title: Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care.
abstract: OBJECTIVE
  To investigate the determinants of adherence to amoxicillin in patients with acute lower respiratory tract infection.
  
  
  METHODS
  Three European data sets were used. Adherence data were collected using self-reported diaries. Candidate determinants included factors relating to patient, condition, therapy, health care system/provider, and the study in which the patient participated. Logistic and Cox regression models were used to investigate the determinants of initiation, implementation, and discontinuation of amoxicillin.
  
  
  RESULTS
  Although initiation differed across samples, implementation and discontinuation were similar. Determinants of initiation were days waited before consulting, duration of prescription, and being in a country where a doctor-issued sick certificate is required for being off work for <7 days. Implementation was higher for older participants or those with abnormal auscultation. Implementation was lower for those prescribed longer courses of amoxicillin (≥8 days). Time from initiation to discontinuation was longer for longer prescriptions and shorter for those from countries where single-handed practices were widespread.
  
  
  CONCLUSIONS
  Nonadherence to amoxicillin was largely driven by noninitiation. Differing sets of determinants were found for initiation, implementation, and discontinuation. There is a need to further understand the reasons for these determinants, the impact of poor adherence to antibiotics on outcomes, and to develop interventions to improve antibiotic use when prescribed.
authors.affiliation: Centre for Trials Research, College of Biomedical & Life Sciences.
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.
authors.forename: Daniel
authors.initials: D
authors.lastname: Farewell
authors.affiliation: Centre for Trials Research, College of Biomedical & Life Sciences.
authors.forename: Lucy
authors.initials: L
authors.lastname: Brookes-Howell
authors.affiliation: Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO); Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA); Clinical Epidemiology and Medical Statistics, Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.affiliation: Aldermoor Health Centre, Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Aldermoor Health Centre, Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.affiliation: Centre for Trials Research, College of Biomedical & Life Sciences.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
keywords: adherence; antibiotics; determinants; general practice