[A study of antibiotic treatment of upper respiratory infections in primary care].
OBJECTIVE
To assess the antibiotic therapy of and approach to treating pharyngitis/tonsillopharyngitis in primary care physicians, including the trends and rationality.


METHODS
In April 2005, a multicentre study was carried out as a sequel to a similar study performed in 1998. The two studies monitored how primary care physicians treated patients subsequently hospitalized in Czech departments of infectious diseases with the diagnosis of acute upper respiratory infection. Patients' data were provided by physicians from the departments of infectious diseases in standard questionnaires and processed by employees of a Prague department of infectious diseases.


RESULTS
In 1998, 14 departments of infectious diseases participated in the study and 241 valid questionnaires were obtained from them. The 2005 study comprised 21 departments and 324 valid questionnaires. According to their final diagnosis, patients were divided into four groups: infectious mononucleosis, viral infection, bacterial infection and infectious mononucleosis with bacterial superinfection. The study included only patients initially treated and/or examined by primary care physicians and later referred to a hospital; patients directly referred to a hospital were not enrolled. The numbers of assessable cases were 188 in 1998 and 199 in 2005. Primary care physicians' approach was evaluated according to defined criteria. Respiratory infections were treated correctly in 63 cases (34 %) in 1998 and in 84 cases (42 %) in 2005. Incorrect treatment was found in 66 cases (35 %) in 1998 and in 60 cases (30 %) in 2005. The most common forms of incorrect approach were as follows: antibiotics prescribed for viral infections, aminopenicillin prescribed for infectious mononucleosis and unwarranted administration of protected aminopenicillins in upper respiratory infections. In all three categories, improvements in prescription were noted in 2005 as compared with 1998, yet the differences were not statistically significant. In 2005, outpatient CRP tests for evaluating the aetiology of pharyngitis/tonsillopharyngitis were significantly more frequent.


CONCLUSIONS
When comparing results of the 1998 and 2005 studies, certain improvements in prescription of antibiotics for treating respiratory infections in primary care were noted. Also positive is the outpatient use of CRP tests. On the other hand, there still are numerous cases when antibiotics are prescribed irrationally, without prior examination, and their choice is not in accordance with guidelines. This study provides an option for close monitoring of prescription by primary care physicians. Specialists are capable of objective evaluation of primary care physicians' work and specification of errors. These may be focused on and dealt with when education programmes for primary care physicians are developing.
Bazalová
Zdenka
Z
Dept. Infect. Dis. 3. Med. Faculty, Charles University, Prague, Czech Republic.
Benes
Jirí
J
Bronská
Eva
E
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D006801:Humans; D010821:Physicians, Family; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents