Prescribing For Respiratory Infections Research Articles

Antibiotic prescribing for respiratory tract infections in general practice

(1) To describe interpractice variation in diagnosis of respiratory infections at consultation. (2) To test the hypotheses that: (a) The decision to prescribe an antibiotic in respiratory infection is influenced by the diagnosis, the perceived certainty of diagnosis, and whether or not a consultation takes place. (b) The choice of antibiotic is influenced by the diagnosis. A regional survey of prescribing and associated morbidity in general practice, over a 2-week period in April 1994. Stratified quota sample of 22 Northern Ireland practices. There was wide interpractice variation in diagnosis of common respiratory infections at consultation, especially tonsillitis (5.0-157.5/1000 consultations). Overall, different diagnoses predicted the decision to prescribe an antibiotic at different levels (coryza 42.3%, tonsillitis 84.8%), but there was wide interpractice variation in the decision to prescribe for most diagnoses. With the exception of coryza and sinusitis, the perceived certainty of diagnosis did not significantly influence the decision to prescribe. The decision to prescribe was not significantly influenced by whether or not a consultation took place. Overall, broad spectrum penicillins were the therapeutic group most frequently prescribed for a given diagnosis with the exception of tonsillitis (phenoxymethylpenicillin) and sinusitis (tetracyclines), but there was wide interpractice variation in choice of antibiotic. Little consensus exists among practices regarding rational prescribing decisions in respiratory illness. The absence of a consultation was no deterrent to antibiotic prescribing. At one extreme, it is suggested that some practices are avoiding consultations for respiratory infections. There is wide variation in choice of antibiotic, despite existing guidelines.

Original Paper: Treatment of respiratory tract infections - a study in 18 general practices in Germany

Background: Respiratory tract infections are common in general practice: antibiotics and symptomatic drugs are frequently prescribed for these conditions. Since most respiratory tract infections are of viral origin, there is no conclusive evidence of usefulness of such medication. The reasons for general practitioners' (GPs') prescribing behaviour are not well understood.Objective: To assess the influence of medical and nonmedical factors on antibiotic and symptomatic drug prescription for respiratory tract infections: the common cold, sinusitis, tonsillitis, laryngitis and bronchitis.Methods: Eighteen GPs recruited all the adult patients (maximum n=30) who consulted them with symptoms of respiratory tract infection during a two-week period. Information on patients was obtained from matched physician-patient questionnaires completed for each patient, or in case of non-responding patients, from the GP questionnaire only. The patient forms focused on symptoms, reasons for consulting and expectations; whereas the physician documentation concentrated on diagnosis, prescriptions and pre-existing chronic conditions. The predictors of antibiotic and symptomatic drug prescriptions were identified by univariate and multivariate analyses.Results: A total of 417 physician questionnaires including 280 matched doctor-patient questionnaires were obtained, 35 GP cases (27 matched pairs) were excluded from the analysis because of a principal diagnosis other than a respiratory tract infection.Antibiotics were prescribed for 106 of 382 patients (27.7%); and cough and cold preparations for 67%. Tonsillitis (odds ratio [OR]: 216.65), bronchitis (OR: 3.44), sinusitis (OR: 2.48) and yellow-green sputum (OR: 4.44) and not being a current smoker (OR: 0.2) significantly predicted antibiotic prescriptions.Patients' wish for a symptomatic drug (OR: 18.84), bronchitis (OR: 3.43), yellow-green sputum (OR: 2.34) and not having tonsillitis (OR: 0.10) predicted prescription of symptomatic drugs.Conclusion: The diagnosis of a presumed bacterial infection is important for a GP's decision to prescribe antibiotics, even though many of these patients probably have a viral disease. Patient expectations are extremely important when prescribing cough and cold drugs. For a better understanding of GPs' prescribing behaviour, a simultaneous consideration of medical and non-medical factors seems appropriate.

Long-lasting improvement in general practitioners' prescribing of antibiotics by means of medical audit

Objective - To evaluate the usefulness of medical audit of GPs' antibiotic prescription habits. Design - Medical audit according to the APO method. Registration of antibiotic prescriptions for respiratory tract infections during a 3 year period. Intervention with courses, visits to the laboratory, and distribution of recommendations concerning diagnosis and treatment of respiratory infections. Setting - 24 Danish GPs in cooperation with Audit Project Odense (APO) and Department of Clinical Microbiology, Odense University Hospital. 207 GPs acted as controls. Main outcome measures - Changes in the number of antibiotic prescriptions and in the penicillin/broad-spectrum antibiotic ratio. Results - The proportion of antibiotic prescriptions was reduced during the investigation period, but a similar reduction was found in the control groups. Only for acute sinusitis was a lasting decrease not found in the control groups recorded. The penicillin/broad-spectrum antibiotic ratio increased in the intervention group (1.33 in 1992, 1.94 in 1993 and 2.70 in 1995). This increase was significantly higher than in the control groups. The change was seen for acute sinusitis, bronchitis, and pneumonia, but not for acute otitis media or acute tonsillitis. The changes induced from 1992 to 1993 were maintained or increased from 1993 to 1995 although the educational measures had stopped. Conclusion - Medical audit according to the APO method is a useful tool for inducing and maintaining desirable changes in GPs' prescription habits.