The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries

Julie Domen¹, Rune Aabenhus², Anca Balan³, Emily Bongard⁴, Femke Böhmer⁵, Valerija Bralić Lang⁶, Pascale Bruno⁷, Slawomir Chlabicz⁸, Annelies Colliers⁹, Ana García-Sangenís¹⁰, Hrachuhi Ghazaryan¹¹, Anna Kowalczyk¹², Siri Jensen¹³, Christos Lionis¹⁴, Tycho M van der Linde¹⁵, Lile Malania¹⁶, Jozsef Pauer¹⁷, Angela Tomacinschii¹⁸, Akke Vellinga¹⁹, Ihor Zastavnyy²⁰, Herman Goossens²¹, Christopher C Butler⁴, Alike W van der Velden¹⁵, Samuel Coenen^{9

21}

Affiliations

¹ Department of Family Medicine & Population Health, Belgium, University of Antwerp, Antwerp Julie.Domen@uantwerpen.be.
² Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
³ BALAN MEDFAM SRL, Cluj Napoca, Romania.
⁴ Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁵ Institute of General Practice, Rostock University Medical Center, Rostock, Germany.
⁶ Department of Family Medicine, "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
⁷ Département de Santé Publique, France, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice.
⁸ Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland.
⁹ Department of Family Medicine & Population Health, Belgium, University of Antwerp, Antwerp.
¹⁰ Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
¹¹ Wigmore clinic, Yerevan and Yerevan State Medical University, Armenia, Yerevan.
¹² Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
¹³ The Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway.
¹⁴ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece.
¹⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands, Utrecht.
¹⁶ National Center for Disease Control and Public Health, Tbilisi and Arner Science Management LLC, Tbilisi, Georgia.
¹⁷ DRC Drug Research Centre, Balatonfüred, Hungary.
¹⁸ University Clinic of Primary Medical Assistance of State University of Medicine and Pharmacy "N. Testemițanu", Chişinǎu, Moldova.
¹⁹ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
²⁰ NGO "Academy of Family Medicine of Ukraine", Lviv, Ukraine.
²¹ Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.

PMID: 39824603
PMCID: PMC12421272
DOI: 10.3399/BJGPO.2024.0166

The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries

Julie Domen et al. BJGP Open. 2025.

. 2025 Jul 23;9(2):BJGPO.2024.0166.

doi: 10.3399/BJGPO.2024.0166. Print 2025.

Authors

Affiliations

¹ Department of Family Medicine & Population Health, Belgium, University of Antwerp, Antwerp Julie.Domen@uantwerpen.be.
² Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
³ BALAN MEDFAM SRL, Cluj Napoca, Romania.
⁴ Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁵ Institute of General Practice, Rostock University Medical Center, Rostock, Germany.
⁶ Department of Family Medicine, "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
⁷ Département de Santé Publique, France, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice.
⁸ Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland.
⁹ Department of Family Medicine & Population Health, Belgium, University of Antwerp, Antwerp.
¹⁰ Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
¹¹ Wigmore clinic, Yerevan and Yerevan State Medical University, Armenia, Yerevan.
¹² Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
¹³ The Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway.
¹⁴ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece.
¹⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands, Utrecht.
¹⁶ National Center for Disease Control and Public Health, Tbilisi and Arner Science Management LLC, Tbilisi, Georgia.
¹⁷ DRC Drug Research Centre, Balatonfüred, Hungary.
¹⁸ University Clinic of Primary Medical Assistance of State University of Medicine and Pharmacy "N. Testemițanu", Chişinǎu, Moldova.
¹⁹ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
²⁰ NGO "Academy of Family Medicine of Ukraine", Lviv, Ukraine.
²¹ Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.

PMID: 39824603
PMCID: PMC12421272
DOI: 10.3399/BJGPO.2024.0166

Abstract

Background: Illness severity, comorbidity, fever, age, and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.

Aim: To quantify the effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.

Design & setting: Prospective audit of general practices in 18 European countries.

Method: Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perceptions of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).

Results: A GP's perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.

Conclusion: GPs' perceptions of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing, and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.

Keywords: antibiotics; general practitioners; primary health care; respiratory tract infections.

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Conflict of interest statement

AWV, CCB, EB and HGo received unrestricted funding for studies from the European Commission (IMI2 and H2020). All other authors: none to declare.

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The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries

Affiliations

The effect of a GP's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources