ArticleBMJ open2012
Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 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
38 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.The Journal of antimicrobial chemotherapy · 2025Pooled it
- Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Pooled it
- Clinical presentation and microbiological diagnosis in paediatric respiratory tract infection: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Pooled it
- Let's Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse.BMJ open · 2022Trial
- C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Trial
- Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Trial
- Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial.Implementation science : IS · 2013Trial
- Article
- Article
- Antibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT.Health technology assessment (Winchester, England) · 2023Article
- A qualitative investigation of paediatric intensive care staff attitudes towards the diagnosis of lower respiratory tract infection in the molecular diagnostics era.Intensive care medicine. Paediatric and neonatal · 2023Article
- Barriers to rational antibiotic prescription in Iran: a descriptive qualitative study.Antimicrobial resistance and infection control · 2022Article
- Barriers and facilitators of appropriate antibiotic use in primary care institutions after an antibiotic quality improvement program - a nested qualitative study.BMC geriatrics · 2022Article
- Factors associated with C-reactive protein testing when prescribing antibiotics in general practice: a register-based study.BMC primary care · 2022Article
- Determinants of clinician and patient to prescription of antimicrobials: Case of Mulanje, Southern Malawi.PLOS global public health · 2022Article
- Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China.Frontiers in public health · 2022Article
- Parent and Clinician Views of Managing Children with Symptoms of a Lower Respiratory Tract Infection and Their Influence upon Decisions to Take Part in a Placebo-Controlled Randomised Control Trial.Antibiotics (Basel, Switzerland) · 2021Article
- Review
- Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials.Antibiotics (Basel, Switzerland) · 2020Review
- Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study.Family practice · 2020Article
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThere is variation in antibiotic prescribing for lower respiratory tract infections (LRTI) in primary care that does not benefit patients. This study aims to investigate clinicians' accounts of clinical influences on antibiotic prescribing decisions for LRTI to better understand variation and identify opportunities for improvement.
designMulti country qualitative interview study. Semi-structured interviews using open-ended questions and a patient scenario. Data were subjected to five-stage analytic framework approach (familiarisation, developing a thematic framework from the interview questions and emerging themes, indexing, charting and mapping to search for interpretations), with interviewers commenting on preliminary reports.
settingPrimary care.
participants80 primary care clinicians randomly selected from primary care research networks based in nine European cities.
resultsClinicians reported four main individual clinical factors that guided their antibiotic prescribing decision: auscultation, fever, discoloured sputum and breathlessness. These were considered alongside a general impression of the patient derived from building a picture of the illness course, using intuition and familiarity with the patient. Comorbidity and older age were considered main risk factors for poor outcomes. Clinical factors were similar across networks, apart from C reactive protein near patient testing in Tromsø. Clinicians developed ways to handle diagnostic and management uncertainty through their own clinical routines.
conclusionsClinicians emphasised the importance of auscultation, fever, discoloured sputum and breathlessness, general impression of the illness course, familiarity with the patient, comorbidity, and age in informing their antibiotic prescribing decisions for LRTI. As some of these factors may be overemphasised given the evolving evidence base, greater standardisation of assessment and integration of findings may help reduce unhelpful variation in management. Non-clinical influences will also need to be addressed.
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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.