Macrolide antibiotics are often used to treat bacterial respiratory tract infections (RTIs). However, little is known regarding factors influencing physician choice among macrolides.
Online survey about decision-making for macrolide prescriptions and refills for RTIs; 321 family practice and internal medicine physicians participated. Topics included importance of treatment, patient, and economic characteristics and ratings for common macrolides (azithromycin [AZI], clarithromycin [CLARI], erythromycin [ERY]).
The most and least important factors are presented in Table 1
Most and Least Important Factors Influencing Macrolide Treatment DecisionsFactorMean Rating (SD)*% (n) selecting “very important” or “extremely important”Treatment CharacteristicsMost importantImpact on bacteriological cure4.3 (0.8)86.3% (277)Least importantFDA-approved labeling for the condition being treated3.1 (1.0)33.0% (106)Patient CharacteristicsMost importantSeverity of patient’s disease4.2 (0.8)87.2% (280)Least importantEducation2.3 (0.9)8.1% (26)Economic CharacteristicsMost importantDrug listing on formulary3.8 (1.0)64.9% (207)Least importantCost of treatment of side effects3.3 (1.0)43.9% (140)Other CharacteristicsMost importantPersonal experience/familiarity with a treatment option4.0 (0.8)77.6% (61)Least importantManufacturer-sponsored programs2.2 (1.0)8.7% (12)*
Using a five-point scale, where 1 is “not at all important” and 5 is “extremely important.”Economic characteristics were generally rated lower than treatment or patient characteristics. CLARI was rated significantly higher than AZI or ERY for clinical efficacy and bacterial eradication and significantly higher than ERY for time to symptom improvement (Table 2). No significant differences for likelihood to promote resistance were observed. Significantly more physicians reported greater symptom persistance and wrote more refills for AZI than CLARI (p<0.0001).
Results provide general insight into physician attitudes and beliefs regarding RTI antibiotic choices and macrolides in particular.
Physician reports of treatment and patient characteristics are important in macrolide selection; further study into behavior is necessary.*The Sepsis Late-Breaking Science Abstracts are also available on Tuesday, October 28, 2003, at 10:45-11:45 AM. You can find the full body of these abstracts in the Slide Presentations section.
Comparison of Macrolide Ratings (scales range from 0 [lowest value] to 100 [highest value])Comparison of MacrolidesRating of:AzithromycinClarithromycinErythromycinClinical efficacy (no symptom remaining at the end of the first course of therapy)62.2 (33.5)*67.6 (32.0)**56.9 (26.9)Bacterial eradication 262.0 (33.0)70.4 (30.9)**60.1 (27.4)Less likely to promote the development of resistance 355.5 (30.7)58.2 (32.3)53.8 (30.1)Rapid resolution of symptoms 463.9 (31.4)*66.8 (30.5)*57.3 (26.4)*
Difference from rating for erythromycin significant at p<0.05**
Difference from ratings for azithromycin and erythromycin significant at p<0.05
M. Halpern, Research Contractors