Nonadherence to guidelines for prescribing antibiotic therapy to patients with tonsillitis or pharyngotonsillitis: a cross-sectional study

Abstract

Objectives:

Although previous studies have assessed nonadherence to guidelines for prescribing antibiotic therapy in patients with pharyngotonsillitis (prescription of another antibiotic rather than one of first choice: amoxicillin and/or penicillin V, except in the case of penicillin allergy), none analyzed associated factors. Consequently, we conducted a study to assess the possible factors associated with the problem of nonadherence.

Methods:

This cross-sectional study analyzed a sample of 417 patients with tonsillitis or pharyngotonsillitis treated with antibiotics during February 2014 in a Spanish region. The data were obtained through electronic records. Independent variables: gender, disease (tonsillitis or pharyngotonsillitis), clinical specialty (primary care or pediatrics), age and physician’s gender. To identify factors associated with nonadherence, the adjusted odds ratios (ORs) were calculated through a binary logistic regression model with all the independent variables. The confidence interval (CI) was calculated for all relevant parameters.

Results:

Of 417 patients, 303 were categorized to the nonadherence group (72.7%, 95% CI: 68.4–76.9%). Two factors associated with the physician were relevant and close to statistical significance: primary healthcare as a clinical specialty (OR = 2.3, p = 0.055) and male gender (OR = 1.5, p = 0.088).

Conclusions:

Nonadherence in prescribing first-choice antibiotics to patients with tonsillitis or pharyngotonsillitis is highly prevalent. We emphasize the need to implement measures to help minimize this problem and, thus, antibiotic resistance, such as undertaking qualitative studies to assess the reasons for inappropriate prescription or the incorporation of alert systems in the electronic records.

Limitations:

As we analyzed data from all the patients in winter, it would be interesting to replicate this study at another time of the year.

Keywords: :

• Antibacterial agents
• Guideline adherence
• Inappropriate prescribing
• Physician’s practice patterns
• Physicians, primary care
• Tonsillitis

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

P.R.-F., A.P.-B., M.C.-P., and V.F.G.-G. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Maria Repice and Ian Johnstone for help with the English language version of the text.