Antibiotic prescribing in acute infections of the nose or sinuses: a matter of personal habit?

Background: A proper understanding of how and why GPs prescribe antibiotics in general practice is essential for the design of strategies aimed at making prescribing more rational.

Objective: The intention of this study is to contribute to such understanding by investigating which elements are important in the GP's decision to prescribe antibiotics for patients with acute infectious complaints of the nose and/or sinuses.

Methods: During their training in general practice, students observed the following elements while attending encounters between their trainer-GP and patients with a runny nose, blocked nose or cough: patient characteristics, contact characteristics, signs and symptoms, diagnosis and prescriptions. Information on practice characteristics and characteristics of the trainer-GP were collected. Data were analysed using multiple logistic regression and multiple linear regression.

Results: A total of 722 cases were analysed with the following results: the best independent predictor of an antibiotic prescription is the individual antibiotic prescribing rate (IAPR), which expresses the personal habit of the GP in prescribing antibiotics [adjusted odds ratio (OR) 5.27, 95% confidence interval (CI) 3.22-8.62]. Others are the diagnostic labels "sinusitis" (adjusted OR 2.80, 95% CI 1.2-6.49) and "flu-like syndrome" (adjusted OR 0.08, 95% CI 0.01-0.45), and the sign "sinus tenderness" (adjusted OR 4.37, CI 2.15-8.89). The antibiotic prescribing behaviour intensifies with an increasing tendency to prescribe medication in general (beta = 0.46, P: < 0.00) and with an increasing defensive attitude (beta = 0.22, P: < 0.05).

Conclusions: Whether or not a patient with an acute infection of the nose and/or sinuses will be handed an antibiotic prescription seems to depend more on the attending doctor's prescribing behaviour than on the clinical picture. Further qualitative research into attitudes which may be related to a high tendency to prescribe antibiotics consequently is of the utmost importance.