Antibiotic Use for the Treatment of Upper Respiratory Infections in a Diverse Community

The diverse population sampled in this study appeared to be even more likely to seek care and to believe that antibiotics are effective for uncomplicated URIs than was previously found in the Kentucky and Louisiana study sample.⁵ This may be in part because of the ethnic diversity of the Bronx. Those subjects with a cultural background from a country or territory where antibiotics are available over the counter were more likely to either seek care in an attempt to obtain antibiotics for a common cold or use antibiotics obtained improperly.

Limitations

Several limitations must be considered when interpreting our results. First, there could be an effect exerted by the sequence of the 2 scenarios: Patients may have responded differently to the second scenario (with discolored discharge) because it followed the first. Although we made an effort to include all socioeconomic groups, 62% of the sample earned less than $20,000 per year. Thus, it is difficult to disentangle the effect of low socioeconomic status from ethnicity or immigration issues. Similarly, it is possible that our finding of differences between groups on the basis of country of origin may reflect variables other than antibiotic access. Moreover, there is a paucity of published information regarding the actual ease of antibiotic access in many developing countries and territories where regulations exist but may not be strictly enforced. This may have led to our lumping together countries with easy access and more restricted access into the REGS group. This, however, would tend to bias our results toward the null hypothesis. A majority of subjects were recruited from health care settings, perhaps resulting in a bias toward those who use antibiotics. This, however, might tend to underestimate the actual number of people obtaining antibiotics improperly. Also, subjects may have been reluctant to report obtaining antibiotics without a prescription, again tending to underestimate the scope of the practice.

Conclusions

Clinicians providing care to ethnically diverse populations need to be sensitive to cultural differences in self-diagnosis and treatment with antibiotics and to provide appropriate patient education. Additional study is necessary to investigate the self-care practices of diverse populations regarding URIs, as they may influence the type and content of patient education. In addition, further study is required to confirm or reject our finding that patients obtain antibiotics directly from pharmacists. Finally, our findings suggest that the worldwide ease of antibiotic access influences the patterns of antibiotic use in some communities in the United States.