title: Do clinical findings in lower respiratory tract infection help general practitioners prescribe antibiotics appropriately? An observational cohort study in general practice.
abstract: BACKGROUND
  Antibiotics are over-prescribed for lower respiratory tract infection (LRTI). The influence of clinicians' history and examination findings on antibiotic prescribing for LRTI has not been directly assessed, and the extent to which these clinical findings predict appropriate antibiotic prescribing is unknown. A clearer understanding is crucial to achieving evidence-based prescribing.
  
  
  OBJECTIVE
  To directly assess the influence of general practitioners' history and examination findings on antibiotic prescribing for LRTI, and to explore the extent to which these clinical findings predict appropriate antibiotic prescribing.
  
  
  METHODS
  In this observational cohort study 25 GPs in The Netherlands were recruited during routine consultations and 247 adult patients with a clinical diagnosis of LRTI. The GPs recorded clinical information. Odds ratios (ORs) with 95% confidence intervals (CIs) for clinical variables predicting a prescription for an antibiotic were calculated. The relationship between antibiotic prescription and radiographic evidence of pneumonia was explored in order to gauge appropriateness of antibiotic prescribing.
  
  
  RESULTS
  Auscultation abnormalities (OR 11.5; 95% CI 5.4-24.7), and diarrhoea (OR>11) were strongly associated with antibiotic prescribing. An antibiotic was prescribed for 195 (79%) patients. Assuming that an antibiotic definitely needs to be prescribed only for patients with pneumonia, antibiotics may have been inappropriately prescribed for 166/193 (86%) of the patients. Antibiotics were not prescribed for 5 of the 32 (16%) patients with a radiographic diagnosis of pneumonia.
  
  
  CONCLUSIONS
  Abnormal findings on auscultation in patients with LRTI strongly predict antibiotic prescribing and this is probably inappropriate for most patients. These results should prompt GPs to consider the extent to which finding 'crackles/rhonchi on auscultation' influences their decisions to prescribe antibiotics for their patients with LRTI, and to consider the predictive value of individual clinical signs in reaching evidence-based prescribing decisions.
authors.affiliation: Maastricht University, Care and Public Health Research Institute, Department of General Practice, PO Box 616, 6200 MD Maastricht, The Netherlands. rogier.hopstaken@hag.unimaas.nl
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Hopstaken
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Muris
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
authors.forename: Arnold D M
authors.initials: AD
authors.lastname: Kester
authors.forename: Paula E L M
authors.initials: PE
authors.lastname: Rinkens
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents