Abstract
BackgroundAntibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors.MethodsIn family medicine practices in Białystok, Poland, family medicine residents directly observed consultations with patients with RTI symptoms. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors.ResultsOf 1546 consultations of patients with RTIs, 54.26 % resulted in antibiotic prescription. Antibiotic prescription was strongly associated with rales (OR 26.90, 95 % CI 9.00–80.40), tonsillar exudates (OR 13.03, 95 % CI 7.10–23.80), and wheezing (OR 14.72, 95 % CI 7.70–28.10). The likelihood of antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 % CI 2.80–5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40–6.10), starting self-medication with antibiotics (OR 4.11, 95 % CI 2.30–7.30), and direct request for antibiotics (OR 1.87, 95 % CI 1.30–2.80). Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI 0.27–0.55).ConclusionWhile clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.
Highlights
The present results confirmed a high rate of antibiotic prescription (54.26 %), even though the majority of diagnoses made by family physicians suggested a viral aetiology
A 2002 study of family physicians’ prescription choices in the same region of Poland showed an even higher percentage of patients receiving antibiotic prescriptions, with more than 60.00 % of consultations ending with antibiotic prescription, including 90.00 % of patients diagnosed with acute bronchitis [18]
Wheezing or rhonchi significantly increased the probability of antibiotic prescription, even though about 95 % of cases of acute bronchitis are attributed to viruses
Summary
Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors. The majority of antibiotics prescriptions are issued in primary care for respiratory tract infections (RTIs) [1, 2]. Multiple interventions aiming at decreasing unnecessary antibiotics prescriptions for common RTIs have been targeted to doctors [7]. There are reportedly multiple reasons for unjustified prescription of antibiotics [13, 14], with pressure from patients and their families appearing to be an important factor [13, 14]. Patients use different types of direct and indirect pressure to influence physicians’ decisions concerning antibiotic
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