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Reasons for non-guideline-based antibiotic prescriptions for acute otitis media in The Netherlands
R A Damoiseaux1, R A de Melker, M J Ausems
1Department of General Practice/Family Medicine, Utrecht, The Netherlands.
Background:
Appropriate use of antibiotics is a major issue in today's medicine. The increasing worldwide bacterial resistance to antimicrobial agents is forcing us to prescribe antibiotics more rationally. It is known that overuse of antibiotics for upper respiratory tract infections exists. Little is known about the reasons for actual prescribing of antibiotics. In order to be able to implement strategies to restrict inappropriate antibiotic prescriptions, insight into the reasons for the actual prescribing could be important.
Objective:
We aimed to explore the reasons, other than those stated in the guidelines of the Dutch College of GPs, for prescribing antibiotics for acute otitis media.
Method:
Seventy antibiotic prescriptions for acute otitis media, prescribed by 22 Dutch GPs, were evaluated to see whether they followed the guidelines on acute otitis media of the Dutch College of General Practitioners. Non-guideline-based antibiotic prescriptions were discussed in stimulated recall interviews with the prescribing GPs regarding their prescribing behaviour of antibiotics for acute otitis media.
Results:
In total, 77% of the antibiotic prescriptions did not follow the guidelines of the Dutch College of General Practitioners. Medical reasons for prescribing antibiotics were mentioned most often for non-guideline-based antibiotic prescriptions; however, in a substantial number of cases doctors gave non-medical reasons as well.
Conclusions:
Appropriate use of antibiotics might not be reached by focusing only on the efficacy of these drugs. The impact of doctors' awareness of their non-medical motives for prescribing antibiotics on more rational antibiotic prescribing should be investigated further.
Insights
Most antibiotic prescriptions for acute otitis media in the Netherlands do not follow guidelines. Doctors cite medical and non-medical reasons, highlighting the need to explore prescribing motives for rational antibiotic use.
Area of Science:
- General Practice
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic resistance is a growing global health concern, necessitating rational prescribing.
- Overuse of antibiotics for upper respiratory tract infections is recognized, but reasons for prescribing are less understood.
- Understanding prescribing motivations is crucial for developing strategies to limit inappropriate antibiotic use.
Purpose of the Study:
- To investigate the reasons behind antibiotic prescriptions for acute otitis media that deviate from established guidelines.
- To explore factors influencing general practitioners' (GPs) antibiotic prescribing behavior beyond official recommendations.
Main Methods:
- Evaluation of 70 antibiotic prescriptions for acute otitis media from 22 Dutch GPs against Dutch College of General Practitioners guidelines.
- Conducting stimulated recall interviews with GPs regarding non-guideline-based antibiotic prescriptions.
Main Results:
- A significant majority (77%) of antibiotic prescriptions for acute otitis media did not adhere to national guidelines.
- Medical reasons were the most frequently cited justification for non-guideline-based prescriptions.
- Non-medical factors also played a role in a substantial proportion of these prescribing decisions.
Conclusions:
- Focusing solely on antibiotic efficacy may not achieve appropriate antibiotic use.
- Further research is needed to assess how physicians' awareness of their non-medical prescribing motives impacts rational antibiotic prescribing.
- Investigating non-medical influences on prescribing is essential for improving antibiotic stewardship.