Respiratory tract infections: diagnosis and use of antibiotics by family physicians in north-eastern Poland

doi:10.1016/j.ijantimicag.2003.10.009

International Journal of Antimicrobial Agents

Volume 23, Issue 5, May 2004, Pages 446-450

https://doi.org/10.1016/j.ijantimicag.2003.10.009 Get rights and content

Abstract

The aim of our study was to describe the pattern of antibiotic prescribing for respiratory tract infections. Forty-four family physicians from Białystok (north-eastern Poland) filled in questionnaires regarding 1315 patients with respiratory tract infections. Antibiotics were prescribed in 803 cases (61.1%). The four principle diagnoses associated with prescribing an antibiotic were: bacterial pharyngitis/tonsillitis, acute bronchitis, unspecified bacterial superinfection and acute sinusitis for which a total of 572 antibiotic treatments were given (71.2% of all antibiotic prescriptions). The study shows that Polish family physicians diagnose respiratory tract infections empirically and frequently prescribe wide-spectrum antibiotics. More information is required about the diagnostic value of certain clinical symptoms such as purulent sputum, duration of cough and indications for broad-spectrum antibiotic use.

Introduction

Respiratory tract infections are the most common reasons for prescribing antibiotics in primary care. The diagnosis in the ambulatory setting is often made on clinical grounds and antibiotic therapy is usually started on an empirical basis. It is widely believed that the use of antibiotics in many situations is inappropriate since the majority of infections are of viral aetiology. The recent guidelines of Centres of Disease Control and Prevention in the United States stress that antibiotics are not appropriate for the treatment of most cases of acute bronchitis, pharyngitis, and rhinosinusitis [1], [2], [3]. The excessive use of antibiotics in ambulatory practice contributed to higher health-care expenditures and spread of antibiotic resistance. In this context respiratory tract infections are an appropriate target for action aimed at reducing antibiotic prescribing.

Previously published studies show great variability in the use of antibiotics for the treatment of respiratory tract infections in different European countries [4]. This variability is sometimes attributable to differences in aetiology, in the pathogens’ susceptibility to antibiotics or to different labelling of similar entities, but in many situations it is the result of the prescribing physician’s personal preference and/or lack of specific knowledge.

Polish guidelines on diagnosis and antibiotic use in respiratory tract infections are available but have not been widely distributed. The largest professional organisation of family physicians in Poland, The College of Family Physicians, has not yet issued national guidelines on antibiotic prescribing.

The aim of this study was: to describe frequency and reasons for prescribing antibiotics for respiratory tract infections in primary care, to evaluate the utilisation of diagnostic tests, to learn how family physicians label different groups of symptoms and to characterise types of antibiotics chosen in different clinical entities.

Section snippets

Methods

The study was carried out from September to November 2002. All family physicians from Białystok (a city of 300 000 inhabitants and the capital of Podlaskie Woiewodship, north-eastern Poland) having a contract with the Local Sick Fund were invited to participate in the study. The addresses of the practices were obtained from the list published by the Sick Fund. Currently there are two major types of primary health care providers in Poland: district health centres employing doctors with different

Results

Of the 50 eligible family physicians, 44 agreed to participate in the study (response rate 88.0%) and questionnaires for 1315 patients with respiratory tract infections were collected (five doctors returned 29 completed questionnaires instead of 30). The majority of family physicians were women 32/44 (72.3%), and the mean age was 38.6 years (S.D.=4.8). Among the patients there were 718 females (54.6%) and 597 males (45.4%) and the mean age of the patients was 29.3 years (S.D.=21.1; range 1–92

Discussion

This is the first study in north-eastern Poland to collect information on family physicians’ treatments and choices of antibiotics for outpatients consulting about respiratory tract infections. The survey confirms that antibiotics are overused in primary care—overall more than 60% of consultations ended with prescribing an antibiotic. These results show that Polish physicians tend to prescribe antibiotics as frequently as, for example, physicians in Sweden, where 54% of patients with

Acknowledgements

The work was supported by grant 4-25 948 from the Medical University of Białystok.

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Respiratory tract infections: diagnosis and use of antibiotics by family physicians in north-eastern Poland

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

J Clin Epidemiol

Principles of appropriate antibiotic use for acute rhinosinusitis in adults

Ann Intern Med

Principles of appropriate antibiotic use for acute pharyngitis in adults

Ann Intern Med.

Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis

Ann Intern Med.

Antibiotic prescription rates very markedly between 13 European countries

Scand J Infect Dis

Antibiotic prescribing in outpatients: a 1-week diagnosis-prescribing study in 5 counties in Sweden

Scand J Infect Dis

Physicians’ antibiotic prescribing habits for upper respiratory tract infections in Turkey

J Chemother.

Prescribing systemic antibiotics in general practice. A report from the More & Romsdale Prescription Study

Scand J Prim Health Care