Compliance with recommendations on outpatient antibiotic prescribing for respiratory tract infections: the case of Spain.

Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bac- terial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evalu- ating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and anti- biotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsil- litis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifac- eted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.