Antibiotic prescribing for acute otitis media and acute sinusitis: a cross-sectional analysis of the ReCEnT study exploring the habits of early career doctors in family practice.
Antibiotic resistance is a public health concern, and is linked to over-prescribing. In self-limiting infections such as acute otitis media (AOM) and acute sinusitis, prescribing remains high despite strong guideline recommendations against the routine use of antibiotics. Early career General Practitioners may find evidence-based prescribing challenging.



To establish the prevalence and associations of antibiotic prescribing for AOM and acute sinusitis by Australian vocational trainees in General Practice.



A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. This ongoing, multicentre prospective cohort study documents trainees' consultation-based clinical experiences. Univariate and logistic regression analyses were conducted on data recorded in consultations for AOM or acute sinusitis in nine collection periods during 2010-2014.



Data from 856 individual trainees (response rate 95.2%) were analysed. AOM was managed in 0.9% of encounters. Antibiotics were prescribed in 78.8% of cases. Prescribing was significantly associated with longer consultation time and first presentation for this problem. There was no significant association with patient age group. Acute sinusitis was managed in 0.9% of encounters. Antibiotics were prescribed in 71.2% of cases. Later-stage trainees and trainees who did not receive their primary medical qualification in Australia were more likely to prescribe an antibiotic for acute sinusitis.



Early career GPs are not prescribing in an evidence-based manner. The complexity of guidelines for AOM and acute sinusitis may be confusing for prescribers, especially early career doctors struggling with inexperience and diagnostic uncertainty. Educational interventions are necessary to bring prescribing rates closer to quality benchmarks.
Discipline of General Practice, University of Queensland, Brisbane, Australia.
Anthea
A
Dallas
Discipline of General Practice, University of Queensland, Brisbane, Australia.
Mieke
M
van Driel
Elermore Vale General Practice, Newcastle, Australia.
Simon
S
Morgan
GP Synergy, Newcastle, Australia.
Amanda
A
Tapley
GP Synergy, Newcastle, Australia.
Kim
K
Henderson
HMRI / CReDITTS, Newcastle, Australia.
Chris
C
Oldmeadow
HMRI / CReDITTS, Newcastle, Australia.
Jean
J
Ball
Discipline of General Practice, University of Newcastle, Newcastle, Australia.
Andrew
A
Davey
GP Synergy, Newcastle, Australia.
Katie
K
Mulquiney
Department of Infectious Diseases, John Hunter Hospital, Newcastle, Australia.|Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.
Joshua
J
Davis
Eastern Victoria General Practice Training, Melbourne, Australia.|Department of General Practice, University of Melbourne, Melbourne, Australia.
Neil
N
Spike
University of Adelaide, Adelaide, Australia.
Lawrie
L
McArthur
Medical Education Experts, Townsville, Australia.
Rebecca
R
Stewart
GP Synergy, Newcastle, Australia.|Discipline of General Practice, University of Newcastle, Newcastle, Australia.
Parker
P
Magin
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D007396:Internship and Residency; D008297:Male; D010033:Otitis Media / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D012852:Sinusitis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents
Antibacterial agents; drug resistance; evidence-based medicine; general practice; graduate medical education; microbial; physician prescribing patterns