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JAC Advance Access published online on June 10, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn230
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs

David S. Y. Ong1,*, Marijke M. Kuyvenhoven1, Liset van Dijk2 and Theo J. M. Verheij1

1 Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 2 NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands

Received 19 February 2008; returned 27 March 2008; revised 15 May 2008; accepted 16 May 2008

* Corresponding author. Tel: +31-88-756-8198; Fax: +31-88-756-8099; E-mail: davidsyong{at}gmail.com

Objectives: To describe specific diagnoses for which systemic antibiotics are prescribed, to assess adherence of antibiotic choice to national guidelines and to assess consistency among general practitioners (GPs) in prescribed volumes of antibiotics for respiratory, ear and urinary tract disorders.

Methods: The cross-sectional study included 174 GPs from 89 general practices. Data were derived from the Second Dutch National Survey of General Practice (DNSGP-2) in 2001. Outcome measures were the antibiotic prescriptions for respiratory, ear and urinary tract disorders defined according to the International Classification of Primary Care codes, the percentage of first-choice antibiotics complying with national guidelines and the number of antibiotic prescriptions per 1000 patients per GP per year.

Results: The most antibiotics for respiratory tract infection (RTI) were prescribed for acute bronchitis (25%), sinusitis (22%) and acute upper RTI (14%). The most antibiotics were prescribed for acute otitis media (77% of ear disorders) and cystitis (95% of urinary tract disorders). First-choice antibiotics were prescribed in ~75% of the cases, whereas macrolides and amoxicillin/clavulanate (second-choice antibiotics) were prescribed in ~25%, especially in lower RTIs. The correlations (Spearman {rho}) between prescribed volumes for the three main groups of disorders varied from 0.39 to 0.67.

Conclusions: GPs were consistent in prescribing antibiotics for the three groups of diseases. Improvement strategies should focus on the management of acute upper RTIs and acute bronchitis and also on the use of amoxicillin/clavulanate and macrolides, these being mostly second-choice antibiotics in national guidelines.

Key Words: antibiotics , prescription , general practice , The Netherlands , guideline adherence


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