Some non-bacteriological determinants and implications of antibiotic use in upper respiratory tract illness.

Antibiotics are widely but inconsistently used by general practitioners in the UK for treatment of respiratory infections. Although it might be expected that antibiotic use would be governed by biomedical factors this is often not the case. Four non-bacteriological determinants of antibiotic use are identified and discussed; these are (i) the doctor's anxiety about his workload, (ii) the response of doctors to social pressures, (iii) misinterpretation of underlying reasons for a consultation and (iv) fear of the possible development of sequels to streptococcal illness. The implications of the variable response of doctors to these influences are discussed. These apply, not only to doctors and patients, but also to relationships between them. In addition there are important implications for the credibility of general practice as a critical and academically respectable discipline.