The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance

Abstract

Background: To assess the drug compliance observed among patients with lower respiratory tract infection treated with once-daily, twice-daily and thrice-daily antibiotic regimens. Methods: We performed a prospective study in the primary care setting including patients with suspected bacterial lower respiratory tract infections, not allergic to β-lactam antimicrobials, macrolides or quinolones, treated with several antibiotic regimens. Patient compliance was assessed by electronic monitoring. Results: A total of 251 patients were enrolled (136 in the thrice-daily group, 70 in the twice-daily group and 45 in the once-daily group). The mean container openings ranged from 94.3 ± 12.6% with once-daily antibiotics to 74.8 ± 17.7% with thrice-daily drugs (P < 0.001). Seventy-five patients in the thrice-daily group took at least 80% of the medications (55.1%), being significantly less than those receiving twice-daily (71.4%) or once-daily (86.7%; P < 0.001) drugs. Only 20.6% of the patients assigned to the thrice-daily regimens opened the container every 8 ± 4 h during at least 80% of the course. Among the patients assigned the same number of doses daily, compliance was better with the shortest antibiotic courses, being worse with schedules of 7 days or more. The percentage of patients who opened the MEMS container the satisfactory number of times a day was lower among the thrice-daily regimens. Moreover, the thrice-daily group more frequently forgot the afternoon dose. Conclusions: The rate of compliance was very low, mainly when antibiotics were administered thrice daily and in regimens of 7 days or more. New strategies addressed to improve antibiotic drug compliance are, therefore, necessary. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.