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Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
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2002 (English)In: Scandinavian Journal of Infectious Diseases, Vol. 34, no 12, 880-886 p.Article in journal (Refereed) Published
Abstract [en]

A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.

Place, publisher, year, edition, pages
2002. Vol. 34, no 12, 880-886 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13636DOI: 10.1080/0036554021000026952OAI: diva2:21090
Available from: 2003-03-29 Created: 2003-03-29
In thesis
1. Rules of Thumb and Management of Common Infections in General Practice
Open this publication in new window or tab >>Rules of Thumb and Management of Common Infections in General Practice
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.

GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.

In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2004
Linköping University Medical Dissertations, ISSN 0345-0082 ; 840
General practice, rules of thumb, decision making, respiratory tract infections, urinary tract infections, diagnostic tests, C-reactive protein test, antibiotic prescribing
National Category
Urology and Nephrology
urn:nbn:se:liu:diva-5183 (URN)91-7373-812-3 (ISBN)
Public defence
2004-03-12, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
On the day of the public defence the status of the articles IV and V was: Accepted.Available from: 2003-03-29 Created: 2003-03-29

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André, MalinMölstad, Sigvard
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