JAC Advance Access published online on September 9, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki283
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1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Location Stratenum, PO Box 85060, 3508 AB Utrecht, The Netherlands
* To whom correspondence should be addressed. Objectives: To assess determinants of antibiotic overprescribing in patients with sinusitis, tonsillitis and bronchitis in Dutch general practice. Patients and methods: A total of 146 general practitioners (GPs) from the Netherlands included all patients with sinusitis, tonsillitis and bronchitis during a 4 week period in the winter of 2002/2003, and recorded patient characteristics, clinical presentation and management. Overprescribing of antibiotics was assessed using the recommendations of the Dutch national guidelines as a benchmark. Results: In almost 50% of all 1469 respiratory tract infection (RTI) consultations (694/1469), the antibiotic prescribing decisions were in accordance with the recommendations of the Dutch national guidelines. Overprescribing was highest in tonsillitis and bronchitis [71% (168/238) and 63% (415/656), respectively], while in sinusitis this was only 22% (128/575). Underprescribing was seen in 1% (3/238), 3% (17/656) and 8% (44/575), respectively. Patients who received an antibiotic prescription that was not in accordance with the guidelines had more inflammation signs such as fever (ORs 2.08, 2.18 and 3.04, for sinusitis, tonsillitis and bronchitis, respectively), were more severely ill according to their GP (ORs 2.37, 1.87 and 1.42, respectively), and their GP assumed more often that they expected an antibiotic (ORs 1.95, 1.70 and 2.11, respectively), compared with those who did not receive an antibiotic prescription. Conclusions: GPs overestimate symptoms and probably patients' expectations when indicating antibiotic therapy in RTI cases in daily practice. Correct interpretation of combinations of symptoms for antibiotic treatment should be emphasized, combined with adopting more patient-centred consulting skills to rationalize the prescribing of antibiotics.
Received June 1, 2005
Revised July 15, 2005
Accepted July 24, 2005
Original article
Determinants of antibiotic overprescribing in respiratory tract infections in general practice
2 Department of General Practice, Erasmus MC--University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
Annemiek E. Akkerman, E-mail: A.Akkerman-2{at}umcutrecht.nl
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