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Management of upper respiratory tract infections in Dutch family practice
R A de Melker1, M M Kuyvenhoven
1Department of Family Medicine, University of Utrecht, The Netherlands.
Background:
Family physicians vary in their management of upper respiratory tract infections (URTIs), especially regarding prescription of antimicrobial drugs and patient referral. This study was designed to provide insight into this variation in the management of URTI.
Methods:
A secondary data analysis of a nationwide study of morbidity and interventions regarding the management of cases of acute otitis media, otitis media with effusion, acute upper respiratory tract infections (acute URTIs), sinusitis, and acute tonsillitis was performed. One hundred sixty-one Dutch family physicians and 335,000 patients were included in the study.
Results:
About 10% of all first contacts in this study were house calls, which are most often made to patients in the youngest and oldest age categories. In one third of all first contacts, an antimicrobial drug was prescribed, most frequently for sinusitis (72%) and acute tonsillitis (74%), much less frequently for otitis media and acute URTI. Doxycycline and amoxicillin were prescribed most frequently; two thirds of all antimicrobial prescriptions for the first contact were for one of these two drugs. In 1% of all first contacts and 6% of repeat contacts, patients with URTI were referred to a specialist.
Conclusions:
Compared with physicians in other countries, Dutch family physicians show a relatively restrictive and selective prescription behavior in dealing with URTI. This may be why the Netherlands has one of the lowest reported levels of antibiotic resistance. House calls are still important in Dutch family practice.