title: Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007-2008.
abstract: BACKGROUND
  Prescribing of antibiotics for upper respiratory tract infections (URTI) varies substantially in primary care.
  
  
  OBJECTIVE
  To describe and compare antibiotic and antipyretic/anti-inflammatory drugs use, URTI symptoms' resolution and occurrence of potentially-associated infections in patients seeking care from general practitioners (GPs) who exclusively prescribe conventional medications (GP-CM), regularly prescribe homeopathy within a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho).
  
  
  METHODS
  The EPI3 survey was a nationwide population-based study of a representative sample of 825 GPs and their patients in France (2007-2008). GP recruitment was stratified by self-declared homeopathic prescribing preferences. Adults and children with confirmed URTI were asked to participate in a standardized telephone interview at inclusion, one-, three- and twelve-month follow up. Study outcomes included medication consumption, URTI symptoms' resolution and potentially-associated infections (sinusitis or otitis media/externa) as reported by patients. Analyses included calibration to account for non-respondents and groups were compared using multivate analyses adjusting for baseline differences with a propensity score.
  
  
  RESULTS
  518 adults and children with URTI (79.3% rhinopharyngitis) were included (36.9% response rate comparable between groups). As opposed to GP-CM patients, patients in the GP-Ho group showed significantly lower consumption of antibiotics (Odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.27-0.68) and antipyretic/anti-inflammatory drugs (OR = 0.54, 95% CI: 0.38-0.76) with similar evolution in related symptoms (OR = 1.16, 95% CI: 0.64-2.10). An excess of potentially-associated infections (OR = 1.70, 95% CI: 0.90-3.20) was observed in the GP-Ho group (not statistically significant). No difference was found between GP-CM and GP-Mx patients.
  
  
  CONCLUSIONS
  Patients who chose to consult GPs certified in homeopathy used less antibiotics and antipyretic/anti-inflammatory drugs for URTI than those seen by GPs prescribing conventional medications. No difference was observed in patients consulting GPs within mixed-practice. A non-statistically significant excess was estimated through modelling for associated infections in the GP-Ho group and needs to be further studied.
authors.affiliation: LA-SER, Paris, France; Pharmacoepidemiology and Infectious Diseases Research Group, Pasteur Institute, Paris, France.
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
authors.affiliation: INSERM U657, University of Bordeaux Segalen, U657, Bordeaux, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bégaud
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; LA-SER Center for Risk Research, Montreal, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.affiliation: LA-SER, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Avouac
authors.affiliation: INSERM U1018, Center for Epidemiology and Population Health, Villejuif, France.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: Sainte-Anne Hospital, University of Paris V René Descartes, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Rouillon
authors.affiliation: INSERM U657, Pharmacoepidemiology and evaluation of the impact of health products on human health, Department of Pharmacology, University Victor Segalen Bordeaux 2, Tondu Hospital - Case 41, Bordeaux, France; Department of Biostatistics, University Hospital of Rouen, Rouen, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bénichou
authors.affiliation: Faculty of Medicine, University of Franche Comté, Besançon, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Massol
authors.affiliation: Cyklad Group, Rillieux la Pape, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Duru
authors.affiliation: Faculty of Medicine, University Pierre and Marie Curie, Paris, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Magnier
authors.affiliation: Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; LA-SER Europe Limited, London, United Kingdom.
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
authors.affiliation: Pasteur Institute, Paris, France; Faculty of Medicine, University of Paris-Ile de France Ouest, Guyancourt, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D058633:Antipyretics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019468:Disease Management; D005194:Family Practice; D005260:Female; D005602:France; D058005:General Practitioners / Q000523:psychology; D019538:Health Care Surveys; D006705:Homeopathy / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D058633:Antipyretics