ArticleBMC family practice2005
Influence of patient symptoms and physical findings on general practitioners' treatment of respiratory tract infections: a direct observation study.
Article in BMC family practice, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Clinical Practice Guideline: Sore Throat.Deutsches Arzteblatt international · 2021Guideline
- Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections.Antimicrobial agents and chemotherapy · 2016Pooled it
- Effects of C-reactive protein rapid testing and communication skills training on antibiotic prescribing for acute cough. A cluster factorial randomised controlled trial.NPJ primary care respiratory medicine · 2024Trial
- Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial.BMJ (Clinical research ed.) · 2013Trial
- Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.BMJ (Clinical research ed.) · 2009Trial
- Reducing unnecessary prescriptions of antibiotics for acute cough: adaptation of a leaflet aimed at Turkish immigrants in Germany.BMC family practice · 2008Trial
- Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC3T): study protocol of a cluster randomised controlled trial.BMC family practice · 2007Trial
- Factors associated with antibiotic prescription among patients with respiratory illness in Thailand: The potential impact of rapid influenza diagnostic testing in antimicrobial stewardship.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026Article
- Article
- The portrayal of antimicrobial resistance in Bangladeshi newspapers during 2010-2021: Toward understanding the narrative.PloS one · 2024Article
- Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China.Epidemiology and infection · 2022Article
- Factors associated with C-reactive protein testing when prescribing antibiotics in general practice: a register-based study.BMC primary care · 2022Article
- [Sore Throat - Guideline-based Diagnostics and Therapy].ZFA. Zeitschrift fur Allgemeinmedizin · 2022Article
- Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study.BMJ open · 2020Article
- Antibiotics without Prescriptions: US & Indian Perspective.Indian journal of pediatrics · 2020Article
- Article
- General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices.BMC family practice · 2019Article
- Health service utilization following symptomatic respiratory tract infections and influencing factors among urban and rural residents in Anhui, China.Primary health care research & development · 2019Article
- Management of sore throat in Danish general practices.BMC family practice · 2019Article
- Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review.Irish journal of medical science · 2018Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe high rate of antibiotic prescriptions general practitioners (GPs) make for respiratory tract infections (RTI) are often explained by non-medical reasons e.g. an effort to meet patient expectations. Additionally, it is known that GPs to some extent believe in the necessity of antibiotic treatment in patients with assumed bacterial infections and therefore attempt to distinguish between viral and bacterial infections by history taking and physical examination. The influence of patient complaints and physical examination findings on GPs' prescribing behaviour was mostly investigated by indirect methods such as questionnaires.
methodsDirect, structured observation during a winter "cough an cold period" in 30 (single handed) general practices. All 273 patients with symptoms of RTI (age above 14, median 37 years, 51% female) were included.
resultsThe most frequent diagnoses were 'uncomplicated upper RTI/common cold' (43%) followed by 'bronchitis' (26%). On average, 1.8 (95%-confidence interval (CI): 1.7-2.0) medicines per patient were prescribed (cough-and-cold preparations in 88% of the patients, antibiotics in 49%). Medical predictors of antibiotic prescribing were pathological findings in physical examination such as coated tonsils (odds ratio (OR) 15.4, 95%-CI: 3.6-66.2) and unspecific symptoms like fatigue (OR 3.1, 95%-CI 1.4-6.7), fever (OR 2.2, 95%-CI: 1.1-4.5) and yellow sputum (OR 2.1, 95%-CI: 1.1-4.1). Analysed predictors explained 70% of the variance of antibiotic prescribing (R2 = 0,696). Efforts to reduce antibiotic prescribing, e.g. recommendations for self-medication, counselling on home remedies or delayed antibiotic prescribing were rare.
conclusionsPatient complaints and pathological results in physical examination were strong predictors of antibiotic prescribing. Efforts to reduce antibiotic prescribing should account for GPs' beliefs in those (non evidence based) predictors. The method of direct observation was shown to be accepted both by patients and GPs and offered detailed insights into the GP-patient-interaction.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.