Antibiotics for coughing in general practice: a qualitative decision analysis

Diagnosing infections: a qualitative view on prescription decisions in general practice over time

“…A practical approach towards use of cultures was also found in Canadian studies, where GPs usually prescribed antibacterials for sore throat before getting results of a culture and when limited access to laboratories could play a role [20,21]. Our informants' uncertainty about their clinical observations, laboratory tests and scientifically proven facts agrees with research indicating that diagnoses in general practice often are less certain than in hospitals, and sometimes based more on signs and symptoms than tests [22,23]. Microbiological diagnosis for infections in the community is rarely available at the time of prescribing, often not at all and the aetiology is variable, even mixed [4,24], which underlines GPs need for user-friendly, up-todate information on susceptibility trends [24].…”

“…Informants in a Belgian study, who considered diagnoses for respiratory tract infections to be uncertain, questioned the value and feasibility of technical investigations such as blood or sputum analysis and X-ray [23], which also has been described as risky [4].…”

GPs' views in five European countries of interventions to promote prudent antibiotic use

“…[9][10][11] Previous research has found that decisions can be based on GPs' desire to maintain good patient relationships, 12,13 a result of GPs choosing to prioritise patients' immediate perceived demands over long-term issues, 14 or a result of worries about complications. 13,15,16 Authors concluded that guidelines should include information to help identify patients more at risk of complications, should emphasise patients' individual risk from antibiotics, and should emphasise positive aspects of non-antibiotic treatment.…”

Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice

“…Defensive prescription behavior, busy consultation hours, repeated incentives by the pharmaceutical industry, and reports of increasing occurrences of newly emerging pathogens are a constant threat to a rational or evidence-based approach (e.g., antibiotic prescribing in indicated cases only) by the physician toward a patient with a respiratory tract infection [4,[9][10][11][12]. Furthermore, the physician's diagnostic uncertainty increases the likelihood of unnecessary antibiotic prescribing [13]. This is especially true in lower respiratory tract infections (LRTI), with a diagnosis in general practice of 30-55 new episodes per thousand patients per year [14][15][16][17]; the infrequently occurring pneumonias (20% of all LRTI) are clinically misclassified in most cases [18][19][20].…”