Treatment of upper respiratory tract infections--a comparative study of dispensing and non-dispensing doctors.

Background: The reported results are part of an overall evaluation of drug management by dispensing (DDs) and non-dispensing doctors (NDDs). This study focuses on appropriate prescription. Other studies assess good pharmacy practice. Whereas rationality of prescription has been studied based on simple indicators, appropriate prescription in relation to diagnoses and symptoms has not been assessed.

Objective: To analyse prescriptions by DDs and NDDs for patients diagnosed with upper respiratory tract infection.

Methods: Cohort study of 28 private sector DDs and 28 NDDs, using retrospective registry data from a mean of 14.5 and 16.0 patient records per practice, respectively.

Outcome Measures: Drug choice, frequency of the drugs being used, use of antibiotics and dosages for respiratory infections where antibiotics are/are not justified.

Results: DDs were associated with a greater number of drugs per encounter (P < = 0.001), a greater number of injections (P = < 0.002), more use of analgesic drugs (P = < 0.001), cough and cold preparations (P < 0.001) and psycholeptics (P = < 0.03). The choice of antibiotics for upper respiratory tract infection (URTI) was assessed as rational, although different for the two practices, but both practices over-prescribe antibiotics frequently. Dispensing doctors frequently prescribe sub-curative dosages and fewer curative dosages (P = < 0.001), compared with NDDs.

Conclusion: Irrational prescription for URTI is widespread by both dispensing doctors and to a lesser extent, by NDDs. Symptomatic treatments with 'a drug for each symptom' was common, particularly by the DDs. There was also over-prescription of antibiotics and use of sub-therapetitic dosages. This poly-pharmacy, poses a safety risk, a risk of development of resistance and, unnecessarily costly treatment.