Antibiotics for lower respiratory tract infections. Still too frequently prescribed?
OBJECTIVE
To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs).


METHODS
Prospective assessment of adults with symptoms of LRTIs.


METHODS
Offices of 120 community-based members of the College of Family Physicians of Canada.


METHODS
Four hundred seven adults (16 years and older).


METHODS
Clinical findings, diagnoses, tests ordered, and prescriptions for antibiotics were documented on a standardized form.


RESULTS
Antibiotics were prescribed to 58.4% of patients presenting with symptoms of LRTIs. Prescribing was higher (77.9%) for those diagnosed with acute bronchitis, which accounted for 70.3% of prescriptions. Physicians were often uncertain about the need for antibiotics, were concerned that patients could become sicker, and felt pressured by patients to prescribe antibiotics. Macrolides were most frequently prescribed; no tests were ordered in 85.0% of encounters.


CONCLUSIONS
The number of antibiotic prescriptions for adults with LRTIs remains high in Canada. Rates of prescribing are increased by diagnosis of acute bronchitis, clinical uncertainty, pressure from patients to receive antibiotics, and concern that patients will deteriorate if left untreated.
McIsaac
Warren J
WJ
Ray D Wolfe Department of Family Medicine, Mt Sinai Hospital, Toronto, Ont. wmcisaac@mtsinai.on.ca
To
Teresa
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy*; D002170:Canada; D004363:Drug Utilization; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents