Skip to main content
Top
Published in: BMC Primary Care 1/2012

Open Access 01-12-2012 | Research article

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

Authors: Marion Murphy, Colin P Bradley, Stephen Byrne

Published in: BMC Primary Care | Issue 1/2012

Login to get access

Abstract

Background

Information about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs) felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care.

Methods

Participating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients’ consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary.

Results

171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.16% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15–64 years (62.23%). There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP.

Conclusion

The study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad-spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection.
Appendix
Available only for authorised users
Literature
1.
go back to reference Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010, 340: c2096-10.1136/bmj.c2096.CrossRefPubMed Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010, 340: c2096-10.1136/bmj.c2096.CrossRefPubMed
3.
go back to reference Goossens H, Ferech M, vander Stichele R, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005, 365: 579-587.CrossRefPubMed Goossens H, Ferech M, vander Stichele R, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005, 365: 579-587.CrossRefPubMed
4.
go back to reference Van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M: Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. 2008, 14: 1722--1730. 10.3201/eid1411.070467.CrossRefPubMedPubMedCentral Van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M: Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. 2008, 14: 1722--1730. 10.3201/eid1411.070467.CrossRefPubMedPubMedCentral
6.
go back to reference Goossens H, Guillemot D, Ferech M, Schlemmer B, Costers M, van Breda M, Baker LJ, Cars O, Davey PG: National campaigns to improve antibiotic use. Eur J Clin Pharmacol. 2006, 62: 373-379. 10.1007/s00228-005-0094-7.CrossRefPubMed Goossens H, Guillemot D, Ferech M, Schlemmer B, Costers M, van Breda M, Baker LJ, Cars O, Davey PG: National campaigns to improve antibiotic use. Eur J Clin Pharmacol. 2006, 62: 373-379. 10.1007/s00228-005-0094-7.CrossRefPubMed
7.
go back to reference Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y, Watier L, Guillemot D: Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007. PLoS Med. 2009, 6: e1000084-10.1371/journal.pmed.1000084.CrossRefPubMedPubMedCentral Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y, Watier L, Guillemot D: Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007. PLoS Med. 2009, 6: e1000084-10.1371/journal.pmed.1000084.CrossRefPubMedPubMedCentral
8.
go back to reference Macfarlane J, Holmes W, Macfarlane R, Britten N: Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997, 315: 1211-1214. 10.1136/bmj.315.7117.1211.CrossRefPubMedPubMedCentral Macfarlane J, Holmes W, Macfarlane R, Britten N: Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997, 315: 1211-1214. 10.1136/bmj.315.7117.1211.CrossRefPubMedPubMedCentral
9.
go back to reference Cotter M, Daly L: Antibiotic prescription practices of general practitioners. Ir Med J. 2007, 100: 598-601.PubMed Cotter M, Daly L: Antibiotic prescription practices of general practitioners. Ir Med J. 2007, 100: 598-601.PubMed
10.
go back to reference Murphy M, Byrne S, Bradley CP: Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study. Br J Gen Pract. 2011, 61: e549-e555.CrossRefPubMedPubMedCentral Murphy M, Byrne S, Bradley CP: Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study. Br J Gen Pract. 2011, 61: e549-e555.CrossRefPubMedPubMedCentral
11.
go back to reference O'Dowd T, O'Kelly F, O'Kelly M: Structure of General Practice in Ireland 1982–2005. 2006, Irish College of General Practitioners, Dublin O'Dowd T, O'Kelly F, O'Kelly M: Structure of General Practice in Ireland 1982–2005. 2006, Irish College of General Practitioners, Dublin
12.
go back to reference Health Service Executive: Annual Report and Financial Statements. 2009, Dublin Health Service Executive: Annual Report and Financial Statements. 2009, Dublin
13.
go back to reference Community Antibiotic Stewardship Group: Management of Infection Guidance for Primary Care in Ireland. 2011, Health Protection Surveillance Centre, Dublin Community Antibiotic Stewardship Group: Management of Infection Guidance for Primary Care in Ireland. 2011, Health Protection Surveillance Centre, Dublin
14.
go back to reference Hak E, Rovers M, Kuyvenhoven M, Schellevis F, Verheij T: Incidence of GP- diagnosed respiratory tract infections according to age, gender and high-risk co-morbidity: the Second Dutch National Survey of General Practice. Fam Pract. 2006, 23: 291-294. 10.1093/fampra/cmi121.CrossRefPubMed Hak E, Rovers M, Kuyvenhoven M, Schellevis F, Verheij T: Incidence of GP- diagnosed respiratory tract infections according to age, gender and high-risk co-morbidity: the Second Dutch National Survey of General Practice. Fam Pract. 2006, 23: 291-294. 10.1093/fampra/cmi121.CrossRefPubMed
15.
go back to reference Akkerman AE, van der Wouden JC, Kuyvenhoven MM, Dieleman JP, Verheij TJM: Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities. J Antimicrob Chemother. 2004, 54: 1116-1121. 10.1093/jac/dkh480.CrossRefPubMed Akkerman AE, van der Wouden JC, Kuyvenhoven MM, Dieleman JP, Verheij TJM: Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities. J Antimicrob Chemother. 2004, 54: 1116-1121. 10.1093/jac/dkh480.CrossRefPubMed
16.
go back to reference Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC: Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007, 335: 982-10.1136/bmj.39345.405243.BE.CrossRefPubMedPubMedCentral Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC: Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007, 335: 982-10.1136/bmj.39345.405243.BE.CrossRefPubMedPubMedCentral
18.
go back to reference Welschen I, Kuyvenhoven M, Hoes A, Verheij T: Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction. Fam Pract. 2004, 21: 234-237. 10.1093/fampra/cmh303.CrossRefPubMed Welschen I, Kuyvenhoven M, Hoes A, Verheij T: Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction. Fam Pract. 2004, 21: 234-237. 10.1093/fampra/cmh303.CrossRefPubMed
19.
go back to reference McDonell Norms Group: Antibiotic Overuse: the influence of social norms. J Am Coll Surg. 2008, 207: 265-275.CrossRef McDonell Norms Group: Antibiotic Overuse: the influence of social norms. J Am Coll Surg. 2008, 207: 265-275.CrossRef
20.
go back to reference Van Duijn H, Kuyvenhoven M, Tiebosch H, Schellevis F, Verheij T: Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice. BMC Fam Pract. 2007, 8: 55-10.1186/1471-2296-8-55.CrossRefPubMedPubMedCentral Van Duijn H, Kuyvenhoven M, Tiebosch H, Schellevis F, Verheij T: Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice. BMC Fam Pract. 2007, 8: 55-10.1186/1471-2296-8-55.CrossRefPubMedPubMedCentral
21.
go back to reference Jelinski S, Parfrey P, Hutchinson J: Antibiotic utilisation in community practices: guideline concurrence and prescription necessity. Pharmacoepidemiol Drug Saf. 2005, 14: 319-326. 10.1002/pds.1007.CrossRefPubMed Jelinski S, Parfrey P, Hutchinson J: Antibiotic utilisation in community practices: guideline concurrence and prescription necessity. Pharmacoepidemiol Drug Saf. 2005, 14: 319-326. 10.1002/pds.1007.CrossRefPubMed
22.
go back to reference Froom J, Culpepper L, Green LA, de Melker RA, Grob P, Heeren T, van Balen F: A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit. Report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN). J Am Board Fam Pract. 2001, 14: 406-417.PubMed Froom J, Culpepper L, Green LA, de Melker RA, Grob P, Heeren T, van Balen F: A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit. Report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN). J Am Board Fam Pract. 2001, 14: 406-417.PubMed
23.
go back to reference Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJM: Analysis of under- and overprescribing of antibiotics in acute otitis media in general practice. J Antimicrob Chemother. 2005, 56: 569-574. 10.1093/jac/dki257.CrossRefPubMed Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJM: Analysis of under- and overprescribing of antibiotics in acute otitis media in general practice. J Antimicrob Chemother. 2005, 56: 569-574. 10.1093/jac/dki257.CrossRefPubMed
24.
go back to reference Nadeem Ahmed M, Muyot MM, Begum S, Smith P, Little C, Windemuller FJ: tibiotic Prescription Pattern for Viral Respiratory Illness in Emergency Room and Ambulatory Care Settings. Clin Pediatr. 2010, 49: 542-547. 10.1177/0009922809357786.CrossRef Nadeem Ahmed M, Muyot MM, Begum S, Smith P, Little C, Windemuller FJ: tibiotic Prescription Pattern for Viral Respiratory Illness in Emergency Room and Ambulatory Care Settings. Clin Pediatr. 2010, 49: 542-547. 10.1177/0009922809357786.CrossRef
25.
go back to reference Ong DSY, Kuyvenhoven MM, van Dijk L, Verheij TJM: Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs. J Antimicrob Chemother. 2008, 62: 587-592. 10.1093/jac/dkn230.CrossRefPubMed Ong DSY, Kuyvenhoven MM, van Dijk L, Verheij TJM: Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs. J Antimicrob Chemother. 2008, 62: 587-592. 10.1093/jac/dkn230.CrossRefPubMed
26.
go back to reference Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, Huovinen P: The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997, 337: 441-446. Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, Huovinen P: The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997, 337: 441-446.
27.
go back to reference Butler CC, Dunstan F, Heginbothom M, Mason B, Roberts Z, Hillier S, Howe R, Palmer S, Howard A: Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices. Br J Gen Pract. 2007, 57: 785-792.PubMedPubMedCentral Butler CC, Dunstan F, Heginbothom M, Mason B, Roberts Z, Hillier S, Howe R, Palmer S, Howard A: Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices. Br J Gen Pract. 2007, 57: 785-792.PubMedPubMedCentral
28.
go back to reference Barry M: Economies in Drug Usage in the Irish Healthcare Setting. 2009, , Dublin Barry M: Economies in Drug Usage in the Irish Healthcare Setting. 2009, , Dublin
29.
go back to reference McGowan B, Bergin C, Bennett K, Barry M: Utilisation of antibiotic therapy in community practice. Ir Med J. 2008, 101: 273-276.PubMed McGowan B, Bergin C, Bennett K, Barry M: Utilisation of antibiotic therapy in community practice. Ir Med J. 2008, 101: 273-276.PubMed
30.
go back to reference Søndergaard J, Vach K, Kragstrup J, Andersen M: Impact of pharmaceutical representative visits on GPs' drug preferences. Fam Pract. 2009, 26: 204-209. 10.1093/fampra/cmp010.CrossRefPubMed Søndergaard J, Vach K, Kragstrup J, Andersen M: Impact of pharmaceutical representative visits on GPs' drug preferences. Fam Pract. 2009, 26: 204-209. 10.1093/fampra/cmp010.CrossRefPubMed
31.
go back to reference Hróbjartsson A, Norup M: The Use of Placebo Interventions in Medical Practice—A National Questionnaire Survey of Danish Clinicians. Eval Health Prof. 2003, 26: 153-165. 10.1177/0163278703026002002.CrossRefPubMed Hróbjartsson A, Norup M: The Use of Placebo Interventions in Medical Practice—A National Questionnaire Survey of Danish Clinicians. Eval Health Prof. 2003, 26: 153-165. 10.1177/0163278703026002002.CrossRefPubMed
32.
go back to reference Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG: Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ. 2008, 337: a1938-10.1136/bmj.a1938.CrossRefPubMedPubMedCentral Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG: Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ. 2008, 337: a1938-10.1136/bmj.a1938.CrossRefPubMedPubMedCentral
Metadata
Title
Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective
Authors
Marion Murphy
Colin P Bradley
Stephen Byrne
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2012
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-13-43

Other articles of this Issue 1/2012

BMC Primary Care 1/2012 Go to the issue