Differences in incidence and prescribing antibiotics in upper respiratory tract infections in Dutch general practice between 1987–2001: did publication of national guidelines make a difference?

Abstract number: 1133_26

Verheij T.J.M., Kuyvenhoven M., Essen G.A., Schellevis F.G.

Objective:  

Most antibiotic prescriptions are prescribed in primary care with respiratory tract infections (RTI's) being the most common indication. Although Dutch antibiotic rates are low, even in the Netherlands up to 50% of antibiotic prescriptions for RTI's are assumed to be unnecessary. Over-prescribing unnecessarily exposes patients to risk of side effects, encourages re-consulting for similar problems and enhances antimicrobial resistance. In the nineties the Dutch College of General Practitioners has published guidelines for management of upper RTI's with clear indications for antimicrobial treatment. It is unknown whether these guidelines have yielded a reduction in prescribing antibiotics. This study is aimed to assess differences in antibiotic prescribing and incidence rates of upper RTI's in Dutch General Practice between 1987 and 2001, before and after publication of Guidelines.

Methods:  

Data were collected in 96 general practices in 1987 (First Dutch National Survey of General Practice; practice population n = 344,449 patients) and in 90 general practices in 2001 (Second Dutch National Survey of General Practice; practice population n = 358,008 patients). Outcome measures: (1) percentage of contacts for AOM, common cold, sinusitis and acute tonsillitis in which an antibiotic was prescribed (= antibiotic prescription rate); (2) number of antibiotic prescriptions per 1000 patients per year; (3) incidence rates of urti's per 1000 patients per year.

Results:  

Antibiotic prescribing rates in AOM and common cold were increased in 2001 compared to 1987 (from 27% to 48% and from 17% to 23% respectively), while the rates for sinusitis and tonsillitis were the same. The number of antibiotic prescriptions per 1000 patients decreased except for AOM. Incidence rates of all upper rti's were lower in 2001 as compared to 1987.

Conclusion:  

Antibiotic prescribing rates have not declined several years after publication of urti-guidelines. The total volume of antibiotic prescriptions per 1000 patients/per year for common cold, sinusitis and tonsillitis has decreased mainly because of a reduction of incidences. The question arises whether patients’ reduced inclination to present illness to their GPs is an indirect consequence of a more selective use of antibiotics by their GPs or a concurrent trend among patients in community. Long term trends studies in antibiotic prescribing rates should include information about incidences in outcome measurement.