Immediate or delayed prescription of antibiotics – factors that influence general practitioner decision

Katarina Stavrikj, Valentina Risteska - Nejasmic, Aleksandar Kirkovski, Nikica Jovanovski, Martin Angelov, Bekim Ismaili, Marta Tundzeva

Keywords: antibiotic prescription, primary care, acute respiratory infections

Respiratory tract infections are one of the most common causes for antibiotic prescription in primary care. The inappropriate and over use of antibiotics leads to increased emergence of antimicrobial resistance.

Research questions:
What are the factors that influent prescription pattern of antimicrobials in patients with acute respiratory tract infections in primary care in Macedonia.

A cross sectional study, based on a representative sample of 87 general practitioners (GP) was conducted during the period of 4 weeks in November 2019. All patients with episode of acute respiratory infection (ARI) were involved in the survey. We used special questioner that was used during the same survey in 2014/2015 year. The association between diagnosis, patient sociodemographic factors and manner of antibiotic prescription (immediate or delayed prescription) was investigated. For statistical analysis was used program Statistica.

Antibiotic was prescribed to 4237 patients (53%) with ARI. GP used immediately manner of prescription for 2878 patients (77.39%) while delayed prescription for 841 patients (22.61%).
Most frequently immediate antibiotic was prescribed for diagnosis J03 Tonsillitis 32.45%, J20 Bronchitis 19.74% and J02 Pharyngitis 16.33%. Delayed prescription was more often used for J03 Tonsillitis 24.39%, J02 Pharyngitis 21.64% and J20 Bronchitis 20.33%.
Multiple regression analysis was run to predict prescription manner of antibiotics. Lower age, workday - Friday and follow up visit statistically significantly predicted delayed prescription of antibiotics (p<0.05).
Perception of doctors for delayed prescription of antibiotics were mainly difficulties to follow up (20.33%), presence of complication (14.39%), patient pressure (11.41%) and uncertainty in diagnosis (6.66%), while for immediate prescription it was indication for antibiotics (79.95%).

Exploring the factors that influence the doctors decision for immediate or delay prescription of antibiotics for ARI is important for improving antibiotic stewardship in primary care and closing evidence based gap.

Points for discussion:
1. How to change doctors’ attitude towards use of guidelines?

2. Methods for antibiotic stewardship in primary care