Abstract
European guidelines for treating acute cough/lower respiratory tract infection (LRTI) aim to reduce nonevidence-based variation in prescribing, and better target and increase the use of first-line antibiotics. However, their application in primary care is unknown. We explored congruence of both antibiotic prescribing and antibiotic choice with European Respiratory Society (ERS)/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for managing LRTI.
The present study was an analysis of prospective observational data from patients presenting to primary care with acute cough/LRTI. Clinicians recorded symptoms on presentation, and their examination and management. Patients were followed up with self-complete diaries.
1,776 (52.7%) patients were prescribed antibiotics. Given patients’ clinical presentation, clinicians could have justified an antibiotic prescription for 1,915 (71.2%) patients according to the ERS/ESCMID guidelines. 761 (42.8%) of those who were prescribed antibiotics received a first-choice antibiotic (i.e. tetracycline or amoxicillin). Ciprofloxacin was prescribed for 37 (2.1%) and cephalosporins for 117 (6.6%).
A lack of specificity in definitions in the ERS/ESCMID guidelines could have enabled clinicians to justify a higher rate of antibiotic prescription. More studies are needed to produce specific clinical definitions and indications for treatment. First-choice antibiotics were prescribed to the minority of patients who received an antibiotic prescription.
Footnotes
For editorial comments see page 9.
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Support Statement
This study was funded by the 6th Framework Programme of the European Commission (LSHM-CT-2005-518226). The South East Wales Trials Unit is funded by the Wales Office for Research and Development. The funders had no role in the design and conduct of the study, or the collection, management, analysis or interpretation of the data, or in the preparation, reviewer approval of this manuscript. C. Butler had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Statement of Interest
Statements of interest for T. Verheij, A. Torres and T. Schaberg can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received September 14, 2010.
- Accepted December 20, 2010.
- ©ERS 2011
