Parents’ and Physicians’ Views on Antibiotics

Abstract

ABSTRACT. Objective. To describe parents' opinions and concerns about antibiotics and to contrast these opinions with those of pediatricians.Design. Parents were surveyed using an intervieweradministered questionnaire and pediatricians were mailed a self-administered questionnaire.Results. Parents from two private practices (N ‫؍‬ 300) were largely white (84%) and had completed college (81%). The parents from a community health center (N ‫؍‬ 100) were mostly black (80%) and had not completed college (91%). Twenty-nine percent of parents were worried that their children were receiving too many antibiotics. Eighty-five percent believed there were problems with receiving too many antibiotics, with 55% mentioning resistance or immunity as concerns. Eighteen percent of parents had given their child an antibiotic at home before consulting a physician. Parents believed that antibiotics were always or sometimes required for ear infections (93%), throat infections (83%), colds (32%), cough (58%), and fever (58%). Fourteen percent of parents believed that their child had required an antibiotic when the doctor did not prescribe one, with clinic parents significantly more likely to report this issue (22%) than private practice parents (12%). Nine percent believed that their doctor had prescribed an antibiotic unnecessarily (private practice ‫؍‬ 12%, community health center ‫؍‬ 3%). Parents from the private practices were also more likely to report requesting a specific antibiotic (34%) in comparison with 19% of clinic parents.Sixty-one percent of the physician surveys were returned after two mailings and a follow-up phone call. The pediatricians had been in practice for a median of 12 years, seeing a median of 110 patients per week. Fiftyeight percent of pediatricians reported that some, many, or most of the parents in their practices were worried that their children were receiving too many antibiotics. Seventy-one percent indicated that four or more times during the previous month, a parent had requested an antibiotic when the physician believed it was unnecessary, and 35% said that at least occasionally they went along with these requests. Sixty-one percent reported that parents requested a different antibiotic from the one they were going to prescribe at least four times in the previous month, and 30% of pediatricians said that they agreed to parents' requests often or most of the time.Conclusions. Both the parent and the physician surveys suggest that parents are concerned about the overuse of antibiotics, but often request them when their physicians believe they are unnecessary. Parents often administer antibiotics without physician knowledge, and many parents have misconceptions about which illnesses warrant antibiotic therapy. Understanding parents' concerns and beliefs about antibiotics and the range of physician practice styles with respect to antibiotics may direct the development of intervention strategies to reduce the inappropriate use of oral antibiotics. Pediatrics 1997; 99(6). URL: http://www.pediatrics.org/...

‘The Body Gets Used to Them’: Patients’ Interpretations of Antibiotic Resistance and the Implications for Containment Strategies

“…Lindberg and colleagues found that the 13 patients they interviewed related resistance to the bacterium, which is not so surprising given that the term itself declares the Staphylococcus resistant, and that this organism is also commonly known as a 'super-bug'. 37 Nevertheless, most surveys about the public perception of antibiotic resistance have been naïve to the possibility of multiple interpretations of the term antibiotic resistance', [11][12][13][14][15] and did not give respondents the opportunity to elaborate on the issue. [13][14][15] Respondents to those surveys may not have interpreted antibiotic resistance as intended by the researchers.…”

“…11,12 For example, surveys examining patients' attitudes have used fixed questions with little or no opportunity for follow-up of patients' views or understanding. [13][14][15][16] Few studies have explored patients' understanding of antibiotic resistance as a term used in healthcare discourse. Although two recent qualitative studies have explored patient and public attitudes towards antibiotic resistance, they were limited to the United Kingdom, and the wider implications were not considered in depth.…”

Factors associated with antibiotic use for acute bronchitis

“…Some patients seek care for acute respiratory illnesses, such as upper respiratory infections, with the explicit intent of getting a prescription for antibiotics, [36][37][38] and clinicians appear to prescribe antibiotics in response to these expectations. 38,39 A final possible explanation for the high antibiotic prescription rate for acute bronchitis is that clinicians believe antibiotics benefit acute bronchitis, despite the evidence in the medical literature. When we reviewed the management of acute bronchitis in several popular general medicine and family medicine textbooks, we found a wide range of treatment recommendations that both promoted 40,41 and denounced 42,43 antibiotic use for acute bronchitis.…”

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

“…Research has shown that parent pressure is commonly cited by physicians as a reason for prescribing (Barden, Dowell, Schwartz, & Lackey, 1998;Palmer & Bauchner, 1997;Schwartz, 1999;Schwartz, Freij, Ziai, & Sheridan, 1997). Several communication practices used by parents appear to be what actually constitutes ''pressure'' (Stivers, 2002a, b, in press;.…”