Family Practice Advance Access originally published online on August 28, 2007
Family Practice 2007 24(5):427-434; doi:10.1093/fampra/cmm040
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Socially responsible antibiotic choices in primary care: a qualitative study of GPs’ decisions to prescribe broad-spectrum and fluroquinolone antibiotics
Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionydd, Heath Park, Cardiff, Wales CF10 3XQ, UK
Correspondence to Fiona Wood, Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionydd, Heath Park, Cardiff, Wales CF14 4XN, UK; Email: Wood{at}cardiff.ac.uk
Received 19 December 2006; Revised 29 May 2007; Accepted 17 June 2007.
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Abstract |
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Background. There is considerable variation within and between countries in general medical practitioners’ (GPs’) prescribing of broad-spectrum antibiotics such as fluroquinolones, and resistance to these agents is increasing worldwide. Urgently promoting cautious fluroquinolone prescribing in primary care may limit increase in resistance.
Objective. We therefore interviewed 40 GPs in order to explore the reasons for their choice of prescribed antibiotic, in particular their decision to prescribe fluroquinolones.
Methods. We used a grounded theory approach to data collection and analysis, incorporating purposive and theoretical sampling, based on high and average fluroquinolone prescribing. Interviews were conducted with 26 GPs from practices known to be high prescribers of fluroquinolone antibiotics and 14 from average fluroquinolone prescribing practices.
Results. Chosing to prescribe a broad-spectrum antibiotic such as a fluroquinolone, rather than a narrow-spectrum antibiotic, related to a number of clinical considerations, perceptions of patient expectations and organizational influences. GPs from high fluroquinolone prescribing practices were more likely to prioritize patients’ immediate needs, whereas GPs from average prescribing practices were more likely to consider longer term issues. GPs from both high and average fluroquinolone prescribing practices justified their antibiotic choices on the basis of a desire to do their best for their patients and society.
Conclusion. Choosing to prescribe powerful, broad-spectrum antibiotics such as fluroquinolones, as well as choosing to keep these agents in reserve, was justified on the basis of social responsibility. Strategies to change fluroquinolone and broad-spectrum antibiotic prescribing will need to take into account clinicians’ perceptions of social responsibility.
Keywords. Drug resistance, prescribing, qualitative research.
Wood F, Simpson S and Butler CC. Socially responsible antibiotic choices in primary care: a qualitative study of GPs’ decisions to prescribe broad-spectrum and fluroquinolone antibiotics. Family Practice 2007; 24: 427–434.
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