Prescribing antibiotics in family medicine practices for upper respiratory tract infections

Uvod: Najčešća indikacija za propisivanje antibiotika u primarnoj zdravstvenoj zaštiti su akutne infekcije gornjih respiratornih puteva. Istražili smo učestalost propisanih antibiotika u pacijenata sa akutnom infekcijom gornjih respiratornih puteva. ----- Metode: Provedeno je presječno istraživanje listopada - prosinca 2017. godine u 17 ordinacija obiteljske medicine na području Hrvatske. Okosnica istraživanja je posjet pacijenta sa simptomima infekcije gornjih respiratornih puteva liječniku obiteljske medicine. Alat za procjenu razloga dolaska, kliničkog statusa i postupaka liječnika je namjenski strukturirani upitnik. Klinički status pacijenata sa grloboljom svrstan je u kategorije prema Centor kriterijima. ----- Rezultati: U istraživanje je uključeno 709 posjeta pacijenata. 73.4% posjeta obiteljskom liječniku zbog akutne respiratorne infekcije je inicijalna. Simptomi su prije posjete liječniku trajali 1-2 dana u 43.8% posjeta. Antibiotik je za akutnu infekciju gornjih respiratornih puteva propisan u ukupno 32.6% slučajeva. Za grlobolju koja ispunjava Centor 1, 2 kriterija antibiotik je propisan u 53.1% slučajeva, a za Centor 3, 4 u 94.1% slučajeva. Logistička regresijska analiza o utjecaju nekliničkih varijabili na propisivanje antibiotika pokazala je da je najviše antibiotika propisano ponedjeljkom. Najpropisivanija skupina antibiotika je penicilinska skupina 74.8% (fenoksimetilpenicilin 26.7%, amoksicilin 26.1% te amoksicilin + klavulonska kiselina 22.7%), slijede makrolidni antibiotici 17.6% i cefalosporini 4.0%. ----- Zaključak: Liječnici obiteljske medicine propisuju antibiotike za ARI u većem omjeru nego prema medicini utemeljenoj na dokazima i stručnim kriterijima.Aim: Acute upper respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The frequency of antibiotics prescribed to patients with upper respiratory tract infections has been studied. ----- Methods: A cross-sectional survey has been conducted from October to December 2017 with participation of 17 General Practices in Croatia. Visits of patients with symptoms of upper respiratory tract infections made the survey framework. A specially structured questionnaire was a tool for the assessment of reasons for encounters, clinical statuses and practitioners’ decisions. According to the registered clinical status, two independent doctors classified patients with tonsilitis using Centor criteria. ----- Results: The survey analysed 709 patients’ visits. Seventy three percent of general practice visits due to acute respiratory tract infection were initial. Antibiotics had been prescribed in the total of 32.6% of cases. Analysing tosilitis with Centor score 1 and 2, antibiotics had been prescribed in 53.1% cases and for tonsilitis with the Centor score 3 and 4, antibiotics had been prescribed in 94.1% of cases. Logistic regression analysis about the contribution of nonclinical variables to antibiotic prescribing showed that most often antibiotics had been prescribed on Mondays. The most prescribed group of antibiotics was the penicillin group (74.8%), followed by macrolides (17.6%) and cephalosporins (4.0%). ----- Conclusion: General practitioners prescribe antibiotics for acute respiratory tract infections more than recommended by evidence based medicine and professional criteria