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69 Preventing overdiagnosis of suspected bacterial respiratory tract infections by means of antibiotic deprescribing when antibiotic is no longer needed: general practitioners’ views
  1. Carl Llor1,2,3,
  2. Ana Moragas4,
  3. Ana García-Sangenís1,
  4. Lars Bjerrum5
  1. 1University Institute in Primary Care Research Jordi Gol, Barcelona, Spain
  2. 2CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
  3. 3Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
  4. 4University Rovira i Virgili, Reus, Spain
  5. 5Department of Public Health and Primary Care, University of Copenhagen, Copenhagen, Denmark


Objectives Dogmas are taken for granted until new evidence poses questions about their validity. A clear example is the long-standing belief that a course of antibiotics always should last for a defined number of days, despite considering that this antibiotic course is no longer necessary. In a recent randomised clinical trial with patients with uncomplicated respiratory tract infections (RTI) who had already taken a dose of an antibiotic course when clinicians consider it unnecessary, we found that the mean duration of severe symptoms was similar in the group of patients who discontinued antibiotic therapy and among those who completed the therapy. Conversely, those discontinuing antibiotic treatment notably reduced antibiotic consumption. This study was aimed at exploring general practitioners’ (GP) opinions about the use of antibiotic deprescribing in general practice.

Method Cross-sectional, questionnaire-based study answered from February to March 2022. 6,083 GPs affiliated with the largest Spanish scientific society of primary care were invited to participate. The survey included two statements related to use and fourteen views about antibiotic deprescribing rated by GPs using a 5-item Likert scale.

Results A total of 1,107 doctors completed the survey (18.2%). 92.5% of GPs reported having used the antibiotic deprescribing strategy in their practice at least once. GPs felt very confident in using a deprescribing strategy in patients with common cold and flu (97.6% and 93.5%, respectively), but less in acute bronchitis (45.5%). Regarding attitudes towards antibiotic deprescribing, only a minority of GPs (12.1%) considered it harmful to patients. Thus, the majority agreed that this strategy should be included in clinical guidelines. Respondents reported using antibiotic deprescribing more frequently when they themselves initiated the antibiotic course (96.8%; 95% CI, 95.5-97.7) than when the treatment was initiated by another doctor (52.3%; 95% CI, 49.3-55.3%), but doctors aged >60 years were more prone to use antibiotic deprescribing compared with younger colleagues (64.5% vs. 50%; p<0.005).

Conclusions Many GPs would consider that discontinuing antibiotics in these circumstances should be the standard of care. However, the decision to discontinue an antibiotic recently started is not easy, particularly if initiated by a colleague. In fact, as suggested by qualitative research, GPs do not feel comfortable discontinuing treatments in general, and guidelines are not as authoritative for discontinuation as they are for starting drugs. Important differences lie in their views of the way the strategy is used. Further studies are warranted to explore the beliefs behind these perceptions and promote wider use of the antibiotic deprescribing by GPs, leading to a lesser overdiagnosis of suspected bacterial infections.

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