Antibiotics for lower respiratory tract infections. Still too frequently prescribed?

Abstract

Objective: To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs).

Design: Prospective assessment of adults with symptoms of LRTIs.

Setting: Offices of 120 community-based members of the College of Family Physicians of Canada.

Participants: Four hundred seven adults (16 years and older).

Main outcome measures: Clinical findings, diagnoses, tests ordered, and prescriptions for antibiotics were documented on a standardized form.

Results: Antibiotics were prescribed to 58.4% of patients presenting with symptoms of LRTIs. Prescribing was higher (77.9%) for those diagnosed with acute bronchitis, which accounted for 70.3% of prescriptions. Physicians were often uncertain about the need for antibiotics, were concerned that patients could become sicker, and felt pressured by patients to prescribe antibiotics. Macrolides were most frequently prescribed; no tests were ordered in 85.0% of encounters.

Conclusion: The number of antibiotic prescriptions for adults with LRTIs remains high in Canada. Rates of prescribing are increased by diagnosis of acute bronchitis, clinical uncertainty, pressure from patients to receive antibiotics, and concern that patients will deteriorate if left untreated.