Determinants of antibiotic overprescribing in respiratory tract infections in general practice.
OBJECTIVE
To assess determinants of antibiotic overprescribing in patients with sinusitis, tonsillitis and bronchitis in Dutch general practice.


METHODS
A total of 146 general practitioners (GPs) from The Netherlands included all patients with sinusitis, tonsillitis and bronchitis during a 4 week period in the winter of 2002/2003, and recorded patient characteristics, clinical presentation and management. Overprescribing of antibiotics was assessed using the recommendations of the Dutch national guidelines as a benchmark.


RESULTS
In almost 50% of all 1469 respiratory tract infection (RTI) consultations (694/1469), the antibiotic prescribing decisions were in accordance with the recommendations of the Dutch national guidelines. Overprescribing was highest in tonsillitis and bronchitis [71% (168/238) and 63% (415/656), respectively], while in sinusitis this was only 22% (128/575). Underprescribing was seen in 1% (3/238), 3% (17/656) and 8% (44/575), respectively. Patients who received an antibiotic prescription that was not in accordance with the guidelines had more inflammation signs such as fever (ORs 2.08, 2.18 and 3.04, for sinusitis, tonsillitis and bronchitis, respectively), were more severely ill according to their GP (ORs 2.37, 1.87 and 1.42, respectively), and their GP assumed more often that they expected an antibiotic (ORs 1.95, 1.70 and 2.11, respectively), compared with those who did not receive an antibiotic prescription.


CONCLUSIONS
GPs overestimate symptoms and probably patients' expectations when indicating antibiotic therapy in RTI cases in daily practice. Correct interpretation of combinations of symptoms for antibiotic treatment should be emphasized, combined with adopting more patient-centred consulting skills to rationalize the prescribing of antibiotics.
Akkerman
Annemiek E
AE
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Location Stratenum, PO Box 85060, 3508 AB Utrecht, The Netherlands. A.Akkerman-2@umcutrecht.nl
Kuyvenhoven
Marijke M
MM
van der Wouden
Johannes C
JC
Verheij
Theo J M
TJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy; D014069:Tonsillitis / Q000188:drug therapy
D000900:Anti-Bacterial Agents