Knowledge of the principles of judicious antibiotic use for upper respiratory infections: a survey of senior medical students.

Objective: Senior medical students (n = 2,433) from 21 accredited medical schools in New England and the mid-Atlantic states were surveyed to evaluate their knowledge of and compliance with principles of judicious antimicrobial use, as defined by the Centers for Disease Control and others. Materials and Methods: A self-administered questionnaire with six vignettes on the clinical management of different upper respiratory tract infections was used. Compliance was calculated by using an ordinal response scale (1 to 4) for each question on the six vignettes. Results: The adjusted response rate was 46%. More than 47% of the respondents had read none of the principles, and only 2.9% had read all six. Approximately 36% of the respondents would start antibiotics within 2 days of an 18-month-old presenting with purulent rhinitis, whereas 55.9% would immediately prescribe antibiotics if the child had wheezy bronchitis. For a 4-year-old with pharyngitis, 29.5% of respondents would either give an antibiotic office sample to start that night and a prescription for continuation of treatment at home, would give an antibiotic prescription with instructions to discontinue treatment with a negative throat culture, or would treat without a throat culture. Almost all of the respondents (99%) were informed regarding the problems of antibiotic resistance, usually from multiple sources. The number of sources of knowledge about problems of antibiotic resistance was the only predictor of compliance (P = 0.02). The number of principles read was not correlated with compliance. Conclusions: Among students surveyed, large gaps remain regarding the appropriate use of antimicrobial agents for the treatment of upper respiratory infections.