Evaluating the presentation and management of upper respiratory tract infection in primary care clinics in Saudi Arabia: biomedical factors do not govern clinical decision making.

Abstract

Introduction: Upper respiratory tract infection (URTI) is a common health problem among patients attending primary health care (PHC) clinics (Kuyvenhoven et al. 1993; Khattab et al. 1997) and sore throat is one of the most common presenting symptoms in PHC clinics. It imposes a heavy burden on resources and time and results in the prescription of an oral antibiotic in 20% to 90% of cases (Kuyvenhoven et al. 1993; Carr et al. 1994). Two‐thirds of all antimicrobial drugs prescribed by Dutch PHC physicians, for example, are prescribed for URTI (Kuyvenhoven et al. 1993). PHC physicians prescribe antibiotics for sore throat for different reasons, including the „prevention of complications (e.g. rheumatic fever, glomerulonephritis, sinusitis, otitis media, etc.), the relief of symptoms and for psychosocial „reasons (Little & Williamson 1994). The majority of PHC physicians working in Saudi Arabia are expatriates contracted from outside the Kingdom. These colleagues come with varied backgrounds and attitudes to prescribing. A minority of patients presenting with sore throat have acute tonsillitis and only one‐third appeared to harbour Group A b‐haemolytic streptococci (GABHS), including carriers (Dangnelie et al. 1996). Thus a large number of patients may be unnecessarily exposed to risk of antibiotics and development of resistance with a concomitant drain on the health budgets. Furthermore, it is common for broad‐spectrum antibiotics, particularly amoxycillin, to be chosen, despite consistent advice that penicillin or erythromycin are still the most appropriate antibiotics for sore throat of bacterial origin (Fry 1993).Local studies that have evaluated the presentation and management pattern of such problems in PHC clinics in Saudi Arabia are rare. This study was initiated to address the following research questions:1 What is the pattern of presentation and management of sore throat in PHC clinics?2 Could clinical presentation guide us in the initiation of antimicrobial therapy?3 What is the outcome of this minor illness employing such management?