Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients.
BACKGROUND
Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available.


OBJECTIVE
The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs.


METHODS
This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined.


RESULTS
The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in <4% of the consultations without a prescription.


CONCLUSIONS
Awareness of indications and patient groups provoking antibiotic overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. a.r.j.dekker-8@umcutrecht.nl.
Anne R J
AR
Dekker
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Theo J M
TJ
Verheij
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Alike W
AW
van der Velden
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D055815:Young Adult
D000900:Anti-Bacterial Agents
Antibacterial agents; guideline; overprescription; primary health care; respiratory system; respiratory tract infection.