title: Mycoplasma pneumoniae detection causes excess antibiotic use in Norwegian general practice: a retrospective case-control study.
abstract: BACKGROUND
  The 2011 Mycoplasma pneumoniae epidemic in Norway resulted in many GP consultations and significantly increased the prescription of macrolide antibiotics.
  
  
  OBJECTIVE
  To investigate the signs, symptoms, course, and prescription patterns of antibiotics in patients positive for M. pneumoniae compared with patients negative for M. pneumoniae.
  
  
  METHODS
  A retrospective case-control study using questionnaires collected from GPs in a county in Norway. A total of 212 M. pneumoniae positive and 202 control patients were included.
  
  
  METHODS
  Descriptive statistics and logistic regression analyses were performed on the reported findings.
  
  
  RESULTS
  Forty-eight per cent of patients positive for M. pneumoniae received an antibiotic at first consultation. Another 45% in the same group received antibiotics after the polymerase chain reaction (PCR) result was known, although these patients were not clinically different from all other patients not receiving an antibiotic at first consultation. Logistic regression analysis to evaluate independent predictors for prescription of antibiotics at first consultation showed that the following factors were significantly associated: elevated C-reactive protein (CRP) level, temperature >38.0°C, pathological findings on pulmonary auscultation, and impaired general condition. Elevated CRP level, younger age, temperature >38.0°C, short duration of symptoms, and absence of rhinitis were found to be positive predictors for M. pneumoniae infection.
  
  
  CONCLUSIONS
  A positive PCR test for M. pneumoniae tends to trigger an antibiotic prescription, irrespective of the severity of the patient's condition at first consultation. New guidelines for treatment and possibly PCR testing should be established.
authors.affiliation: Stokke Centre of Primary Care, Stokke, Norway.
authors.forename: Mats
authors.initials: M
authors.lastname: Foshaug
authors.affiliation: Department of Internal Medicine; Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Maria
authors.initials: M
authors.lastname: Vandbakk-Rüther
authors.affiliation: Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Skaare
authors.affiliation: Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Nils
authors.initials: N
authors.lastname: Grude
authors.affiliation: Antibiotic Centre for Primary Care, University of Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Lindbæk
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D058006:General Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008508:Medication Errors / Q000639:trends*; D009177:Mycoplasma pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D009664:Norway / Q000453:epidemiology; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial
keywords: Mycoplasma pneumoniae; Norway; antibiotics; epidemic; general practice; macrolide antibiotics; overprescription; prescribing