BACKGROUND: Upper respiratory infections (URIs) are mainly viral in nature, rendering antibiotics ineffective. Little is known about what college students believe concerning the effectiveness of antibiotics as a treatment for URIs.
METHODS: Students (n=425) on 3 college campuses were surveyed using a survey describing 3 variations in presentation of an uncomplicated URI. Participants were questioned about their likelihood of using a variety of treatments for the URI and about their likelihood of seeking a physician’s care.
RESULTS: The percentage of students endorsing antibiotic use differed significantly by symptom complex. Likelihood of seeking medical care also differed significantly across symptom groups, with greater endorsement in the discolored nasal discharge and low-grade fever scenarios. Stepwise multiple regression analysis revealed that belief in antibiotic effectiveness for cold symptoms decreased with increasing years of higher education. Likelihood of antibiotic use across different scenarios increased with age. Likelihood of seeking care across different scenarios was related to type of health insurance and belief in antibiotic effectiveness.
CONCLUSIONS: Undergraduate college students show poor recognition of typical presentations of the common cold and have misconceptions about effective treatment. Although increasing years of college correlated with decreasing belief in antibiotics’ effectiveness for a cold, more health education at the college level is recommended.
Infections of the upper respiratory tract account for some of the most common acute illnesses seen in primary care settings. The term “upper respiratory infection” (URI) covers any infectious disease process that involves the respiratory system, starting with the nose and ending just before the lungs. Our study dealt exclusively with the common cold.
Most patients with typical URI syndromes can be treated symptomatically. Although antimicrobial therapy is indicated in the presence of bacterial infection, it is believed that most cases are viral in nature.1 However, of those patients who seek a physician’s care for colds and bronchitis, 50% to 70% receive an antibiotic prescription.2 Ten percent of all antibiotics prescribed are for the common cold and other URIs.2 The percentage is even higher in the pediatric population where antibiotic prescriptions for colds, URIs, and bronchitis (ie, conditions not affected by antibiotics) accounted for more than 20% of all antibiotics prescribed to US children in 1992.3
Prescribing antibiotics for URIs does not improve patient outcome, and this practice does not benefit physicians by reducing return visits or increasing patient satisfaction.4,5 It is also not a cost-effective strategy. Evidence from a Medicaid population suggests that the antibiotics used to treat colds account for 23% of the total cost of managing URIs and add more than $11 to the cost of managing every URI episode.6 Nevertheless, a 1996 study conducted on a Medicaid population concluded that a majority of individuals receiving medical care for the common cold are still given prescriptions for unnecessary antibiotics.7
Clinicians often report that they are motivated to prescribe antibiotics by patient expectations.8 For example, parents frequently have misconceptions about which illnesses warrant antibiotic therapy leading them to request these drugs for their children.9 A survey conducted in Kentucky showed that when patients do not recognize the normal presentation of a URI or understand the effectiveness of antibiotics, inappropriate use and expectations may arise.10 Also questionable is whether physicians are able to accurately identify situations for which antibiotics are appropriate. Even without the influence of misinformed patients, physicians may be prescribing antibiotics inappropriately because of misdiagnosis.11
The purpose of our study was to determine what a select segment of the population (undergraduate college students) knows about URIs and the perceptions of antibiotic therapy held by members of that segment. The information provided can contribute to our understanding of what types of interventions are required to change patients’ perceptions about the appropriateness of antibiotic therapy.
Methods
Participants (n=425) were students aged 18 years and older on 3 college campuses in Louisiana and Indiana. Two of the colleges were public institutions; the third was private. Data were collected in November 1999 in accordance with human subject guidelines after approval by the appropriate institutional review boards. Research assistants distributed the surveys in public areas on each of the campuses.
Survey Instrument
Participants completed a self-report survey primarily composed of 3 symptom scenarios. Two of these scenarios were employed in previous studies.10,12 The scenarios represented variations in presentation of an uncomplicated URI along 3 dimensions: duration of symptoms, color of nasal discharge, and the presence of a low-grade fever. The scenarios were: (1) “You have had an illness for 5 days with the following symptoms: sore throat, cough, and runny nose with clear nasal discharge”; (2) “You have had an illness for 5 days with the following symptoms: sore throat, cough, and runny nose with discolored (yellow, green, brown) discharge”; and (3) “You have had an illness for 3 days with the following symptoms: sore throat, cough, runny nose with clear discharge, and low grade fever (less than 101ÞF).”