Does It Really Take Longer Not to Prescribe Antibiotics for Viral Respiratory Tract Infections in Children?

BackgroundAlthough overuse of antibiotics in children has been well documented, few studies have evaluated if the visit time for viral infections varies when antibiotics are or are not prescribed.ObjectiveTo examine the relationship between physician visit time and antibiotic prescribing for children with viral respiratory tract infection (RTI).MethodsData obtained from the National Ambulatory Medical Care Survey (NAMCS) 1993-2003 were surveyed for children ≤18 years who were seen by a primary care physician and given a primary diagnosis suggestive of viral RTI (cold, upper respiratory infection (URI), bronchiolitis, or brochitis). We excluded visits of children given a comorbid diagnosis justifying antibiotics or a prolonged visit time and those with implausible physician visit times (0 minutes or >40 minutes). Using univariate and multivariate analysis, we compared self-reported physician visit time when antibiotics were and were not prescribed for viral RTIs.Results2739 visits from the NAMCS database, representing 119,926 visits nationally, met study criteria. Antibiotics were prescribed at 46,949 (39%) visits—75% with a diagnosis of bronchitis, 54% with bronchiolitis, and 30% with cold or URI. After adjusting for factors related to physician visit time, there was no difference in visit duration when antibiotics were or were not prescribed (13.6 ± 8.4 and 13.3 ± 9.6 minutes, respectively, P = 0.24).ConclusionWhile antibiotics prescribing for viral RTI in children occurred frequently, our findings do not support the contention that it takes longer ‘not to prescribe’ antibiotics for children with viral RTIs.