Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice: Comparison between Denmark and Iceland

Figures & data

Table 1. Criteria for classification of appropriate and inappropriate antibiotic prescribing in patients with upper respiratory tract infections.

	Appropriate antibiotic prescribing	Inappropriate antibiotic prescribing
Acute sinusitis [20,21]	Duration of symptoms >5 days AND fever	Duration of symptoms ≤5 days AND no fever
Acute otitis media [20,22]	Duration of symptoms >3 days AND purulent ear secretion OR age <2 years	Duration of symptoms ≤3 days AND no purulent ear secretion
Acute pharyngotonsillitis [20,22]	Fulfil ≥2 Centor criteria AND a positive Strep-A test OR Fulfil 4 Centor criteria	Fulfil <2 Centor criteria OR a negative Strep-A test

Notes: ¹Patients ≥5 years of age, suspected of acute pharyngotonsillitis. ²The Centor criteria include: fever >38.5c, tonsillar exudates, tender anterior cervical adenopathy, and absence of cough.

Figure 1. Appropriateness of antibiotic prescribing in patients with upper respiratory tract infections in Iceland (IS) and Denmark (DK).

Note: The bars show the proportion of patients prescribed antibiotics.

Table 2. Number and characteristics of patients with upper respiratory tract infections in Iceland and Denmark.

	Iceland (n = 220)	Denmark (n = 1208)	p-value
Males (%)	106 (48.2)	505 (41.8)	0.08
Median age (years) (IQR^1)	25 (6-42)	23 (7-40)	0.91
Acute otitis media (%)	72 (32.7)	286 (23.7)	<0.005
Acute pharyngotonsillitis (%)	75 (34.1)	650 (53.8)	<0.0001
Acute sinusitis (%)	73 (33.2)	272 (22.5)	<0.005
Antibiotic prescribing^2 (%)	166 (75.8)	712 (59.3)	<0.0001

Notes: ¹IQR = interquartile range. ²Nine missing values (Iceland = 1, Denmark = 8).

Table 3. Distribution of symptoms and signs and antibiotic prescribing in patients with upper respiratory tract infections in Iceland and Denmark.

	Iceland	Denmark	p-value
Acute otitis media, no. (%)	72 (32.7)	286 (23.7)	<0.05
Males, no. (%)	44 (61.1)	139 (47.6)	0.06
Median age, years (IQR)	3 (1–8)	3 (1–7)	0.92
Duration of symptoms,   median days, (IQR)	4 (2–7)	3 (2–5)	<0.01
Fever^1 no. (%)	28 (38.9)	152 (53.2)	<0.05
Purulent ear secretion no. (%)	18 (25.0)	69 (24.1)	0.88
Antibiotic prescribing no. (%)	50 (70.4)	210 (73.7)	0.58
Pharyngotonsillitis, no. (%)	75 (34.1)	650 (53.8)	<0.0001
Males, no. (%)	35 (46.7)	281 (43.2)	0.57
Age, median years (IQR)	28 (18–41)	24 (12–38)	<0.05
Duration of symptoms,   median days (IQR)	4 (3–6)	3 (2–5)	<0.05
No. of patients (%) with ≥ 2   Centor criteria	41 (54.7)	336 (51.7)	0.63
No of patients (%) with a Strep-A^2   test performed	50 (66.7)	543 (83.5)	<0.05
Antibiotics prescribed, no. (%)	44 (58.7)	299 (46.3)	<0.05
Sinusitis, no. (%)	73 (33.2)	272 (22.5)	<0.05
Males, no. (%)	27 (37.0)	85 (31.3)	0.35
Median age, years (IQR)	39 (27–55)	41 (32–55)	0.41
Duration of symptoms,   median days (IQR)	11 (8–20)	7 (4–12)	<0.0001
Fever, no. (%)	17 (23.3)	83 (30.5)	0.23
No. of patients (%) with   CRP^3 performed	2 (2.7)	159 (58.5)	<0.0001
Antibiotics prescribed, no. (%)	72 (98.6)	203 (75.5)	<0.0001

Notes: ¹Fever = >38.5°c. ²Rapid Streptococcus A antigen detection test. ³C-reactive protein measurement.

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