Acute upper respirtory tract infections in everyday family practice

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 bolesnika i liječnika. MATERIJALI I METODE: U istraživanje je uključeno 4373 ispitanika 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 od 1229 osiguranika (min. 746, max. 1410). Promatrana obilježja bolesnika 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 bolesnika 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 ispitanika i postojanje laboratorijskih nalaza te dob, specijalizacija i radni staž liječnika.OBJECTIVES: The aim of this study was to investigate family physicians\u27 habits in 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. Data were collected in the period from January 1, 2015 to December 31, 2016. There were 8073 cases diagnosed as J00-J06 or H65-H67. This research included nine family medicine practices with an average of 1229 patients (min. 746, max. 1410). The observed characteristics among the patients were age, gender and laboratory findings and those observed among the 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%). Antibiotic was not prescribed (51.1%) for most cases of acute nasopharyngitis (J00). The most common antibiotic prescribed for acute sinusitis (J01),was clarithromycin (67.5%) while acute pharyngitis (J02) was most commonly treated with amoxicilin (78.6%). The most common antibiotic for acute tonsilitis (J03) was penicilin (82.1%), and for acute middle ear infection (H65, H66, H67) cefuroxime (24.8%). There was statistically significant difference in antibiotic prescribing with respect to the patients\u27 age, gender and laboratory findings as well as with respect to physicians\u27 work experience and specialization. CONCLUSION: Family physicians do not follow recommended guidelines in the treatment of acute upper respiratory tract infections except in cases of acute pharyngitis and tonsilitis. Prescribing decisions are influenced by patients\u27 age and gender and the existance of laboratory findings as well as physicians\u27 age, work experience and specialization