Antibiotic prescriptions for suspected respiratory tract infection in primary care in South America.
To describe and compare antibiotic prescribing patterns for primary care patients with respiratory tract infections (RTIs) in four South American countries.



This was a prospective observational study. General practitioners (GPs) from Argentina, Bolivia, Paraguay and Uruguay registered data about all consultations of patients with suspected RTIs in the winter of 2014 (June-August). Variation in antibiotic prescriptions was assessed using a two-level hierarchical logistic model.



Participating GPs (n = 171) registered 11 446 patients with suspected RTI; 3701 (33%) of these received an antibiotic prescription. There was a wide variation across countries in the use and selection of antibiotics. For example, 94% of patients with acute bronchitis were prescribed antibiotics in Bolivia, while in Uruguay only 21% received antibiotics. Amoxicillin was the most commonly prescribed antibiotic across countries, but prescription rates varied between 45% in Bolivia and 69% in Uruguay. Compared with the overall mean prescribing rate, and after adjusting for clinical presentation and demographics, prescribing of antibiotics varied by a factor of 6, the OR ranging from 0.37 (95% CI = 0.21-0.65) in Uruguay to 2.58 (95% CI = 1.66-4) in Bolivia.



The large variation in use and selection of antibiotics across countries is not explained by different patient populations. It could be explained by diagnostic uncertainty and contextual characteristics beyond clinical practice. Reducing uncertainty and country variation requires greater support from the healthcare systems by providing GPs with evidence-based guidelines and tools to apply them.
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark gloriac@sund.ku.dk.
Gloria
G
Cordoba
Dr Pedro Baliña Hospital, Public Health Ministry, Posadas - Misiones, Argentina.
Lidia
L
Caballero
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Håkon
H
Sandholdt
Policlínica Central de la Caja Nacional de Salud, La Paz, Bolivia.
Fátima
F
Arteaga
Department of Family and Community Medicine, Faculty of Medicine, University of the Republic, Montevideo, Uruguay.
Monica
M
Olinisky
Faculty of Medicine, National University of Itapua, Encarnacion, Paraguay.
Luis Fabián
LF
Ruschel
Finnish Office for Health Technology Assessment (FINOHTA) - National Institute for Health and Welfare, Helsinki, Finland.
Marjukka
M
Makela
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Lars
L
Bjerrum
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D055656:Prescriptions; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013020:South America; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents