Antibiotic prescribing for respiratory tract infections in general practice

Objectives - (1) To describe interpractice variation in diagnosis of respir atory infections at consultation. (2) To test the hypotheses that: (a) The decision to prescribe an antibiotic in respiratory infection is influenced by the diagnosis, the perceived certainty of diagnosis, and whether or not a consultation takes place. (b) The choice of antibiotic is influenced by t he diagnosis. Design - A regional survey of prescribing and associated morbidity in gener al practice, over a 2-week period in April 1994. Setting - Stratified quota sample of 22 Northern Ireland practices. Results - There was wide interpractice variation in diagnosis of common res piratory infections at consultation, especially tonsillitis (5.0-157.5/1000 consultations). Overall, different diagnoses predicted the decision to pre scribe an antibiotic at different levels (coryza 42.3%, tonsillitis 84.8%), but there was wide interpractice variation in the decision to prescribe fo r most diagnoses. With the exception of coryza and sinusitis, the perceived certainty of diagnosis did not significantly influence the decision to pre scribe. The decision to prescribe was not significantly influenced by wheth er or not a consultation took place. Overall, broad spectrum penicillins we re the therapeutic group most frequently prescribed for a given diagnosis w ith the exception of tonsillitis (phenoxymethylpenicillin) and sinusitis (t etracyclines), but there was wide interpractice variation in choice of anti biotic. Conclusions - Little consensus exists among practices regarding rational pr escribing decisions in respiratory illness. The absence of a consultation w as no deterrent to antibiotic prescribing. At one extreme, it is suggested that some practices are avoiding consultations for respiratory infections. There is wide variation in choice of antibiotic, despite existing guideline s. Copyright (C) 1999 John Wiley & Sons, Ltd.