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Antibiotic prescriptions for suspected respiratory tract infection in primary care in South America

Cordoba, Gloria; Caballero, Lidia; Sandholdt, Hakon; Arteaga, Fatima; Olinisky, Monica; Fabian Ruschel, Luis; Makela, Marjukka; Bjerrum, Lars (2017)

 
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Cordoba, Gloria
Caballero, Lidia
Sandholdt, Hakon
Arteaga, Fatima
Olinisky, Monica
Fabian Ruschel, Luis
Makela, Marjukka
Bjerrum, Lars
2017
doi:10.1093/jac/dkw370
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Julkaisun pysyvä osoite on
http://urn.fi/URN:NBN:fi-fe2017101050026
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY : 1
Tiivistelmä
Objectives
To describe and compare antibiotic prescribing patterns for primary care patients with respiratory tract infections (RTIs) in four South American countries.
Methods
This was a prospective observational study. General practitioners (GPs) from Argentina, Bolivia, Paraguay and Uruguay registered data about all consultations of patients with suspected RTIs in the winter of 2014 (June–August). Variation in antibiotic prescriptions was assessed using a two-level hierarchical logistic model.
Results
Participating GPs (n = 171) registered 11 446 patients with suspected RTI; 3701 (33%) of these received an antibiotic prescription. There was a wide variation across countries in the use and selection of antibiotics. For example, 94% of patients with acute bronchitis were prescribed antibiotics in Bolivia, while in Uruguay only 21% received antibiotics. Amoxicillin was the most commonly prescribed antibiotic across countries, but prescription rates varied between 45% in Bolivia and 69% in Uruguay. Compared with the overall mean prescribing rate, and after adjusting for clinical presentation and demographics, prescribing of antibiotics varied by a factor of 6, the OR ranging from 0.37 (95% CI = 0.21–0.65) in Uruguay to 2.58 (95% CI = 1.66–4) in Bolivia.
Conclusions
The large variation in use and selection of antibiotics across countries is not explained by different patient populations. It could be explained by diagnostic uncertainty and contextual characteristics beyond clinical practice. Reducing uncertainty and country variation requires greater support from the healthcare systems by providing GPs with evidence-based guidelines and tools to apply them.
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