A study identifies older, busier practitioners and those trained abroad. Antibiotic misuse occurs everywhere in medical practice, but it is most difficult to control in the outpatient setting. Studies show that some physicians write far more antibiotic prescriptions for common colds and other viral illnesses than do other physicians (NEJM JW Gen Med Mar 15 2016 and Lancet 2016; 387:1743), but reasons behind these practice differences are largely speculative. In this retrospective analysis, researchers in Ontario reviewed billing and claims data for older adults (age, >65) who sought care during 2012 for acute respiratory illnesses. Immunocompromised patients and those deemed likely to have bacterial infections were excluded. Of 185,000 patients, 85,500 (46%) were prescribed antibiotics, including 32% of those with nasopharyngitis, 67% of those with bronchitis, 58% of those with sinusitis, and 35% of those with laryngitis. Patients given antibiotic prescriptions were more likely to have received antibiotics during the previous year than those who did not but were otherwise similar in age and comorbidities. Among 9000 treating physicians, those who prescribed antibiotics were more likely to be in practice for more than 10 years, to see more than 25 patients daily, and to be international medical graduates (rather than U.S. or Canadian graduates). Source
