Socially responsible antibiotic choices in primary care: a qualitative study of GPs' decisions to prescribe broad-spectrum and fluroquinolone antibiotics.
BACKGROUND
There is considerable variation within and between countries in general medical practitioners' (GPs') prescribing of broad-spectrum antibiotics such as fluroquinolones, and resistance to these agents is increasing worldwide. Urgently promoting cautious fluroquinolone prescribing in primary care may limit increase in resistance.


OBJECTIVE
We therefore interviewed 40 GPs in order to explore the reasons for their choice of prescribed antibiotic, in particular their decision to prescribe fluroquinolones.


METHODS
We used a grounded theory approach to data collection and analysis, incorporating purposive and theoretical sampling, based on high and average fluroquinolone prescribing. Interviews were conducted with 26 GPs from practices known to be high prescribers of fluroquinolone antibiotics and 14 from average fluroquinolone prescribing practices.


RESULTS
Chosing to prescribe a broad-spectrum antibiotic such as a fluroquinolone, rather than a narrow-spectrum antibiotic, related to a number of clinical considerations, perceptions of patient expectations and organizational influences. GPs from high fluroquinolone prescribing practices were more likely to prioritize patients' immediate needs, whereas GPs from average prescribing practices were more likely to consider longer term issues. GPs from both high and average fluroquinolone prescribing practices justified their antibiotic choices on the basis of a desire to do their best for their patients and society.


CONCLUSIONS
Choosing to prescribe powerful, broad-spectrum antibiotics such as fluroquinolones, as well as choosing to keep these agents in reserve, was justified on the basis of social responsibility. Strategies to change fluroquinolone and broad-spectrum antibiotic prescribing will need to take into account clinicians' perceptions of social responsibility.
Wood
Fiona
F
Department of Primary Care and Public Health, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, Wales, UK. wood@cardiff.ac.uk
Simpson
Sharon
S
Butler
Christopher C
CC
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D044466:Asian People / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D024881:Drug Resistance, Bacterial; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D012423:Rural Health; D014504:Urban Health; D014852:Wales; D044465:White People / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones