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      Antibiotic prescribing patterns for sore throat infections in a university-based primary care clinic

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          Abstract

          BACKGROUND

          Recent studies reveal that a high percentage (over 50%) of episodes for URTIs are treated with antibiotics, regardless of appropriateness or the necessity for prescription. We identified antibiotic prescriptions in a primary health care centre (PHC) and evaluated their suitability for sore throat infections. We also to explored whether symptoms, signs, diagnosis and antibiotics prescribed differed by gender.

          PATIENTS AND METHODS

          We collected data on all patients visiting the centre over a period of 12 weeks with a main complaint of sore throat who were prescribed antibiotics after taking a blood count and throat culture. Patients older than 16 years of age were included in the study irrespective of sex, nationality, marital status, occupation or location of residence. The chi square (χ 2) statistical test was used in comparing categorical variables. A P value of <0.05 was considered significant.

          RESULTS

          During the period of study, 579 patients with upper respiratory tract infections (URTIs) presented to the health centre, from which 339 patients with a sore throat were enrolled. Of the study group, 48.7% (165) were male and 51.3% (174) female, with the majority of patients being under 30 years old (54.3%). Throat cultures were positive in 56 patients (16.5%). Most of patients were diagnosed as having pharyngitis (22.7%), and the most frequently prescribed medicine was an oral penicillin (39.1%). Two hundred eight-six patients (84.4%) had 2 or fewer Centor criteria.

          CONCLUSIONS

          Throat cultures were positive in only 16.5% of the patients prescribed antibiotics. This indicates that physicians in the health centre of the university are prescribing antibiotics inappropriately and inconsistently. This also highlights the need for more prescriber education, especially as the range of medications available to the general practitioner for prescribing increases.

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          Most cited references37

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          Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.

          Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of all antibiotic prescribing by ambulatory care physicians. How frequently antibiotics are prescribed for these conditions and for and by whom is not known. To measure antibiotic prescription rates and to identify predictors of antibiotic use for adults diagnosed as having colds, upper respiratory tract infections, and bronchitis in the United States. Sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1992. Office-based physician practices. Physicians (n=1529) completing patient record forms for adult office visits (n=28787). Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. Office visits for colds, upper respiratory tract infections, and bronchitis resulted in approximately 12 million antibiotic prescriptions, accounting for 21% of all antibiotic prescriptions to adults in 1992. A total of 51 % of patients diagnosed as having colds, 52% of patients diagnosed as having upper respiratory tract infections, and 66% of patients diagnosed as having bronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibiotic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower antibiotic prescription rates. Patient age, Hispanic ethnicity, geographic region, physician specialty, and payment sources were not associated with antibiotic prescription rates in the bivariate analysis. Multivariate logistic regression analysis identified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to be independently associated with more frequent antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States. Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based.
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            Antimicrobial resistance in developing countries.

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              The diagnosis of strep throat in adults in the emergency room.

              Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.
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                Author and article information

                Journal
                Ann Saudi Med
                Ann Saudi Med
                Annals of Saudi Medicine
                King Faisal Specialist Hospital and Research Centre
                0256-4947
                0975-4466
                Jan-Feb 2005
                : 25
                : 1
                : 22-28
                Affiliations
                From Osmangazi University, Medico-Social Center, Meselik Eskisehir, Turkey
                Author notes
                Correspondence to: Unal Ayranci, Osmangazi University, Medico-Social Center, Meselik 26480, Eskisehir, Turkey
                Article
                asm-1-22
                10.5144/0256-4947.2005.22
                6150560
                15822490
                4126449f-2e87-43c5-891f-60714fd4e6a3
                Copyright © 2005, Annals of Saudi Medicine

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 01 July 2004
                Categories
                Original Article

                Medicine
                Medicine

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