JAC Advance Access originally published online on November 16, 2008
Journal of Antimicrobial Chemotherapy 2009 63(2):396-399; doi:10.1093/jac/dkn472
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Original research |
The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance
1 Primary Care Centre Jaume I, Tarragona, University Rovira i Virgili, Spain 2 Primary Care Centre Jaume I, Tarragona, Spain 3 Hospital Joan XXIII, Tarragona, Spain 4 Primary Care Centre Valls Urbà, Valls, Spain 5 Department of Pneumology, Institut Clínic del Tòrax (IDIBAPS), Hospital Clinic, CIBER de Enfermedades Respiratorias (CIBERES), Spain
Received 27 July 2008; returned 9 September 2008; revised 5 October 2008; accepted 21 October 2008
* Corresponding author. Tel: +34-671085857; Fax: +34-977248459; E-mail: carles.llor{at}urv.cat
Background: To assess the drug compliance observed among patients with lower respiratory tract infection treated with once-daily, twice-daily and thrice-daily antibiotic regimens.
Methods: We performed a prospective study in the primary care setting including patients with suspected bacterial lower respiratory tract infections, not allergic to β-lactam antimicrobials, macrolides or quinolones, treated with several antibiotic regimens. Patient compliance was assessed by electronic monitoring.
Results: A total of 251 patients were enrolled (136 in the thrice-daily group, 70 in the twice-daily group and 45 in the once-daily group). The mean container openings ranged from 94.3 ± 12.6% with once-daily antibiotics to 74.8 ± 17.7% with thrice-daily drugs (P < 0.001). Seventy-five patients in the thrice-daily group took at least 80% of the medications (55.1%), being significantly less than those receiving twice-daily (71.4%) or once-daily (86.7%; P < 0.001) drugs. Only 20.6% of the patients assigned to the thrice-daily regimens opened the container every 8 ± 4 h during at least 80% of the course. Among the patients assigned the same number of doses daily, compliance was better with the shortest antibiotic courses, being worse with schedules of 7 days or more. The percentage of patients who opened the MEMS container the satisfactory number of times a day was lower among the thrice-daily regimens. Moreover, the thrice-daily group more frequently forgot the afternoon dose.
Conclusions: The rate of compliance was very low, mainly when antibiotics were administered thrice daily and in regimens of 7 days or more. New strategies addressed to improve antibiotic drug compliance are, therefore, necessary.
Keywords: electronic monitoring , RTIs , amoxicillin/clavulanate
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  J. W. L. Cals Comment on: The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance J. Antimicrob. Chemother., May 1, 2009; 63(5): 1083 - 1084. [Full Text] [PDF]
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C. Llor The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance--author's response J. Antimicrob. Chemother., May 1, 2009; 63(5): 1084 - 1085. [Full Text] [PDF]
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