GPs PRESCRIBED ANTIBIOTICS SEVEN TIMES MORE THAN DOCTORS IN KLINIK KESIHATAN
Teng CL, Nik Sherina H, Ng CJ, Chia YC, Atiya AS. Antibiotic prescribing for childhood febrile illness by primary care doctors in Malaysia. J Paediatr Child Health. 2006;42:612-7 [PubMed]
What did doctors do when they were faced with a febrile child in their clinics? Teng et al looked at this issue by interviewing caregivers of 649 febrile children in 13 clinics (one university-based primary care clinic, six public primary care clinic [Klinik Kesihatan], and six private general practice clinics). The doctors’ clinic records were examined for antibiotic prescribing. They found that one-third of the children had prior consultation for the same episode of fever. About 80% of the febrile children were diagnosed to have upper respiratory tract infection, viral fever and gastroenteritis. Overall antibiotic prescribing rate was 36.6% (public primary care clinic 26.8%, private general practice clinic 70.0% and university-based primary care clinic 32.2%). Factors independently associated with antibiotic prescription were: clinic setting, longer duration of fever (>7 days), higher temperature (>38°C) and the diagnosis of upper respiratory tract infections. Taking into account the demographic and clinical factors, antibiotic prescription in private general practice clinic was seven times higher than public primary care clinic and 1.6 times higher than university-based primary care clinic. The amount of antibiotics prescribed was much more than what we should be comfortable with. Are doctors in private general practice clinics more responsive to the parental expectation for antibiotics? Do they regard antibiotics as a safety net or are they practising defensive medicine? As we face the increasing problem of antibiotic resistance, we need to re-examine our current management of febrile children in primary care.
Reprints request: Assoc Prof CL Teng, Department of Family Medicine, International Medical University, 70300 Seremban, Malaysia. Email: firstname.lastname@example.org