title: Fluoroquinolones to treat uncomplicated acute cough in primary care: predictors for unjustified prescribing of antibiotics.
abstract: BACKGROUND
  Despite efforts to ensure more accurate prescribing of antibiotics for respiratory tract infections, inappropriate selection of antibiotic treatment remains a big issue. We tried to ascertain which factors best predict the nature of fluoroquinolone prescribing for acute cough in primary care.
  
  
  METHODS
  Random effects logistic regression models were applied to the baseline prescription data taken from a cluster-randomized controlled trial based on 104 general practitioners (GPs) and 2745 patients.
  
  
  RESULTS
  Significant predictors for the prescription of fluoroquinolones from both patient and GP data were identified. Predictors from a patient's perspective were the severity of illness {odds ratio (OR) 3.56 [95% confidence interval (CI) 2.45-5.19] P < 0.001}, the duration of illness before seeing the GP [OR 1.09 (95% CI 1.04-1.14) P < 0.020] and the individual patient's age [OR 1.01 (95% CI 1.00-1.01) P < 0.015]. Predictors from the GP's perspective were extent/lack of specific vocational training [OR 3.10 (95% CI 1.54-6.22) P < 0.001], status as a general internist [OR 2.00 (95% CI 1.10-3.70) P < 0.002], the physician's overall antibiotic prescription rate for acute cough [OR 1.02 (95% CI 1.01-1.04) P < 0.001], the duration of illness before contact with patient [OR 0.81 (95% CI 0.69-0.95) P < 0.010] and the severity of illness [OR 0.27 (95% CI 0.12-0.63) P < 0.002].
  
  
  CONCLUSIONS
  Whether a fluoroquinolone is prescribed by a GP seems to be determined not only by the patient's characteristics but also by the GP's vocational training and overall antibiotic prescribing rate. As the prescription of fluoroquinolones for the treatment of acute coughing can rarely be justified, such prescriptions may serve as a quality indicator for antibiotic prescribing in primary care.
authors.affiliation: Department of General Practice, Medical Faculty, University of Rostock, 18055 Rostock, Germany. altiner@med.uni-rostock.de
authors.forename: Attila
authors.initials: A
authors.lastname: Altiner
authors.forename: Stefan
authors.initials: S
authors.lastname: Wilm
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Martin
authors.initials: M
authors.lastname: Sielk
authors.forename: Silke
authors.initials: S
authors.lastname: Brockmann
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.forename: Heinz-Harald
authors.initials: HH
authors.lastname: Abholz
authors.forename: Jürgen
authors.initials: J
authors.lastname: In der Schmitten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones