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Determinants of antibiotic overprescribing in respiratory tract infections in general practice

Annemiek E Akkerman1, Marijke M Kuyvenhoven, Johannes C van der Wouden

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Location Stratenum, PO Box 85060, 3508 AB Utrecht, The Netherlands. A.Akkerman-2@umcutrecht.nl

The Journal of Antimicrobial Chemotherapy
|September 13, 2005
PubMed
Abstract

Insights

Antibiotic overprescribing is common for respiratory tract infections (RTIs) in Dutch general practice, particularly for tonsillitis and bronchitis. GPs often overestimate symptoms and patient expectations, leading to unnecessary antibiotic prescriptions.

Area of Science:

  • General Practice
  • Infectious Diseases
  • Pharmacology

Background:

  • Antibiotic overprescribing for respiratory tract infections (RTIs) remains a significant concern in primary care.
  • Dutch national guidelines provide benchmarks for appropriate antibiotic prescribing in sinusitis, tonsillitis, and bronchitis.

Purpose of the Study:

  • To determine the factors influencing antibiotic overprescribing in patients diagnosed with sinusitis, tonsillitis, and bronchitis in Dutch general practice.
  • To compare actual prescribing practices against established national guidelines.

Main Methods:

  • 146 general practitioners (GPs) in the Netherlands recorded data for 1469 patients with sinusitis, tonsillitis, or bronchitis over a 4-week period.
  • Antibiotic prescribing decisions were evaluated against Dutch national guidelines to identify overprescribing and underprescribing.
  • Patient characteristics, clinical presentation, and management were documented.

Main Results:

  • Antibiotic prescribing aligned with guidelines in approximately 50% of all consultations.
  • Overprescribing rates were highest for tonsillitis (71%) and bronchitis (63%), compared to sinusitis (22%).
  • Factors associated with non-guideline antibiotic prescriptions included signs of inflammation (fever), greater perceived illness severity by the GP, and the GP's assumption of patient expectation for antibiotics.

Conclusions:

  • General practitioners may overestimate symptom severity and patient expectations, leading to inappropriate antibiotic use in RTIs.
  • Emphasizing correct interpretation of symptom combinations for antibiotic treatment is crucial.
  • Enhancing patient-centered consulting skills can help rationalize antibiotic prescribing in daily practice.

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