title: The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance.
abstract: BACKGROUND
  To assess the drug compliance observed among patients with lower respiratory tract infection treated with once-daily, twice-daily and thrice-daily antibiotic regimens.
  
  
  METHODS
  We performed a prospective study in the primary care setting including patients with suspected bacterial lower respiratory tract infections, not allergic to beta-lactam antimicrobials, macrolides or quinolones, treated with several antibiotic regimens. Patient compliance was assessed by electronic monitoring.
  
  
  RESULTS
  A total of 251 patients were enrolled (136 in the thrice-daily group, 70 in the twice-daily group and 45 in the once-daily group). The mean container openings ranged from 94.3 +/- 12.6% with once-daily antibiotics to 74.8 +/- 17.7% with thrice-daily drugs (P < 0.001). Seventy-five patients in the thrice-daily group took at least 80% of the medications (55.1%), being significantly less than those receiving twice-daily (71.4%) or once-daily (86.7%; P < 0.001) drugs. Only 20.6% of the patients assigned to the thrice-daily regimens opened the container every 8 +/- 4 h during at least 80% of the course. Among the patients assigned the same number of doses daily, compliance was better with the shortest antibiotic courses, being worse with schedules of 7 days or more. The percentage of patients who opened the MEMS container the satisfactory number of times a day was lower among the thrice-daily regimens. Moreover, the thrice-daily group more frequently forgot the afternoon dose.
  
  
  CONCLUSIONS
  The rate of compliance was very low, mainly when antibiotics were administered thrice daily and in regimens of 7 days or more. New strategies addressed to improve antibiotic drug compliance are, therefore, necessary.
authors.affiliation: Primary Care Centre Jaume I, Tarragona, University Rovira i Virgili, Spain. carles.llor@urv.cat
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Nuria
authors.initials: N
authors.lastname: Sierra
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
authors.forename: Ana
authors.initials: A
authors.lastname: Moragas
authors.forename: Marta
authors.initials: M
authors.lastname: Hernández
authors.forename: Carolina
authors.initials: C
authors.lastname: Bayona
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001330:Electronic Data Processing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents