[Prudent use of antibiotics and suggestions for improvement in the primary health care system]

Abstract

A third of all primary care (PC) visits are due to infectious diseases and more than half of these are due to respiratory tract infections. In most cases, data from the clinical history and physical examinations do not help discern whether the aetiology of the infection is bacterial or not and, when in doubt, the family doctor tends to prescribe antibiotics despite the marginal effect that these drugs have on most respiratory infections. Moreover, PC physicians overestimate the proportion of patients with infections who expect to receive antibiotics and according to the scientific literature this perception is often wrong. In addition, patient expectations are often based on false assumptions or experiences from previous visits. Various strategies have proven useful in promoting more prudent use of antibiotics in PC. Delayed prescription of antibiotics is recommended mainly in non-serious infections of suspected viral aetiology in patients who express a preference for antibiotics. Improving communication skills has also proven useful in reducing prescriptions of antibiotics as has the use of rapid diagnostic tests in the doctor's office, mainly rapid antigen techniques for diagnosis of strep throat and determination of C-reactive protein. The results of the Happy Audit study recently conducted in Spain confirm these findings.