Inappropriateness and Variability of Antibiotic Prescription among French Office-Based Physicians

Objective: To describe oral antibiotic prescription in the community. Design: Audit of anti-infective prescribing in office-based medical practice. Setting: Center of France, in the Loiret, a 600,000 inhabitant administrative division. Main outcome measures: Clinical hypothesis and antimicrobial drugs used as well as daily doses and durations of treatment. Results: Respiratory tract infections with a presumed viral etiology accounted for 36% of prescriptions. In children, a high percentage of antibiotic prescriptions were underdosed as compared to clinical recommendations, particularly in acute otitis media. The variability of the daily dose was high, with coefficients of variation over 40% in acute otitis media or acute tracheobronchitis. Whatever the clinical hypothesis, the duration of treatment was close to 8 days. In acute otitis media, the coefficient of variation was 14%, the lowest for all diagnoses. Conclusion: Our investigation identified two main areas for improving antimicrobial drug prescribing: (1) reduction of useless prescriptions in respiratory tract infections with a presumed viral etiology, and (2) increasing the prescribed daily dose of antimicrobials to the recommended levels.