Objective: This study aims to ascertain the variability in the use of antib
iotics for the treatment of acute respiratory infections in several hospita
l emergency services in Spain, as well as the appropriateness of antibiotic
s prescription through evaluation by a panel of experts using available sci
entific evidence.
Method: A cross-sectional study was carried out in the emergency services o
f 10 hospitals in different Spanish regions. We chose patients diagnosed as
having acute respiratory infection, aged over 14 years. Among the collecte
d variables were: type of respiratory infection, antibiotic prescription, c
omorbidity, qualification of the prescribing doctor and hospital admission.
The consensus conference held by a panel of experts established first choi
ce treatment and the alternative and inappropriate use for each respiratory
infection, based on the available scientific evidence. All the observed pr
escriptions in our study were classified according to this pattern.
Results: A sample of 2899 acute respiratory infections was studied (5.5% of
all emergencies). Antibacterial agent treatment was prescribed in 82.6% of
these, varying according to the infection between 98.5% of pneumonias and
49% of croup-influenza-common cold. The most commonly used antibiotics were
amoxicillin-clavulanate and cefuroxime, The global percentage of inappropr
iate prescription was 40.5% (95% CI; 35.4-45.5), The prescriptions were ina
ppropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronc
hitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and
sinusitis and in 70.8% of croup, flu, common cold and non-specified infecti
ons. Significant variability among participating centres was observed, both
in choice of antibiotics and in their degree of appropriateness.
Conclusions: There is excessive use of antimicrobial drugs in acute respira
tory infections, and the majority are used for viral infections. There is i
ndiscriminate use of broad spectrum antibiotics, which are valid in some in
fections but clearly inappropriate in others. Similarly there are important
differences in the choice of antibiotics and their degree of appropriatene
ss among hospitals, (C) 2000 The British Infection Society.