Canadian researchers recently studied physician characteristics associated with inappropriate prescribing of antibiotics to elderly patients with acute upper respiratory tract infections. The data were drawn retrospectively from Canadian administrative healthcare files. The cohort included nearly 9,000 physicians and some 185,000 patients > 65 years of age who presented with common colds, acute bronchitis, acute sinusitis, or acute laryngitis. Almost half these patients received an antibiotic, with 70% of the prescriptions written for broad spectrum agents. Physicians who were more likely to prescribe an antibiotic for an acute upper respiratory tract infection included mid- and late-career physicians, physicians trained outside of Canada or the United States, and high-volume physicians, including those who saw between 25-44 patients a day, and especially those who saw ≥ 45 patients a day. Physician rationale for prescribing was not studied. (Ann Intern Med 2017;166:765-774)

An accompanying editorial noted that “antibiotic prescribing seems to be more refractory to evidence-based medicine efforts than other low-value treatments, and the question is why.” The authors suggested outpatient antibiotic stewardship programs, which focus on the cognitive and motivational factors driving antibiotic prescribing. (Ann Intern Med 2017;166:844-845)