receive antibiotics for the common cold?

Antibiotics are never appropriate treatment for the common cold, yet many people with a common cold receive them, especially children.

Rate that Antibiotics Were Prescribed at Outpatient Visits with Diagnosis of Common Cold (per 10,000 Population)

Why is this important?

• Overuse of antibiotics contributes to the emergence of antibiotic-resistant bacteria (Lewis 1995), which have been increasing in prevalence (Whitney et al. 2000).
• Inappropriate antibiotic use puts an individual at unnecessary risk for adverse drug reactions and subsequent infection with antibiotic-resistant bacteria (Dowell and Schwartz 1997).
• Medical experts recommend careful antibiotic use for patients who are most likely to benefit (Gonzales et al. 2001). The common cold is caused by a virus, against which antibiotics are not effective (Arroll and Kenealy 2005) and not indicated.

Findings

• The population-based rate of antibiotic prescribing at outpatient visits for patients diagnosed with a common cold was 172 per 10,000 during 2001–2002.
• The apparent trend toward lower antibiotic use from 1997–1998 to 2001–2002 was not statistically significant.
• The antibiotic prescribing rate was 2.7 times higher among children than among adults during 2001–2002 (AHRQ 2006).

Implications

The antibiotic prescribing rate in 2001–2002 was 32 percent lower than the baseline rate of 254 per 10,000 in 1995–1996. More progress is needed to achieve the national Healthy People 2010 goal of 50 percent improvement from the baseline rate to 127 per 10,000.Physicians may prescribe antibiotics for viral infections such as the cold to meet perceived patient or parental expectations for antibiotics (Bauchner et al. 1999; Mangione-Smith et al. 1999; Stivers 2002), or based on a belief that antibiotics will prevent bacterial complications from developing (Pichichero 2002). These are not valid reasons for using antibiotics for the common cold.

Improvement Ideas and Resources

• A systematic review of research concluded that "multi-faceted interventions combining physician, patient, and public education in a variety of venues and formats were the most successful in reducing antibiotic prescribing for inappropriate indications" (Arnold and Straus 2005).
• Another systematic review found that improvement interventions in the outpatient setting reduced antibiotic prescribing for acute respiratory infections by about 9 percent on average (Ranji et al. 2006). Active educational interventions, such as one-on-one outreach, consensus-building sessions, and workshops, were more effective than passive strategies such as literature distribution and lectures.
• In two studies, patient and parent satisfaction with the physician visit depended on meeting their expectations for good communication rather than on whether antibiotics were prescribed (Hamm et al. 1996; Mangione-Smith et al. 1999). Physicians who communicated that there was "no problem" during a child’s examination were less likely to prescribe an antibiotic for an apparent viral infection (Mangione-Smith et al. 2003).

Measure:

The denominator includes outpatient visits by civilian, noninstitutionalized persons of the ages shown who were diagnosed with the common cold. The numerator includes visits in the denominator at which physicians prescribed antibiotics. Thus, this population-based rate reflects two factors: how often patients visited physicians for treatment of a cold, and how often physicians prescribed antibiotics when they did visit.

Source:

Patient encounter data were collected by nationally representative samples of physician offices participating in the National Ambulatory Medical Care Survey and of emergency departments and hospital outpatient clinics participating in the National Hospital Ambulatory Medical Care Survey. Results were compiled by the Agency for Healthcare Research and Quality (AHRQ 2006).

References:

* Indicates source of data used in the chart(s).* AHRQ (Agency for Healthcare Research and Quality). 2006. National Healthcare Quality Report, 2005. Rockville, Md.: Agency for Healthcare Research and Quality. Arnold, S. R., and S. E. Straus. 2005. Interventions to Improve Antibiotic Prescribing Practices in Ambulatory Care. Cochrane Database of Systematic Reviews (4): CD003539. Arroll, B., and T. Kenealy. 2005. Antibiotics for the Common Cold and Acute Purulent Rhinitis. Cochrane Database of Systematic Reviews (3): CD000247. Bauchner, H., S. I. Pelton, and J. O. Klein. 1999. Parents, Physicians, and Antibiotic Use. Pediatrics 103 (2): 395–401. Dowell, S. F., and B. Schwartz. 1997. Resistant Pneumococci: Protecting Patients Through Judicious Use of Antibiotics. American Family Physician 55 (5): 1647–54, 1657–8. Gonzales, R., J. G. Bartlett, R. E. Besser et al. 2001. Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults: Background, Specific Aims, and Methods. Annals of Internal Medicine 134 (6): 479–86. Hamm, R. M., R. J. Hicks, and D. A. Bemben. 1996. Antibiotics and Respiratory Infections: Are Patients More Satisfied When Expectations Are Met? Journal of Family Practice 43 (1): 56–62. Lewis, R. 1995. The Rise of Antibiotic-Resistant Infections. FDA Consumer Magazine. Mangione-Smith, R., E. A. McGlynn, M. N. Elliott et al. 1999. The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior. Pediatrics 103 (4 Pt 1): 711–8. Mangione-Smith, R., T. Stivers, M. Elliott et al. 2003. Online Commentary During the Physical Examination: A Communication Tool for Avoiding Inappropriate Antibiotic Prescribing? Social Science and Medicine 56 (2): 313–20. Pichichero, M. E. 2002. Dynamics of Antibiotic Prescribing for Children. Journal of the American Medical Association 287 (23): 3133–5. Ranji, S. R., M. A. Steinman, K. G. Shojania et al. 2006. Antibiotic Prescribing Behavior. Vol. 4 of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies; Technical Review 9. Rockville, Md.: AHRQ.Stivers, T. 2002. Participating in Decisions About Treatment: Overt Parent Pressure for Antibiotic Medication in Pediatric Encounters. Social Science and Medicine 54 (7): 1111–30. Whitney, C. G., M. M. Farley, J. Hadler et al. 2000. Increasing Prevalence of Multidrug-Resistant Streptococcus Pneumoniae in the United States. New England Journal of Medicine 343 (26): 1917–24.