To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery, researchers in several European centres conducted a cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries.
They found that 3402 patients were recruited. Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to 83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18) to Slovakia (11.2) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics once clinical presentation was taken into account.
The researchers concluded: "Variation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery."
It is not so much that this variation occurs, but rather that after 30 years it still occurs and this study is of primary care research networks.
For the full abstract, click here.
BMJ 23 June 2009;338:b2242 © Butler et al 2009
Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. C C Butler, K Hood, T Verheij et al.. Correspondence to: C Butler: ButlerCC@cardiff.ac.uk
Category: R Respiratory, HSR Health Services Research, Keywords: antibiotic prescribing variation, acute cough, primary care, cross sectional study, journal watch.
Synopsis edited by Dr Jim Vause, Blenheim, New Zealand. Posted on Global Family Doctor 2 July 2009
