The objective of this study was to examine whether physicians are willing to continue to use older antibiotics in the face of drug resistance in order to preserve newer antibiotics for future use. The study was a national sample of 398 generalist physicians and 429 infectious disease (ID) specialists. Clinical vignettes prompted respondents to select the level of resistance to a hypothetical older antibiotic at which they would prefer a newer antibiotic without any current resistance in the treatment of a patient with pneumococcal pneumonia. Vignettes varied in the site of care of the patient as a proxy for variation in disease severity. Respondents significantly reduced their threshold for switching to a newer antibiotic as disease severity increased. Generalists were more responsive to disease severity than ID specialists. Thus, the adoption of recommendations to limit overuse of newer antibiotics may be variable across clinical settings and providers, reducing the impact of these recommendations on emerging resistance.
Hofmann J, Cetron MS, Farley MM, et al.The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med. 1995; 333(8):481-486.
2.
Doern GV, Brueggemann A, Holley HP Jr, Rauch AM. Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study. Antimicrob Agents Chemother. 1996;40(5):1208-1213.
3.
Whitney CG, Farley MM, Hadler J, et al.Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med. 2000;343(26):1917-1924.
4.
Bartlett JG, Breiman RF, Mandell LA, File TM JR.Community-acquired pneumonia in adults: guidelines for management. Clin Infect Dis. 1998;26(4):811-838.
5.
Niederman MS, Mandell LA, Anzueto A, et al.Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163(7):1730-1754.
6.
Levy SB. Confronting multidrug resistance. A role for each of us. JAMA. 1993;269(14):1840-1842.
7.
Schwartz B, Bell DM, Hughes JM. Preventing the emergence of antimicrobial resistance. A call for action by clinicians, public health officials, and patients. JAMA. 1997;278(11):944-945.
8.
Swartz MN. Use of antimicrobial agents and drug resistance. N Engl J Med. 1997;337(7):491-492.
9.
Carbon C, Bax RP. Regulating the use of antibiotics in the community. BMJ. 1998;317(7159):663-665.
10.
Gonzales R, Steiner JF, Lum A, Barrett PH. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281(16):1512-1519.
11.
Finkelstein JA, Davis RL, Dowell SF, et al.Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics. 2001;108(1):1-7.
12.
McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273(3):214-219.
13.
Eisenberg JM. Doctors’ Decisions and the Cost of Medical Care: The Reasons for Doctors’ Practice Patterns and Ways to Change Them. Ann Arbor (MI): Health Administration; 1986.
14.
Metlay JP, Hofmann J, Cetron MS, et al.Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2000;30(3):520-528.
15.
Hooper DC. Expanding uses of fluoroquinolones: opportunities and challenges. Ann Intern Med. 1998;129:908-910.
16.
Heffelfinger JD, Dowell SF, Jorgensen JH, et al.Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniaeTherapeutic Working Group. Arch Intern Med. 2000;160(10):1399-1408.
17.
Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000;31(2):347-382.
18.
Haverly M, Fitt D, Newman F.Constructing case vignettes for evaluating clinical judgement: an empiric model. Eval Prog Planning. 1984;7:45-55.
19.
Elstein AS, Holmes MM, Ravitch MM, Rovner DR, Holzman GB, Rothert ML. Medical decisions in perspective: applied research in cognitive psychology. Perspect Biol Med. 1983;26(3):486-501.
20.
Fine MJ, Hough LJ, Medsger AR, et al.The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 1997;157(1):36-44.
21.
Doern GV, Pfaller MA, Kugler K, Freeman J, Jones RN. Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY antimicrobial surveillance program. Clin Infect Dis. 1998;27(4):764-770.
22.
Asch DA, Christakis NA, Ubel PA. Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives. Med Care. 1998;36(1):95-99.
23.
Mantel N, Haenszel W.Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719-748.
24.
Dowell SF, Schwartz B.Resistant pneumococci: protecting patients through judicious use of antibiotics. Am Fam Physician. 1997;55(5):1647-1654, 1657-1658.
25.
Metlay JP, Shea JA, Crossette LB, Asch DA. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients. J Gen Intern Med. 2002;17(2):87-94.
26.
Pallares R, Linares J, Vadillo M, et al.Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995;333(8):474-480.
27.
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901-904.
28.
Metlay JP, Stafford RS, Singer DE. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Arch Intern Med. 1998;158(16):1813-1818.
29.
Finkelstein JA, Metlay JP, Davis RL, Rifas-Shiman SL, Dowell SF, Platt R.Antimicrobial use in defined populations of infants and young children. Arch Pediatr Adolesc Med. 2000;154(4):395-400.
30.
Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. JAMA. 2001;286(10):1181-1186.
31.
Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M.Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA2000;283(13):1715-1722.
32.
Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50(10):1129-1136.
33.
Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35(6):1347-1355.
34.
Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis. 2000;31(2):383-421.
