REPEAT CONSULTATIONS AFTER ANTIBIOTIC PRESCRIBING FOR RESPIRATORY-INFECTION - A STUDY IN ONE GENERAL-PRACTICE

Background. Several new antibacterial drugs have been introduced in th e last 10 years with the aim of improved treatment of respiratory trac t infection. Aim. The study set out to use repeat consultations as a m easure of the outcome of antibiotic treatment for respiratory tract in fection, and to develop a simple model for discussion of the cost effe ctiveness of alternative antibiotic treatments. Method. All consultati ons to one practice during a single winter were reviewed by one genera l practitioner. Results. A total of 1140 patients had acute symptoms s uggestive of respiratory infection. Of these, 899 patients (79%) were prescribed antibiotics at the first consultation and 160 of the 899 pa tients (18%) returned for one or more repeat consultations; only nine repeat consultations were due to adverse effects of the antibiotics pr escribed. Only two patients were admitted to hospital for respiratory symptoms following initial antibiotic therapy and both patients had ad ditional reasons for their admission. Using the highest estimates, the cost of a repeat consultation was found to be pound 28.54. These data were used to calculate how much more might be spent on more effective antibiotics at the first consultation. It would be difficult to justi fy increasing the cost of antibiotic treatment by more than pound 5 pe r patient, even if the new treatment were 100% effective and all repea t consultations were due to treatment failure (pound 5 is equal to pou nd 28.54 x 0.18, which is the maximum cost of a repeat consultation mu ltiplied by the proportion of patients prescribed antibiotics who make repeat consultations). Conclusion. From these results and a review of the literature it can be concluded that new antibacterial drugs will have to be carefully targeted if they are to prove cost effective in p ractice. Other methods for reducing repeat consultation merit investig ation.