Introduction: Carriage of antibiotic resistant organisms in children has been linked to prior antibiotic use. The purpose of this study is to examine antimicrobial prescribing patterns for respiratory tract infections by general pediatricians in the Greater Toronto Area (GTA).

Methods: Primary care pediatricians in the GTA were stratified according to duration since pediatric certification (<10 years, 10-20 years, >20 years). Twenty pediatricians were randomly selected from each stratum. Their gender and country of medical school from which they graduated was noted. The charts of all patients with respiratory tract infections seen by each physician were reviewed from the week of February 17 to 21, 1997. All Ontario residents have provincially funded health insurance (OHIP). Data collected for each patient included age, diagnosis (as recorded in the chart or diagnostic billing (OHIP) code), antibiotic prescribed (yes/no/prn) and the type of antibiotic prescribed. Antibiotic prescribing was considered appropriate if: 1.diagnosis compatible with bacterial infection (acute otitis media, sinusitis, pneumonia) 2.throat culture was being obtained or rapid test for group A strep was positive when diagnosis was pharyngitis or tonsillitis.

Results: Thus far, a total of 3261 patient visits have been reviewed at 50 pediatricians' offices. The most common respiratory tract illness leading to an office visit was viral upper respiratory tract infection(1372 visits) followed by acute otitis media (715 visits) and asthma (489 visits). The overall rate of appropriate antibiotic prescribing was 88%. There was no significant difference in appropriate antibiotic prescribing rates when physicians were compared according to year of pediatric certification (< 10 years 89%, 10-20 years 90%, > 20 years 87%), gender (male 87%, female 91%) or country of training (Canada and U.S. 89%, all other countries 87%). When visits for viral respiratory tract illnesses were considered alone, the proportion of patients who received inappropriate antibiotic prescriptions rose from 12% to 18%.

Conclusions: Toronto pediatricians have a low rate of inappropriate antibiotic prescribing for viral respiratory tract infection. These findings are in sharp contrast to U.S. studies which find much higher rates of inappropriate antibiotic prescribing by pediatricians and family doctors for these infections.