Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries
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Open Access
- 23 June 2009
- Vol. 338 (jun23 2) , b2242
- https://doi.org/10.1136/bmj.b2242
Abstract
Objective To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery. Design Cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries. Setting Primary care. Participants Adults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection. Main outcome measures Prescribing of antibiotics by clinicians and total symptom severity scores over time. Results 3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to 83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18, 95% confidence interval 0.11 to 0.30) to Slovakia (11.2, 6.20 to 20.27) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics (coefficient −0.01, PConclusions Variation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery. Trial registration Clinicaltrials.gov NCT00353951.Keywords
This publication has 15 references indexed in Scilit:
- Antibiotics in Dutch general practice: nationwide electronic GP database and national reimbursement ratesPharmacoepidemiology and Drug Safety, 2008
- Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices.2007
- Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention studyJournal of Antimicrobial Chemotherapy, 2007
- Interventions to improve antibiotic prescribing practices in ambulatory careCochrane Database of Systematic Reviews, 2005
- Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract InfectionJAMA, 2005
- Prescribing antibiotics for respiratory tract infections by GPs: management and prescriber characteristics.2005
- Outpatient antibiotic use in Europe and association with resistance: a cross-national database studyThe Lancet, 2005
- Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trialJournal of Antimicrobial Chemotherapy, 2004
- Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trialBMJ, 2004
- Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U.K.: implications for developing management guidelinesRespiratory Medicine, 1997