Acute upper respiratory tract infections in everyday work of family physicians

CILJ ISTRAŽIVANJA: Cilj je ovog istraživanja bio ispitati navike propisivanja antibiotika za akutne respiratorne infekcije gornjeg dišnog sustava kod liječnika obiteljske medicine i utvrditi ovisi li odluka o propisivanju o obilježjima pacijenata i liječnika. MATERIJALI I METODE: U istraživanje je uključeno 4373 pacijenata kojima je u periodu od 01. siječnja 2015. godine do 31. prosinca 2016. godine upisana neka od dijagnoza akutnih respiratornih infekcija. Dijagnoze su označene šiframa bolesti prema MKB – 10, a uključivale su šifre J00-J06 i H65-H67. U promatranom periodu ukupno je zabilježeno 8073 slučaja bolesti. U istraživanju je sudjelovalo 9 ordinacija obiteljske medicine sa prosječnim brojem pacijenata od 1229 osiguranika (min. 746, max. 1410). Promatrana obilježja pacijenata bila su dob, spol i postojanje laboratorijskih nalaza, a obilježja liječnika dob, spol, godine radnog staža i specijalizacija LOM. REZULTATI: Antibiotik je propisan za 58,4% akutnih respiratornih infekcija. Najčešće propisana vrsta antibiotika bio je amoksicilin+klavulanska kiselina (25,1%), potom azitromicin (16,8%) i amoksicilin (5,2%). Za akutni nazofaringitis (J00) u najvećem broju slučajeva (51,1%) antibiotik nije propisan. Za upalu sinusa (J01) najčešće propisivan antibiotik bio je klaritromicin (67,5%). Akutna upala ždrijela (J02) najčešće je liječena amoksicilinom (78,6%). Najčešće propisivan antibiotik za akutnu upalu tonzila (J03) bio je penicilin (82,1%). Najčešće propisivan antibiotik kod upale srednjeg uha (H65,H66,H67) bio je cefuroksim (24,8%). Utvrđena je statistički značajna razlika u propisivanju antibiotika za ARI s obzirom na dob i spol pacijenata i postojanje laboratorijskih nalaza kao i s obzirom na godine radnog iskustva i specijalizaciju liječnika. ZAKLJUČAK: Liječnici obiteljske medicine ne pridržavaju se smjernica za liječenje akutnih respiratornih infekcija gornjeg dišnog sustava, osim u slučaju akutnog faringitisa i tonzilitisa. Na odluku o propisivanju utječu dob pacijenta i postojanje laboratorijskih nalaza te dob, specijalizacija i radni staž liječnika.OBJECTIVES: Objective of this research was to examine family physicians' habits of antibiotic prescribing for upper airway respiratory tract infections and to determine wheather their decision depends on factors related to patients and doctors. MATERIALS AND METHODS: 4373 patients were included in this research. The data was collected in the period from January 1st 2015. to December 31st 2016. There was a total of 8073 cases that had one of the diagnosis marked as J00-J06 or H65-H67. The research included nine family medicine practices with an average of 1229 patients (min. 746, max. 1410). Observed characteristics of patients were age, gender and the existance of laboratory findings and observed characteristics of doctors were age, gender, work experience and specialization. RESULTS: Antibiotics were prescribed for 58.4% of acute upper respiratory tract infections. The most common antibiotic prescribed was amoxicilin+clavulanic acid (25.1%) followed by azithromycin (16.8%) and amoxicilin (5.2%). For most cases of acute nasopharyngitis (J00) antibiotic was not prescribed (51.1%). For the acute sinusitis (J01) the most common antibiotic prescribed was clarithromycin (67.5%). Acute pharyngitis (J02) was most commonly treated with amoxicilin (78.6%). The most common antibiotic for acute tonsilitis (J03) was penicilin (82.1%). For acute middle ear infection (H65, H66, H67) the most common antibiotic was cefuroxime (24.8%). There was a statistically significant difference in antibiotic prescribing with respect to patients' age, gender and laboratory findings as well with respect to physicians' work experience and specialization. CONCLUSION: Family physicians do not adhere to recommended guidelines in treatment of acute upper respiratory tract infections except in cases of acute pharyngitis and tonsilitis. Prescribing decisions are influenced by patients' age and gender and the existance of laboratory findings as well as physicians' age, work experience and specialization