Inappropriate antibiotic prescribing and demand for antibiotics in patients with upper respiratory tract infections is hardly different in female versus male patients as seen in primary care

Figures & data

Table 1. Criteria for classification of the appropriateness of antibiotic prescribing (necessary and unnecessary prescribing) in patients with upper respiratory tract infections (RTIs).

	Necessary prescribing^a	Unnecessary prescribing^b
Acute rhinitis	Never	Always
Acute otitis media	Symptoms ≥ 3 days or	Symptoms < 3 days and absence
	purulent ear secretion	of purulent ear secretion
Acute sinusitis	Symptoms ≥ 5 days or	Symptoms < 5 days and fever
	fever ≥ 38.5°C	< 38.5°C
Acute pharyngotonsillitis	≥ 3 Centor criteria^c or ≥ 2 Centor criteria and a positive strep A test^d	< 3 Centor criteria^c or a negative strep A test^d

^aFollowing international guidelines on antibiotic prescribing.

^bAntibiotic prescription in conflict with international guidelines.

^cPresence of tonsillar exudate, tender anterior cervical lymphadenopathy or lymphadenitis, history of fever and absence of cough.

^dStreptococcus antigen test

Figure 1. Flow chart showing the inclusion and exclusion of patients in the study population.

Table 2. Number of office visits, antibiotic prescriptions and proportion of unnecessary prescriptions for antibiotics for upper respiratory tract infections (RTIs) among men and women visiting general practices participating in HAPPY AUDIT^a.

	Total no. of office visits men/women	Men No. of antibiotic prescriptions (%)	No. of unnecessary prescriptions	% of unnecessary prescriptions (95% CI)^b	Women No. of antibiotic prescriptions (%)	No. of unnecessary prescriptions	% of unnecessary prescriptions (95% CI)^b	P-value^b
All upper RTIs	5 946/9 076	1 495 (25.1%)	677	45.3 (41.7; 48.9)	2 320 (25.6%)	1 032	44.5 (41.0; 48.0)	0.77
Acute rhinitis	3 522/5 120	92 (2.6%)	92	100%	127 (2.5%)	127	100%	–
Acute otitis media	192/292	170 (88.5%)	12	7.1 (3.8; 12.8)	257 (88.0%)	37	14.4 (10.6; 19.3)	0.02
Acute sinusitis	318/649	266 (83.6%)	64	24.1 (18.9; 30.1)	562 (86.6%)	123	21.9 (18.1; 26.2)	0.46
Acute pharyngotonsillitis	1 914/3015	967 (50.5%)	509	52.6 (48.4; 56.8)	1 374 (45.6%)	745	54.2 (49.7; 58.7)	0.47

^aHealth alliance for prudent prescribing, yield and use of antimicrobial drugs in the treatment of respiratory tract infections.

^bThe presented proportions of unnecessary prescriptions, confidence intervals and P-value are adjusted for clustering at doctor level

CI, confidence interval.

Table 3. Rate of unnecessary antibiotic prescribing (% of consultations followed by a prescription) in men and women by country and diagnosis.

Unnecessary prescription of antibiotics		Sweden		Denmark		Argentina		Spain		Russia		Lithuania
		n (%)^a	95% CI^b	n (%)	95% CI	n (%)	95% CI	n (%)	95% CI	n (%)	95% CI	n (%)	95% CI
Total number, ♀+♂	47 (19.3)	114 (27.3)	189 (44.2)	1 038 (48.6)	200 (52.2)	121 (59.0)
All upper RTIs	♀	30 (19.1)	13.7–26.0	68 (24.1)	19.2–29.9	124 (47.3)	37.3–57.5	612 (48.6)	44.1–53.2	144 (55.0)	41.4–67.8	54 (54.5)	43.3–65.3
	♂	17 (19.5)	12.0–30.3	46 (34.1)	26.0–43.1	65 (39.2)	28.9–50.5	426 (48.5)	43.7–53.2	56 (46.3)	33.5–59.5	67 (63.2)	52.9–72.4
Acute rhinitis	♀	5 (100.0)	−	10 (100.0)	−	6 (100.0)	−	92 (100.0)	−	11 (100.0)	−	3 (100.0)	−
	♂	5 (100.0)	−	2 (100.0)	−	9 (100.0)	−	63 (100.0)	−	7 (100.0)	−	6 (100.0)	−
Acute otitis media	♀	2 (18.2)	4.4–51.5	4 (22.2)	8.5–46.9	3 (10.0)	3.9–23.1	26 (15.3)	10.5–21.8	1 (5.3)	0.9–24.7	1 (11.1)	1.4–52.1
	♂	0 (0)	−	1 (14.3)	2.0–58.1	1 (4.2)	0.5–25.7	9 (8.3)	4.0–16.3	0 (0)	−	1 (14.3)	1.9–59.3
Acute sinusitis	♀	7 (9.2)	4.7–17.4	20 (14.6)	9.4–21.9	16 (33.3)	20.0–50.0	59 (24.8)	19.1–31.5	17 (37.8)	28.1–48.5	4 (22.2)	7.4–50.5
	♂	5 (21.7)	9.6–42.0	9 (16.1)	8.5–28.3	5 (26.3)	12.0–48.4	33 (24.8)	17.8–33.5	6 (46.2)	25.3–68.4	6 (27.3)	9.0–58.6
Acute pharyngo-	♀	16 (24.6)	15.4–36.9	34 (29.1)	21.1–38.5^c	99 (55.6)	42.8–67.8	435 (57.4)	52.1–62.5	115 (61.5)	42.9–77.2	46 (66.7)	53.0–78.0
tonsillitis	♂	7 (14.6)	7.1–27.7	34 (48.6)	35.4–61.9	50 (43.9)	32.8–55.6	321 (55.9)	50.5–61.2	43 (47.8)	32.8–63.2	54 (76.1)	64.9–84.5

^aNumber of unnecessary prescriptions for antibiotics (% of total antibiotic prescriptions).

^bThe presented proportions of unnecessary prescriptions, confidence intervals and P–value are adjusted for clustering at doctor level.

^cP-value = 0.02.

♀, female; ♂, male; RTIs, respiratory tract infections; CI, confidence interval.