Common Cold (URI)
Over-treatment Facts
"Colds, URIs, and bronchitis accounted for over 20% of all antibiotic prescriptions provided by US ambulatory physicians to children (<18 years) in 1992, despite the lack of evidence that antibiotics improve outcomes in these patients." [ref.: 8-10]

"Our finding that antibiotics were prescribed for the common cold in 44% of visits and for URIs in 46% of visits corroborates other smaller studies of antibiotic-prescribing practices in children. [Ref.: 14-15] Patient age (age 5 to 11 yr) and physician specialty were independent predictors of antibiotic use for these respiratory illnesses. Antibiotic prescribing was more common in visits for children aged 12 to 17 years and by physicians practicing in the South (90% CIs excluded 1.0)."

Nyquist A-C, Gonzales , Steiner JF. Antibiotic Prescribing for Children With Colds, Upper Respiratory Tract Infections, and Bronchitis JAMA.March 18, 1998;279(11):881-882 (See also p. 875, same Journal/Vol.).
8. Gadomski AM. Potential interventions for preventing pneumonia among young children. Pediatr Infect Dis J. 1993;12:115-120.
9. Soyka LF, Robinson DS, Lachant N, et al. The misuse of antibiotics for treatment of upper respiratory tract infections in children. Pediatrics. 1975;55:552-556.
10. Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: do antibiotic prescriptions improve outcomes? J Okla State Med Assoc. 1996;89:267-274.
14. Schwartz RH, Freij BJ, Ziai M, Sheridan MJ. Antimicrobial prescribing for acute purulent rhinitis in children. Pediatr Infect Dis J. 1997;16:185-190.
15. Mainous AG III, Hueston WJ, Clark JR. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold. J Fam Pract. 1996;42:357-361.

Patient Satisfaction and Over-treatment
"65% of the 113 patients with respiratory infection expected antibiotics. Physicians had some ability to perceive this expectation and frequently prescribed antibiotics for patients who expected them."

"Antibiotics were prescribed to over 75% of patients with sinusitis or bronchitis and to 18% of those diagnosed with only viral infections."

"No association was found between a prescription for antibiotics and patient satisfaction; however, patient satisfaction did correlate with the patients' report that they understood the illness and that the physician spent enough time with them."

CONCLUSIONS: "Physicians frequently prescribe antibiotics for upper respiratory infections when they believe patients expect it, but receiving a prescription for antibiotics is not in and of itself associated with increased patient satisfaction."

ICD Codes for Cold Care:
- Acute nasopharyngitis (common cold, International Classification of Diseases, Ninth Revision, Clinical Modification13 [ICD-9-CM] code 460)
- Acute URIs (ICD-9-CM code 465) of multiple or unspecified sites
- Acute bronchitis or bronchiolitis (ICD-9-CM code 466)
- Bronchitis, not otherwise specified (ICD-9-CM code 490).
- Exclusions: Patients with underlying lung diseases such as asthma (ICD-9 code 493) and chronic bronchitis (ICD-9 code 491) are excluded to eliminate subsets of patients for whom antibiotic therapy might be justified.

Colds, URIs, and bronchitis were aggregated to identify common factors associated with antibiotic use for these conditions.

Hamm RM, Hicks RJ, Bemben DA.. (University of Oklahoma Health Sciences Center, Oklahoma City). Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract 1996 Jul;43(1):56-62

Pleconaril when used for colds cleared them up in a median of 11 days, versus 14 days for patients treated with an inactive drug or placebo (ViroPharma Inc.)