Infect Chemother.  2007 Jun;39(3):125-132.

Antibiotic Prescription by Primary Care Physicians for Upper Respiratory Infections

• Chung HJ
• Lee HJ
• Kim ES
• Lee JS
• Chung MH

Abstract

BACKGROUND: Upper respiratory infections (URIs) are common benign illnesses that are associated with significant economic burden, adverse effects of medications, and antimicrobial resistance. These effects have been evaluated chiefly at the tertiary health care centers. The purpose of this study was to investigate the prescribing habits, including antibiotic use, for the management of URIs among the primary care physicians.
METHODS
Between July and August 2006, 23 medical students visited 122 clinics of primary care physicians for the management of simulated common cold. They were instructed to present symptoms that simulated common cold; clear rhinorrhea and nasal stuffiness that lasted for 3 days, and neither was accompanied with fever nor myalgia.
RESULTS
The physicians' specialties were as follows: 43 were general internists; 40, otolaryngologists; 23, general practitioners; 15, family practitioners; and 1, pediatrician. The mean number of prescribed oral medications was 4.71 (S.D.+/-0.951). Glucocorticoids were prescribed in 10 (8.2%) clinics. Antibiotics were prescribed in 50 (41.0%) clinics - cephalosporins in 17, amoxicillin-clavulanate in 16, amoxicillin in 8, fluoroquinolones in 5, macrolides in 3, and trimethoprim-sulfamethoxazole in 1 clinic. There was no difference in the rates of antibiotic prescription among the specialties. Injections were recommended in 32 (26.4%) clinics. With the exception of chest X-ray recommended in 1 clinic, no laboratory or radiologic evaluation was performed.
CONCLUSION
The antibiotic prescription rate observed in this study is lower than those of the previous studies. Since diagnostic tests are seldom performed, diagnostic ambiguity might be a key cause for the overuse of antibiotics in the management of URI. The reasons for the high rates of prescription of parenteral medications need to be evaluated.

Keyword

Upper respiratory infection; Common cold; Primary care physician; Antibiotic; Injection

MeSH Terms

Amoxicillin
Anti-Bacterial Agents
Cephalosporins
Common Cold
Delivery of Health Care
Diagnostic Tests, Routine
Fever
Fluoroquinolones
General Practitioners
Glucocorticoids
Humans
Macrolides
Myalgia
Physicians, Primary Care*
Prescriptions*
Primary Health Care*
Respiratory Tract Infections*
Students, Medical
Thorax
Trimethoprim, Sulfamethoxazole Drug Combination
Amoxicillin
Anti-Bacterial Agents
Cephalosporins
Fluoroquinolones
Glucocorticoids
Macrolides