Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. 826-832 (doi:10.1542/10.1542/peds.2004-2800)
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Antibiotic Prescribing for Children With Nasopharyngitis (Common Colds), Upper Respiratory Infections, and Bronchitis Who Have Health-Professional Parents

Nicole Huang, PhD*,{ddagger}, Laura Morlock, PhD{ddagger}, Cheng-Hua Lee, MD, DrPH§,||, Long-Shen Chen, MS|| and Yiing-Jenq Chou, MD, PhD

* School of Medicine, National Yang Ming University, Taipei, Taiwan
§ Institute of Health Care and Hospital Administration, National Yang Ming University, Taipei, Taiwan
Department of Social Medicine, National Yang Ming University, Taipei, Taiwan
{ddagger} Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
|| Bureau of National Health Insurance, Taipei, Taiwan

Objective. Antibiotic resistance might be reduced if patients could be better informed regarding the lack of benefits of antibiotics for children with viral infections and avoid antibiotic prescriptions in these circumstances. This study investigated whether children having health professionals as parents, a group whose parents are expected to have more medical knowledge and expertise, are less likely than other children to receive antibiotics for nasopharyngitis (common colds), upper respiratory tract infections (URIs), and acute bronchitis.

Methods. Retrospective analyses were conducted by using National Health Insurance data for children of physicians, nurses, pharmacists, and non–health personnel, who had visited hospital outpatient departments or physician clinics for common colds, URIs, and acute bronchitis in Taiwan in 2000. A total of 53733 episodes of care for common colds, URIs, and acute bronchitis in a nationally representative sample of children (aged ≤18 years) living in nonremote areas were analyzed.

Results. The study found that, after adjusting for characteristics of the children (demographic, socioeconomic, and health status) and the treating physicians (demographic, practice style, and setting), children with a physician (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.36–0.68) or a pharmacist (OR: 0.69; 95% CI: 0.52–0.91) as a parent were significantly less likely than other children to receive antibiotic prescriptions. The likelihood of receiving an antibiotic for the children of nurses (OR: 0.91; 95% CI: 0.77–1.09) was similar to that for children in the comparison group.

Conclusions. This finding supports our hypothesis that better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical knowledge alone, however, may not fully reduce the overuse of antibiotics. Physician-parents, the expected medically savvy parents, can serve as a benchmark for the improvement potentially achievable in Taiwan through a combination of educational, regulatory, communication, and policy efforts targeted at more appropriate antibiotic prescribing in ambulatory settings.

Key Words: antibiotic prescribing • children • health-professional parents • Taiwan

Abbreviations: URI, upper respiratory infection • NHI, National Health Insurance • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • SES, socioeconomic status • OR, odds ratio • CI, confidence interval

Accepted May 23, 2005.


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