Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs). On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test.59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' – both medical reasons – and to a lesser extent 'non-medical reasons' (P < 0.001). Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001).This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.Antibiotics are being overprescribed in ambulant care,[1] especially for respiratory tract infections (RTIs).[2] For this prescribing decision different types of determinants are already highlighted. [3-6] However, gaining insight into the actual reasons for context specific prescribing remains important to design effective strategies to optimise antibiotic prescribing.[7]In general practice, medical decisions (concerning RTIs) are prompted most often by complaints about coughing: 169 times per 1000 patients per year for a new illness episode.[8] Since there is no evidence base for the prescription of antibiotics for coughing in case of suspected RTI,[9] and since antibiotic prescribing results in financial costs to the patient and society, adverse effects and development