Antibiotic prescribing practices and patient compliance in the community

Appropriate prescribing of antibiotics should take into account the most likely causal pathogens and severity of the illness. Few laboratory diagnostic aids in community medicine have been available to the clinician. The development of databases on the epidemiology of infectious diseases defining the most probable causal organisms and their sensitivity patterns, and recently developed bedside diagnostics, will provide a level of diagnostic certainty to community medicine. In addition, it should be recognized that the prescribing habits of a community physician are, to some extent perhaps, influenced by patient expectation and belief systems within the medical profession. Patient compliance with antibiotic regimens is poor in the community and this problem has become increasingly relevant as more patients are discharged early from hospital while still on medication. Non-compliance with medication is associated with the negative interaction of four factors: 1. the patient, 2. the physician, 3. the severity of the disease, and 4. therapy (frequency and duration). Careful counselling of the patient by the physician and educational information about therapy are some of the methods successfully employed to improve compliance. Decreasing the frequency and duration of dosing have also improved compliance. The added convenience of new short-course, once-daily therapies such as with azithromycin are expected to improve patient compliance and overall clinical outcome.