Editor—I found Butler et al's article interesting.1 In Norway problems with resistant bacteria are few and have been stable for 10 years. Important reasons for this may be the low total prescriptions for antibiotics and the high proportion of penicillin V prescribed. Prescriptions for antibiotics have decreased by 10% since 1993. One of the reasons for this may be the use of rapid tests in general practice.
A rapid test for detection of group A streptococci (sensitivity and specificity >90%) provides results within 5 minutes. As group A streptococci are the only cause of sore throat that should be treated with penicillin V,2 this can potentially reduce prescriptions. As test results are known quickly, the patient can be told why penicillin V would or would not be prescribed.
In a recent study we showed that a rapid test for C reactive protein performed in general practice and giving results within 10 minutes can be used to identify patients with respiratory tract infections who need antibiotics.3 The test reduced antibiotic intake by one quarter. We believe that this test is one of the best tools to exclude bacterial causes of acute bronchitis and is also a good pedagogic tool.
After 15 years in general practice I perceive that attitudes towards antibiotics have changed. Often parents, knowing from the results of rapid tests that their child probably has a viral infection, are pleased that antibiotics will not be required.
I look forward to more research on this important topic: perhaps the effect of use of a rapid test and how this would affect the rate of prescribing and patients' attitudes?
References
- 1.Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' preceptions of antibiotics for sore throats. BMJ. 1998;317:637–642. doi: 10.1136/bmj.317.7159.637. . (5 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dagnelie CF, van der Graaf Y, de Melker RA. Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice. Br J Gen Pract. 1996;46:589–593. [PMC free article] [PubMed] [Google Scholar]
- 3.Lindbæk M, Hjortdahl P. C-reactive protein in primary care—a useful diagnostic tool in infections. Tidsskr Nor Lægeforen. 1998;118:1176–1179. [PubMed] [Google Scholar]