Antibiotic Use for the Treatment of Upper Respiratory Infections in a Diverse Community
METHODS: A total of 192 adults completed a self-administered questionnaire indicating their likelihood of seeking care, the perceived effectiveness of treatment methods, and their usual use of treatment regimens for 2 scenarios consistent with uncomplicated URIs. Respondents were also asked about their use of antibiotics not prescribed by a physician for a URI.
RESULTS: A majority of subjects reported a belief in the effectiveness of antibiotics for URIs and indicated they are likely to seek care for URIs. Many (26%) had obtained antibiotics from sources other than a physician’s prescription (eg, directly from pharmacists or a supplier outside the United States). Many (31%) believed that antibiotics should be available over the counter. Individuals who reported using antibiotics for a URI were more likely than those who did not to obtain them without a prescription (35% vs 11%, P = .001). Subjects with a cultural background from countries where antibiotics are available over the counter are more likely to use antibiotics not prescribed by a physician than those from countries with variably enforced regulations or the United States (40%, 30%, and 20%, respectively, P = .049).
CONCLUSIONS: Members of an ethnically diverse community believe antibiotics are effective for colds, are very likely to seek care for colds, and often obtain antibiotics without a prescription. The ease of antibiotic access worldwide may influence their use in some communities in the United States.
The widespread use of antibiotics for primarily viral self-limited respiratory infections has become a cause of great concern.1 Investigators report that resistance to common respiratory tract pathogens is positively correlated with exposure to antibiotic treatment.2-4
Efforts in the United States to curtail antibiotic use have focused on changing physician prescribing patterns. However, the widespread use of antibiotics for upper respiratory infection (URIs) may be related to relatively poor knowledge among patients. In a study of adults in Kentucky and Louisiana, 79% thought antibiotics were effective for a clinical syndrome that was consistent with but not labeled a URI.5
In many countries, antibiotics are either legally available without a prescription, or existing regulations are not uniformly enforced. Studies indicate that in countries with little regulation, substantial misuse results.6 In a town on the US side of the US–Mexican border, 75% of the respondents had purchased prescription medications in Mexico without a prescription.7 Data from a variety of countries7-11 suggest that self-medication is common and frequently inappropriate; antibiotics are often purchased without proper indication,8 in insufficient quantities,10-11 or when contraindicated.11-12
Recent reports suggest that in many immigrant neighborhoods in New York City, antibiotics are being obtained from pharmacies without a prescription.13 Such practices, if confirmed, likely mirror the cultural systems of self-diagnosis and self-management in the residents’ countries of origin. The purpose of our project was to examine patients’ knowledge of URI presentation, belief in the effectiveness of antibiotics, and practices regarding the use of antibiotics for common colds in an ethnically diverse community.
Methods
Our data come from a self-administered survey of adults (18 years of age or older) approached by bilingual interviewers in diverse health care settings (outpatient clinics, private practices, emergency departments) and a community center in the Bronx and southern Westchester County, New York. Data were collected from September 1998 to March 1999, after approval from the appropriate institutional review boards. The Bronx and southern Westchester are ethnically and socioeconomically diverse. Spanish is the language spoken at home by 39% of the population.14
Survey Instrument
The survey included 2 scenarios previously used in studies of patients,5 primary care physicians,15 and clinical pharmacists.16 Both scenarios were consistent with an uncomplicated URI, varying only in the presence of clear or discolored nasal discharge. The scenarios were: (1) “You have had an illness for 5 days with the following symptoms: sore throat, cough, and runny nose with clear discharge”; and (2) “You have had an illness for 5 days with the following symptoms: sore throat, cough, and runny nose with discolored discharge (yellow, green, brown).” Following the presentation of each scenario, respondents were asked to report their likelihood of seeking care, usual treatments for the illness described, and the effectiveness of a variety of treatments. For purposes of comparison with previous studies,5,15,16 the list of treatments was the same as that used in those studies and the treatments were randomly ordered to avoid the appearance of a priority of antibiotics. The subjects were asked if they had ever taken antibiotics that were not prescribed for them by a physician and, if so, how they obtained them. For this study, the questionnaire was translated to Spanish and back to English to assure retention of meaning, then pretested with Spanish-speaking subjects and revised.
