Physician behaviour for antimicrobial prescribing for paediatricupper respiratory tract infections: a survey in general practice inTrinidad, West Indies.

ABSTRACT

Background: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (¡Ü 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. Methods: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50 per cent), themost common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics forthe common cold (p = 0.014). Severity (95.7 per cent) and duration of illness(82.5 per cent) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75 per cent) and concern for secondary bacterial infections (70 per cent). Physicians do not request laboratory investigations primarily because they are unnecessary (86 per cent) and the waiting time for results is too long (51 per cent).