Antibiotic prescribing in ambulatory care in Taiwan

Background. The rapid emergence of antimicrobial resistance in the community is a major health concern. Although the research on factors influencing antibiotic prescribing in ambulatory care setting is extensive, it is limited, for the most part, to western countries and adult populations. Antibiotic resistance is equally alarming in children and in Asia.; Objectives. This study investigates patient and physician factors influencing antibiotic prescribing separately for adults and children with nasopharyngitis, acute upper respiratory tract infections (URIs) of multiple or unspecified sites, acute bronchitis and bronchiolitis, and bronchitis not otherwise specified in Taiwan. In addition, this study examines whether children having a physician, pharmacist, or nurse as a parent, a group whose parents possess medical expertise, are less likely than other children to be given antibiotics for these conditions.; Methods. The National Health Insurance (NHI) files and the Family Registration file were used to evaluate antibiotic prescribing patterns among a nationally representative sample of 185,889 NHI beneficiaries in Taiwan in 2000.{09}The generalized estimating equation (GEE) was used to examine factors associated with the chances of having an antibiotic prescribed at the initial encounter of a new episode of care.; Results. On average, antibiotics were prescribed to 45% and 40% of the initial encounters for children and adults, respectively. Patient age was significantly associated with the prescribing of antibiotics. Physician characteristics associated with increased odds of prescription dispensed were those physicians aged 55 or above, with an Ear-Nose-Throat specialty, who were clinic-based, self-dispensing or with on-site pharmacists and with a high patient volume for both children and adults. Furthermore, physicians' children (OR: 0.61, 95% CI: 0.40--0.94) were significantly less likely to receive antibiotic prescriptions than counterpart children.; Conclusions. Prescribing antibiotics to both adults and children with respiratory tract infections in ambulatory care was widespread. Our findings suggest that educational or policy interventions which act on modifiable factors will be most effective in reducing antibiotic prescribing in ambulatory care in Taiwan.{09}The findings in Taiwan may serve as an important reference to global efforts in combating antibiotic resistance.