Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study

Figures & data

Figure 1. Number of redeemed antibiotic treatments, by type of antibiotic (ATC level 4), issued from general practice per 1000 inhabitants per year from 2013 to 2017 in the nine municipalities under study.

Table 1. Frequency of use of diagnostic tests in 2013–2017 provided as the number of tests per 1,000 individuals per year in total and by type of test.

Tests per 1000 individuals per year	2013	2014	2015	2016	2017	Total tests 2013–2017 n (%)
Population in the area	448,149	449,024	450,721	453,561	455,956
Population in database	410,593	409,712	408,807	407,954	405,989
Total tests	1179.3	1230.1	1248.6	1265.4	1260.5	2,526,634 (100.0)
Point-of-care tests
CRP	337.7	363.3	384.2	392.8	398.4	766,586 (30.3)
Strep-A	81.7	83.9	76.5	68.7	68.7	155,094 (6.1)
POC urine tests*	554.7	564.9	561.7	558.2	546.7	1,138,485 (45.1)
Microscopy other	26.6	22.8	19.3	18.1	17.1	42,458 (1.7)
Total POC tests	1000.7	1034.9	1041.6	1037.8	1030.9	2,102,623 (83.2)
Laboratory tests
Culture skin	25.3	28.8	29.0	30.2	30.8	58,833 (2.3)
Culture urine	79.6	88.1	91.0	97.3	100.0	186,282 (7.2)
Culture other	18.2	20.3	20.7	20.2	21.6	41,227 (1.6)
Respiratory tract bacteria PCR	6.0	7.4	11.4	21.9	19.5	27,017 (1.0)
Chlamydia trachomatis PCR	42.1	42.4	44.0	44.3	43.3	88,288 (3.4)
Laboratory test other	7.5	8.3	10.9	13.7	14.4	22,364 (0.9)
Total laboratory tests	178.6	195.2	207.0	227.7	229.6	424,011 (16.4)

At the far right, the total number of tests performed during the five years are shown with the proportion each test comprises.

*Covering: urine dipstick, microscopy, culture/resistance analysed in practice on-site laboratory.

Table 2. Testing performed in relation to antibiotic prescription redemption in 2013–2017 (±7 days).

n (%)	Any antibiotic	J01CE Beta-lactamase susceptible penicillins	J01CA Penicillins with extended spectrum	J01CF Beta-lactamase resistant penicillins	J01CR Combinations of penicillins	J01FA Macrolides	J01AA Tetracyclines	J01E Sulphonamides and trimethoprim	J01MA Fluoroquinolones	P01AB01 Nitroimidazole derivatives	Other antibacterials
Total prescriptions	783,252 (100.0)	262,334 (100.0)	194,824 (100.0)	57,901 (100.0)	36,231 (100.0)	96,136 (100.0)	24,032 (100.0)	57,510 (100.0)	20,514 (100.0)	14,980 (100.0)	18,790 (100.0)
Any test	339,672 (43.4)	94,340 (36.0)	108,312 (55.6)	21,677 (37.4)	14,801 (40.9)	41,117 (42.8)	2,288 (9.5)	32,657 (56.8)	10,635 (51.8)	7038 (47.0)	6807 (36.2)
Point-of-care tests
CRP	134,063 (17.1)	62,091 (23.7)	19,452 (10.0)	5,648 (9.8)	13,443 (37.1)	24,131 (25.1)	926 (3.9)	2,823 (4.9)	3,252 (15.9)	1,516 (10.1)	781 (4.2)
Strep-A	37,945 (4.8)	30,296 (11.5)	2,653 (1.4)	214 (0.4)	666 (1.8)	3,537 (3.7)	104 (0.4)	170 (0.3)	81 (0.4)	168 (1.1)	56 (0.3)
POC urine test*	132,741 (16.9)	4,982 (1.9)	79,451 (40.8)	1,100 (1.9)	1,125 (3.1)	3,538 (3.7)	649 (2.7)	27,945 (48.6)	6,598 (32.2)	1,566 (10.5)	5,787 (30.8)
Any point-of-care test	273,996 (35.0)	83,507 (31.8)	91,330 (46.9)	6,688 (11.6)	14,169 (39.1)	28,268 (29.4)	1,557 (6.5)	28,511 (49.6)	8,600 (41.9)	5,275 (35.2)	6,091 (32.4)
Laboratory tests
Culture skin	26,024 (3.3)	7,167 (2.7)	737 (0.4)	14,020 (24.2)	167 (0.5)	3,100 (3.2)	199 (0.8)	112 (0.2)	354 (1.7)	61 (0.4)	107 (0.6)
Culture urine	73,250 (9.4)	2,495 (1.0)	50,885 (26.1)	475 (0.8)	338 (0.9)	1,224 (1.3)	199 (0.8)	12,144 (21.1)	3,224 (15.7)	492 (3.3)	1,774 (9.4)
Culture other	14,200 (1.8)	4,381 (1.7)	2,005 (1.0)	2,944 (5.1)	596 (1.6)	1,877 (2.0)	164 (0.7)	353 (0.6)	1,158 (5.6)	590 (3.9)	132 (0.7)
Respiratory tract bacteria PCR	8,262 (1.1)	2,548 (1.0)	451 (0.2)	23 (0.0)	427 (1.2)	4,716 (4.9)	26 (0.1)	30 (0.1)	31 (0.2)	10 (0.1)	<5**
Chlamydia trachomatis	17,018 (2.2)	733 (0.3)	2,409 (1.2)	187 (0.3)	14 (0.0)	8,968 (9.3)	649 (2.7)	682 (1.2)	386 (1.9)	2,903 (19.4)	87 (0.5)
Any laboratory test	135,018 (17.2)	17,453 (6.7)	54,905 (28.2)	17,291 (29.9)	1,503 (4.1)	18,995 (19.8)	1,137 (4.7)	12,987 (22.6)	4,909 (23.9)	3,799 (25.4)	2,039 (10.9)

*Covering: Urine dipstick, microscopy, culture/resistance analysed in practice on-site laboratory.

**According to data protection rules exact numbers cannot be reported with <5 individuals.

Table

Group	Type	Anatomical localisation	Restrictions
Culture skin	Ulcer—swab
	Ulcer—swab decubitus ulcer
	Ulcer swab surgery/cicatrice
	Skin swab
	Swab from abscess
	Vesicula fluid
	Insertion site—swab
	Swab
		Anus	If type = swab
		Perineum	If type = swab
Culture urinary tract/genitalia	Urine
	Urine from catheter
	Intrauterine device
	Sperm
	Urethra and cervix—swab
		Cervix	If test category = swab, pus, secretion, tissue, or non-specific
		Genitalia externa
		Uterus
		Vagina
		Catheter (nephrostomia)
		Urethra
Culture other	Tracheal secretion
	Sputum, induced
	Sputum
	Nasopharynx secretion
		Cavum oris	If test category = swab, pus, secretion, tissue, or type indicated in the text
		Tooth
		Tounge
		Nose
		Sinus maxillaris
		Throat/tonsil
		Peritonsillar
		Tracheostomia
	Synovial fluid
	Moucus sac
	Fluid
	Fistula—swab
	Catheter apex
	Pus
	Secretion
	Tissue
	Faeces
	Type indicated in text
		Anatomical localisation indicated in text
		Pilonidal cyst	If type = swab
		Rectum	If type = swab
		Eye	If test category = swab, pus, secretion, tissue, or type indicated in text
		Ear
Respiratory tract bacteria PCR	Bordetella pertussis
	Mycoplasma pneumoniae
	Chlamydia pneumoniae
	Chlamydia ptsittici
	Legionella
Chlamydia trachomatis	Chlamydia trachomatis

Table

Group	Type (reimbursement code)	Type (text)	Site
CRP	807120	CRP test	General practice
Strep-A	807109	Rapid antigen test for group A Streptococcus	General practice
POC urine tests	807101	Urine dip stick	General practice
	807122	Urine microscopy	General practice
	807105	Urine culture	General practice
	807189	Urine susceptibility analysis	General practice
Microscopy other	807116	Microscopy other material	General practice
CRP	837120	CRP test	OOHS
Strep-A	837109	Rapid antigen test for group A Streptococcus	OOHS
POC urine tests	837101	Urine dip stick	OOHS
	837122	Urine microscopy	OOHS
	837105	Urine culture	OOHS
	837189	Urine susceptibility analysis	OOHS
Microscopy other	837116	Microscopy other material	OOHS

Table

	2013		2014		2015		2016		2017
	n (%)	Courses per 1000 inh. per year	n (%)	Courses per 1000 inh. per year	n (%)	Courses per 1000 inh. per year	n (%)	Courses per 1000 inh. per year	n (%)	Courses per 1000 inh. per year
Total antibiotic prescriptions	175,142 (100.0)	390.8	163,515 (100.0)	364.2	154,694 (100.0)	343.2	145,137 (100.0)	320.0	144,764 (100.0)	317.5
J01CE Beta-lactamase susceptible penicillins	60,757 (34.7)	135.6	56,748 (34.7)	126.4	51,544 (33.3)	114.4	45,660 (31.5)	100.7	47,625 (32.9)	104.5
J01CA Penicillins with extended spectrum	39,769 (22.7)	88.7	38,879 (23.8)	86.6	38,621 (25.0)	85.7	36,796 (25.4)	81.1	40,759 (28.2)	89.4
J01CF Beta-lactamase resistant penicillins	11,659 (6.7)	26.0	11,540 (7.1)	25.7	11,476 (7.4)	25.5	11,388 (7.8)	25.1	11,838 (8.2)	26.0
J01CR Combinations of penicillins, including beta-lactamase inhibitors	7,413 (4.2)	16.5	7,355 (4.5)	16.4	7,938 (5.1)	17.6	7,678 (5.3)	16.9	5,847 (4.0)	12.8
J01FA Macrolides	22,954 (13.1)	51.2	19,606 (12.0)	43.7	18,687 (12.1)	41.5	18,662 (12.9)	41.2	16,227 (11.2)	35.6
J01AA Tetracyclines	6,314 (3.6)	14.1	5,257 (3.2)	11.7	4,300 (2.8)	9.5	4,180 (2.9)	9.2	3,981 (2.7)	8.7
J01E Sulphonamides and trimethoprim	13,705 (7.8)	30.6	12,763 (7.8)	28.4	11,152 (7.2)	24.7	10,187 (7.0)	22.5	9,703 (6.7)	21.3
J01MA Fluoroquinolones	4748 (2.7)	10.6	4233 (2.6)	9.4	4074 (2.6)	9.0	3956 (2.7)	8.7	3503 (2.4)	7.7
P01AB01 Nitroimidazole derivatives	3,390 (1.9)	7.6	3,148 (1.9)	7.0	2,977 (1.9)	6.6	2,779 (1.9)	6.1	2,686 (1.9)	5.9
Other antibacterials	4,433 (2.5)	9.9	3,986 (2.4)	8.9	3,925 (2.5)	8.7	3,851 (2.7)	8.5	2,595 (1.8)	5.7