MANAGEMENT OF UPPER RESPIRATORY-TRACT INFECTIONS IN DUTCH FAMILY-PRACTICE

Background. Family physicians vary in their management of upper respir atory tract infections (URTIs), especially regarding prescription of a ntimicrobial drugs and patient referral. This study was designed to pr ovide insight into this variation in the management of Methods. A seco ndary data analysis of a nationwide study of morbidity and interventio ns regarding the management of cases of acute otitis media, otitis med ia with effusion, acute upper respiratory tract infections (acute URTI s), sinusitis, and acute tonsillitis was performed. One hundred sixty- one Dutch family physicians and 335,000 patients were included in the study. Results. About 10% of all first contacts in this study were hou se calls, which are most often made to patients in the youngest and ol dest age categories. In one third of all first contacts, an antimicrob ial drug wasacute tonsillitis (74%), much less frequently for otitis m edia and acute URTI. Doxycycline and amoxicillin were prescribed most frequently; two thirds of all antimicrobial prescriptions for the firs t contact were for one of these two drugs. In 1% of all first contacts and 6% of repeat contacts, patients with URTI were referred to a spec ialist. Conclusions. Compared with phpsicians in other countries, Dutc h family physicians show a relatively restrictive and selective prescr iption behavior in dealing with URTI. This may be why the Netherlands has one of the lowest reported levels of antibiotic resistance. House calls are still important in Dutch family practice.