Infectious diseases in primary care; managing the interface between the person and the community

Area of Science:

• Primary Care Medicine
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Respiratory infections, particularly acute cough, are common primary care diagnoses.
• Antibiotic prescribing decisions are complicated by diagnostic uncertainty, patient preferences, and rising antimicrobial resistance.
• A causal link exists between primary care antibiotic prescribing and the development of antimicrobial resistance.

Purpose of the Study:

• To investigate variations in antibiotic prescribing for acute cough in primary care.
• To evaluate the impact of interventions on antibiotic prescribing behavior.
• To enhance the evidence base for reducing diagnostic uncertainty and managing patient expectations to combat antimicrobial resistance.

Main Methods:

• Observational studies (GRACE) analyzed antibiotic prescribing variations across Europe.
• A large randomized controlled trial (RCT) assessed antibiotic effects for acute cough, comparing amoxicillin to placebo.
• A multi-country GRACE RCT is evaluating web-based interventions, including C-reactive protein point-of-care testing, communication training, and patient booklets.

Main Results:

• Observational data revealed considerable variation in European antibiotic prescribing for acute cough, unexplained by clinical presentation.
• Recovery rates were similar for patients receiving any antibiotic, a specific class, or no antibiotic.
• An ongoing RCT is powered to identify patient subgroups benefiting from amoxicillin.

Conclusions:

• Clinical presentation does not fully explain variations in antibiotic prescribing for acute cough.
• Evidence supports reducing diagnostic uncertainty and managing expectations for more evidence-based antibiotic prescribing.
• Interventions aimed at patient-centered care are crucial for containing antimicrobial resistance.