General practitioner management of upper respiratory tract infections: when are antibiotics prescribed?

AIM

To assess General Practice (GP) description and management of upper respiratory tract infections (URTI), including conditions under which they prescribe antibiotics.

METHOD

A telephone survey of a randomised sample of Auckland GPs.

RESULTS

There was a 61% response rate. 82 of the 100 GPs interviewed agreed that most patients presenting with URTI expected antibiotics. Persistent symptoms and indication of specific infection (tonsillitis, otitis media, sinusitis, pharyngitis, purulent sputum) were common reasons for prescribing. Patients travelling overseas, expecting or requesting antibiotics and prior use of over-the-counter (OTC) medications increased antibiotic prescribing-rates. Most GPs (95%) issued as-needed prescriptions on occasion; 13% did this often. Amoxicillin and amoxicillin/clavulanic acid were most commonly used. Despite wide-ranging antibiotic use for URTI (0 to 90%), only 6% of GPs felt they prescribed more antibiotics than others.

CONCLUSIONS

The results suggest over-prescription is common-place, but use of as-needed prescriptions to reduce antibiotic use is encouraging. Exploration of patient expectations in the consultation may assist in decreasing prescribing rates.