Diagnostics and Therapy of Sore Throat Patients Presenting in Primary Care: an Observational Study
DOI: 10.3238/zfa.2016.0269-0275german translation / full article
Background: In Germany there is currently no up-to-date data available concerning family practitioners’ prescription rates of antibiotics for patients with sore throat. Given the increasing antibiotic resistances among outpatients, knowledge of prescription habits for such patients is an important prerequisite for planning interventions aimed at reducing the use of antibiotics. The main indication for antibiotics in cases of sore throat is pharyngitis caused by Group-A-Streptococcus (GAS).
Methods: From June to October 2010 a cross-sectional study was conducted among 475 patients from 58 family practices in Schleswig-Holstein. The prescription rate of antibiotics was the primary outcome. Secondary results concerned the amount of laboratory testing, presumptive diagnosis, the antibiotics chosen and the doctors’ further recommendations. Univariate and multivariate statistical analyses were used to evaluate how the rate of prescription was influenced by factors specific to patients, practice and doctor and by the diagnoses.
Results: 41 % of the patients received treatment with antibiotics at the first visit (95%-CI: 37–46 %). The use of antibiotics depended significantly on the complaints described and the mostly unspecific presumptive diagnosis. Pharyngeal swabs were hardly ever employed. Penicillin was chosen in only 40% of all prescriptions. Further recommendations were documented in 66 % of all cases, including Ibuprofen or Paracetamol in 17% of all cases.
Conclusions: Antibiotics were prescribed at least twice as often as the number of GAS pharyngitis cases to be expected. The results suggest a high grade of diagnostic uncertainty.