Prescribing systemic antibiotics in general practice. A report from the More and Romsdal prescription study

Abstract

Objective - To describe general practitioners' (GPs) prescribing patterns for antibiotics and to compare them with therapeutic guidelines. Design - Cross-sectional, observational study. Setting - In the Norwegian county More and Romsdal the GPs recorded all contacts with patients and prescriptions during two months. Subjects - 69843 contacts with 56758 prescriptions, of which 7905 were for systemic antibiotics. Main outcome measures - Prescriptions in relation to diagnosis, kind of consultation, and patients' age and sex. Results - 61% of all antibiotic prescriptions were for females, 26% were issued during indirect contacts, and 14% were repeat prescriptions. Phenoxymethylpenicillin was prescribed most frequently (32%), followed by co-trimoxazole (19%), tetracyclines (18%), erythromycin (16%), and penicillins with extended spectrum (6%). Urinary tract infection was the most frequent diagnosis for antibiotic prescribing (24%), followed by acute bronchitis (13%), ear infections (9%), upper respiratory tract infections (8%), and acute tonsillitis (8.2%). A regression analysis showed that first- time consultations for tonsillitis and otitis, but not for acute bronchitis and pneumonia, patient age 13-64 years, female physician, urban practice location, and a fixed GP salary were associated with the prescribing of phenoxymethylpenicillin in contrast to other antibiotics. Conclusion - Antibiotics are often prescribed for viral infections (e.g. acute bronchitis). Broad spectrum antibiotics are often prescribed for diagnoses where penicillin is recommended as first choice. The issue of antibiotic misuse should be addressed more explicitly in general practice.