How Nova Scotia general practitioners choose antibiotics for the empirical treatment of community-acquired pneumonia.
OBJECTIVE
To gain an understanding of how physicians in general practice choose antibiotics for the empirical treatment of community-acquired pneumonia (CAP).


METHODS
Questionnaire with three sample cases of CAP and a knowledge assessment (mailed to half of the physicians).


METHODS
Nova Scotia family physicians.


RESULTS
One hundred and eighty-four of the 841 (21.9%) physicians who were mailed a questionnaire responded. A knowledge assessment showed satisfactory knowledge except in two areas - an overestimation of the prevalence of penicillin-resistant Streptococcus pneumoniae in Nova Scotia and the view that ciprofloxacin was an effective antibiotic for the treatment of CAP (42% of physicians). As the complexity of the case increased, there was decreasing consensus regarding the choice of antibiotic therapy and a decline in prescribing according to guidelines for the treatment of CAP. Also, as the complexity of the cases increased, it became increasingly difficult to discern a decision-making strategy. For the simplest case - a 17-year-old male with presumed Mycoplasma pneumoniae pneumonia - physician factors (age, family practice training), desire to target specific pathogens, and concern with resistance and side effects affected the choice of antibiotic. However, for the most complex case - a 45-year-old female with severe pneumonia - familiarity with such a case was the only significant factor and led to treatment with a combination of antibiotics designed to treat both typical and atypical pathogens.


CONCLUSIONS
For uncomplicated cases of CAP, physician factors, desire to treat specific pathogens and concern with resistance affect the choice of antibiotic therapy. For complex cases, familiarity with such cases was the only factor that influenced choice of antibiotic therapy.
Pendergrast
J
J
Departments of Medicine and Microbiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia.
J Marrie
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