153 Routine data registries as a basis to analyse and improve the quality of antimicrobial prescription in Primary Care 6 This number would have been even higher if we had not used a broad definition of appropriate antimicrobial prescribing for an RTI. Prescribing an antimicrobial was considered inappropriate only if the recommendations advised against prescription. It is important to note that Dutch primary care guidelines on RTIs generally advise against prescribing an antimicrobial because RTIs are most commonly caused by viruses (26-28). In two other Dutch studies, one a prospective observational study with detailed registration of RTI episodes and the other a pragmatic, cluster-randomized intervention that examined appropriateness of antimicrobial prescriptions for RTI episodes, 46% and 44% of RTI prescriptions, respectively, did not follow guidelines (18, 19). Furthermore, an observational study by Dekker et al. focused on antimicrobial prescriptions for RTIs and reported justifications for antimicrobial prescriptions that did not follow recommendations in guidelines; these included a GPs’ perception of high patient expectations for antimicrobial prescription, presence of fever, GPs’ judgement of a more severe illness, age > 18 years, duration of symptoms ≥ 7 days, comorbidity, reduced general health state and female gender of the patient. In our study, only a small proportion of antimicrobial prescriptions for UTIs failed to follow guideline recommendations. This is comparable to a study from the United Kingdom which showed that that 94% of consultations for a UTI led to an antimicrobial prescription within 30 days (21). Dutch primary care guidelines generally advise treatment of UTI’s with antimicrobials (26). The prescription of macrolides, that were neither first or second guideline choices recommended, was higher than for any other group of antimicrobial compounds. Another Dutch study found similar overprescribing of 2nd choice broad-spectrum antimicrobials (29). In The Netherlands, macrolides are usually only advised in case of antimicrobial allergy or proven antimicrobial resistance, and they are first or second choice antimicrobials for only a handful of infections. Overprescribing is probably due to the presumed lower burden of use associated with macrolides (fewer daily dosages, shorter courses, less side effects), as most prescriptions in our data were for children below 5 years of age. Macrolides are taken once a day for three days, whereas penicillin must be taken 3 to 4 times a day for five or more days (27, 28). Prescription of macrolides in a context where they might not be needed however, should nevertheless be reduced, as macrolides generally have a broader antibacterial spectrum compared to penicillin and consequently increase the risk of AMR.
RkJQdWJsaXNoZXIy MTk4NDMw