Factors influencing inappropriate management of upper respiratory infections in general practice

Abstract

Abstract Background Upper respiratory tract infections (URIs) are common in general practice, and inappropriate antibiotic prescribing remains a major concern that contributes to antimicrobial resistance. This prospective study aims to examine the factors influencing inappropriate antibiotic prescribing for URIs in general practice. Methods The study was conducted during the winter of 2017 by 15 general practice trainees in Alsace, France, in collaboration with 25 general practitioners. Data from random general practice consultations were collected, and specific grids were used for URI-related consultations. Results Out of the 807 consultations, 173 were related to URIs. Antibiotics were prescribed in 35% of cases, and management was deemed appropriate in 75% of cases. Amoxicillin was the most frequently prescribed antibiotic. Certain infections, such as sinusitis and bronchitis, were more likely to result in inappropriate antibiotic prescriptions. Factors influencing inappropriate management included a light clinical examination compared to systematic clinical examination (OR 4.83, 95% CI: [1.55–15.08], p = 0.007), perceiving the patient as "at risk" (OR 7.05, 95% CI [2.55–19.50], p < 0.001), repeated consultations for the same reason (OR 4.13, 95% CI [1.51–11.27], p = 0.006), and diagnostic uncertainty (OR 4.99, 95% CI [1.40–17.71, p = 0.013). Diagnosis explanation decrease the risk of inappropriate management (OR 0.41, 95% CI [0.17–0.99], p = 0.047]. Physicians who received visits from pharmaceutical industry representatives were more likely to improperly prescribe antibiotics (OR 4.59, 95% CI [1.51–13.95]. Conclusions While inappropriate antibiotic prescribing for URIs remains significant, this study highlights the complexity of the clinical reasoning underlying this practice. The study identifies modifiable factors, including conducting a thorough clinical examination, patient explanation, and independence from pharmaceutical promotion. It also highlights the critical role of managing diagnostic uncertainty. Rapid diagnostic tests and antibiotic prescription software help to reduce uncertainty, but it is equally important to learn to work with uncertainty in daily practice. These findings remain valid in the post-COVID period and call for ongoing medical education and public health policies aimed at promoting prudent antibiotic use in general practice.