Abstract
A total of 59,535 patients with respiratory tract infections were registered in the Happy Audit project, an audit-based, before-and-after study conducted in primary care centres of six countries (Argentina, Denmark, Lithuania, Russia, Spain, and Sweden) in 2008 and 2009. An antibiotic was explicitly requested by the patient in 1,255 cases (2.1%), with a great variation across countries ranging from 0.4%–4.9%. Antibiotics were significantly more often prescribed to patients requesting them compared to those who did not (64% vs. 28%; p < 0.001). Patients with acute exacerbations of chronic bronchitis/chronic obstructive pulmonary disease were most likely to request antibiotics while those with common colds were least likely (3.9% vs. 1.2%, respectively). The presence of tonsillar exudates and dyspnoea were more commonly associated with a demand for antibiotics. Even though physicians very often perceive that patients demand an antibiotic, the results of this study clearly show that patients only request antibiotics in a low percentage of cases. Patients were most likely to request antibiotics when they had symptoms of lower respiratory tract infections and when they came with more severe symptoms. Furthermore, there were considerable differences between countries, suggesting that the different backgrounds and traditions largely explain this variability in patients’ requests for antibiotics.
Highlights
IntroductionSince the development of penicillin, antibiotic use in all parts of the health care system has significantly contributed to reducing the likelihood of dying from an infectious disease [1]
Antibiotics are among the most frequently used pharmaceuticals today
A total of 59,535 contacts with respiratory tract infections were observed during the two years and of these, 1,255 cases requested the prescription of an antibiotic (2.1%)
Summary
Since the development of penicillin, antibiotic use in all parts of the health care system has significantly contributed to reducing the likelihood of dying from an infectious disease [1]. One of the primary strategies to prevent and control the emergence and spread of resistant organisms is to reduce the selective pressure of overuse and misuse of antibiotics in human medicine. The perceptions of general practitioners (GP) regarding patient expectations for a prescription are one of the strongest predictors of prescribing, and this is even more so for antibiotic therapy [3]. Physicians are not very good at determining whether the patients expect antibiotic therapy [6]. Patient dissatisfaction has been shown to be more significantly related only to poor communication during the visit [6]
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