title: [Acute infections of the upper respiratory tract--factors that contribute to diagnosis and antibiotic prescription decisions].
abstract: Acute infections of the upper respiratory tract contribute to over 20% of the morbidity of the population in ambulatory care, with the highest incidence in children. A noted problem in the treatment of these diseases is overprescription of antibiotics. In addition, there is a high degree of variability among physicians in the frequency and cost of antibiotic prescription.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the factors that contribute to the diagnosis, and those that affect the decision of a family care physician or otolaryngologist to prescribe an antibiotic to a patient suffering from an upper respiratory tract infection.
  
  
  METHODS
  In this prospective study, data were collected on 75 patients with acute middle ear infection, 49 with acute tonsillitis, 57 with acute sore throat, and 39 with a streptococcal sore throat and tonsillitis, in 6 family physician offices and otolaryngological practices in Zagreb University Hospital and Osijek University Hospital, Osijek. The questionnaire included general patient data, data on the current disease (patient history and the relevant clinical status), diagnostic and therapeutic procedures and patient follow-up. Doctors noted patients' symptoms and rated (from one to five) the influence of a particular symptom to arriving at the diagnosis, and to deciding to prescribe antibiotics. The physicians also noted any additional factors that influenced antibiotic prescription. The data were analysed using appropriate statistical measures, such as chi2-test, chi2-test using the hypothesis of rectangular distribution and t-test for independent samples.
  
  
  CONCLUSIONS
  The results show that diagnostic criteria for these diseases and decisions for prescribing antibiotics are based on clinical criteria and in concordance with current guidelines. Otolaryngologists recommended microbiological analyses for 54% of patients, while GPs did so for only 4.2% of the patients. While the clinical status is the most important factor for antibiotic prescription, the results of this study indicate that other additional factors such as familiarity with the patient, likelihood of complications, and knowing the patient's living circumstances and his/her ability to use health care facilities should be considered in the complex process of antibiotic prescribing.
authors.affiliation: Odjel za otorinolaringologiju, Klinicka bolnica Osijek, Osijek, Hrvatska.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Vranjes
authors.forename: Vladimir
authors.initials: V
authors.lastname: Katić
authors.forename: Nevenka
authors.initials: N
authors.lastname: Vinter-Repalust
authors.forename: Ljiljanka
authors.initials: L
authors.lastname: Jurković
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Tiljak
authors.forename: Venija
authors.initials: V
authors.lastname: Cerovecki-Nekić
authors.forename: Rajka
authors.initials: R
authors.lastname: Simunović
authors.forename: Dragomir
authors.initials: D
authors.lastname: Petric
authors.forename: Milica
authors.initials: M
authors.lastname: Katić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents