Huug J. van Duijn and his team at the Julius Center for Health Sciences and Primary Care from the University Medical Center Utrecht, The Netherlands, looked at the practice records of 163 GPs from 85 Dutch practices over a 12 month period, and carried out a survey of the doctors' attitudes to prescribing antibiotics for RT infections. Diagnostic labelling (the tendency to encode RT episodes as infections rather than as symptoms) seemed to be an arbitrary process, often used to justify antibiotic prescribing. GPs may give out antibiotics unnecessarily to defend themselves against unforeseen complications, even if these are unlikely to materialize.
Although Dutch GPs prescribe relatively small antibiotic volumes and international colleagues often envy the quality assurance system in Dutch primary care with guidelines and peer review groups, Van Duijn suggests that the results of his study should be used to update quality assurance programs and postgraduate courses, to emphasise the use of evidence-based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics instead of single signs of inflammation or diagnostic labels. "Even in the Netherlands there is an over-prescribing of antibiotics; about 50% of the antibiotic prescriptions for acute RT episodes are not in accordance with Dutch national guidelines," says van Duijn. "Considering costs, side-effects and the growing resistance to pathogens, it is important to rationalise antibiotic prescribing as much as possible."