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Antibiotics (Basel). 2013 Nov 19;2(4):477-84. doi: 10.3390/antibiotics2040477.

Low Request of Antibiotics from Patients with Respiratory Tract Infections in Six Countries: Results from the Happy Audit Study.

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Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona 43205, Spain.
Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen 1014, Denmark.
Department of Clinical Sciences, General Practice/Family Medicine, Lund University, Malmö 205 02, Sweden.
Family Doctors Centre Mano šeimos gydytojas, Klaipeda 91220, Lithuania.
Association of Family Doctors, Kaliningrad 236044, Russia.
Misiones Association of General Family Medicine, Posadas 3300, Argentina.


A total of 59,535 patients with respiratory tract infections were registered in the Happy Audit project, an audit-based, before-and-after study conducted in primary care centres of six countries (Argentina, Denmark, Lithuania, Russia, Spain, and Sweden) in 2008 and 2009. An antibiotic was explicitly requested by the patient in 1,255 cases (2.1%), with a great variation across countries ranging from 0.4%-4.9%. Antibiotics were significantly more often prescribed to patients requesting them compared to those who did not (64% vs. 28%; p < 0.001). Patients with acute exacerbations of chronic bronchitis/chronic obstructive pulmonary disease were most likely to request antibiotics while those with common colds were least likely (3.9% vs. 1.2%, respectively). The presence of tonsillar exudates and dyspnoea were more commonly associated with a demand for antibiotics. Even though physicians very often perceive that patients demand an antibiotic, the results of this study clearly show that patients only request antibiotics in a low percentage of cases. Patients were most likely to request antibiotics when they had symptoms of lower respiratory tract infections and when they came with more severe symptoms. Furthermore, there were considerable differences between countries, suggesting that the different backgrounds and traditions largely explain this variability in patients' requests for antibiotics.


antibiotics; audit; demand; respiratory tract infections

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