A survey on prescription of antibiotics in respiratory tract infections

Background: Spain is one of the European countries with greatest antibiotic consumption, and therefore, with greatest bacterial resistance. Most antibiotics are prescribed in primary health care, mainly for the treatment of respiratory tract infections. There is little data to assess if the prescriptions of antibiotics by primary care paediatricians for the treatment of respiratory tract infections follow the current recommendations. Objective: to evaluate the pattern of antibiotic prescription in respiratory tract infections by primary care paediatricians in Madrid. Secondary objectives were to determine the source of information on the use of antibiotics and the influence of parents on the prescription. Method: an anonymous survey was designed with the following questions: 8 about the physician and their job, 2 to evaluate the sources of information on antibiotics, 2 to evaluate the influence of parents on the prescriptions and finally 35 questions to evaluate the treatment of nine clinical cases of common respiratory tract infectious diseases (all cases provided had open diagnosis). In a first phase, the printed survey was sent to 20% of primary care paediatricians of Madrid, selected randomly. In a second phase the rest 80% were invited in a personal letter by mail to complete the same survey trough intra or internet. Results and conclusions: the survey was completed by 144 (19% of all the primary care paediatricians of Madrid), 71 of 137 (52%) selected in the first part (printed survey) and 73 of 679 (11%) in the second round (electronic survey). The statistical analysis was descriptive. The most important conclusions were: doctors prescribe antibiotics unnecessarily specially in common cold with fever, bronchiolitis and bronchitis. There was a great disparity of criteria in the treatment of a case of possible bacterial sinusitis and a case of probably streptococcal pharyngitis. The global prescription of amoxicillin-clavulanic was excessive, whereas the prescription of cephalosporins and macrolide antibiotics was low and adequate. The use of internet to update knowledge in this area was very poor. The most trustable scientific information were revisions and meta-analysis. 31% of paediatricians reported frequent pressure to prescribe antibiotics by the patients? parents even against the paediatrician?s recommendations. The response to printed survey was much higher than the electronic survey what questions the utility of electronic surveys at present.