title: Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong.
abstract: BACKGROUND
  Upper respiratory tract infection (URTI) has a significant healthcare burden worldwide. Considerable resources are consumed through health care consultations and prescribed treatment, despite evidence for little or no effect on recovery. Patterns of consultations and care including use of symptomatic medications and antibiotics for upper respiratory tract infections are poorly described.
  
  
  METHODS
  We performed a retrospective review of computerized clinical data on patients presenting to all public primary care clinics in Hong Kong with symptoms of respiratory tract infections. International Classification of Primary care (ICPC)codes used to identify patients included otitis media (H71), streptococcal pharyngitis (R72), acute URTI (R74), acute sinusitis (R75), acute tonsillitis (R76), acute laryngitis (R77), and influenza (R80). Sociodemographic variables such as gender, age, chronic illness status, attendance date, type and duration of drug prescribed were also collected.
  
  
  RESULTS
  Of the 5,529,755 primary care consultations for respiratory symptoms from 2005 to 2010, 98% resulted in a prescription. Prescription patterns of symptomatic medication were largely similar across the 5 years. In 2010 the mean number of drugs prescribed per consultation was 3.2, of which the commonly prescribed medication were sedating antihistamines (79.9%), analgesia (58.9%), throat lozenges (40.4%) and expectorant cough syrup (33.8%). During the study period, there was an overall decline in antibiotic prescription (8.1% to 5.1%). However, in consultations where the given diagnosis was otitis media (H71), streptococcal pharyngitis (R72), acute sinusitis (R75) or acute laryngitis (R76), over 90% resulted in antibiotic prescription.
  
  
  CONCLUSIONS
  There was a decline in overall antibiotic prescription over the study period. However, the use of antibiotics was high in some conditions e.g. otitis media and acute laryngitis a. Multiple symptomatic medications were given for upper respiratory tract infections. Further research is needed to develop clinical and patients directed interventions to reduce the number of prescriptions of symptomatic medications and antibiotics that could reduce costs for health care services and iatrogenic risk to patients.
authors.forename: Kenny
authors.initials: K
authors.lastname: Kung
authors.affiliation: Division of Family Medicine, School of Public Health & Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong. carmenwong@cuhk.edu.hk.
authors.forename: Carmen Ka Man
authors.initials: CK
authors.lastname: Wong
authors.forename: Samuel Yeung Shan
authors.initials: SY
authors.lastname: Wong
authors.forename: Augustine
authors.initials: A
authors.lastname: Lam
authors.forename: Christy Ka Yan
authors.initials: CK
authors.lastname: Chan
authors.forename: Sian
authors.initials: S
authors.lastname: Griffiths
authors.forename: Chris
authors.initials: C
authors.lastname: Butler
mesh_terms: D000328:Adult; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies