Prescribing antibiotics when the stakes are higher — do GPs prescribe less when patients are pregnant? A retrospective observational study

Guro Haugen Fossum; Svein Gjelstad; Kari J Kværner; Morten Lindbaek

doi:10.3399/bjgpopen18X101505

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Figure 1. Selection of GPs and patients from the Rx-PAD study database and the Norwegian birth registry in the study period December 2004–February 2007.
^aGPs with <10 episodes were excluded.
RTI = respiratory tract infection. Rx-PAD = Peer Academic Detailing.
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Figure 2. Diagnosis of respiratory tract infection episodes in study period, showing adjusted odds ratio for 'pregnant' and 95% confidence intervals (significant difference in bold and italic, P<0.05). Diagnoses based on ICPC-2: acute upper respiratory tract infections, URTI (R01–05, 07–29, 74, and 80), tonsillitis (R72 and 76), sinusitis (R75), bronchitis (R78), pneumonia (R81), otitis (H01, 71, 72, and 74), and other respiratory tract infections (R71, 77, 82, and 83). N = 18 890 episodes.
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Figure 3. Antibiotic prescriptions for URTIs in patients who were pregnant during study period showing adjusted odds ratio for 'pregnant' and 95% confidence intervals, (significant difference in bold and italic, P<0.05). N = 18 890 episodes.
^aCiprofloxacin and cephalosporins.
Penicillins WES = penicillins with extended spectrum.

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Table 1. Characteristics of GPs (n = 458)

Characteristic	n (%)
Sex
Female	145 (31.7)
Male	313 (68.3)
Practice location
Urban	247 (53.9)
Rural	211 (46.1)
Practice type
Group	423 (92.4)
Single	35 (7.6)
GP specialist
Yes	394 (86)
No	64 (14)
Mean age, years (SD)	49.7 (8.1)
Years since authorisation, mean (SD)	19.8 (8.7)
Listed patients^a, mean (SD)	1341 (385)
Patient consultations per year, mean (SD)	2886 (996)
Antibiotic prescription rate^b, mean (SD)	29.8 (10.9)

^aIncludes only GPs with listed patients (n = 449). ^bPer 100 respiratory tract infection episodes.

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Table 2. Antibiotic prescriptions in respiratory tract infection episodes, showing rates for pregnant and non-pregnant patients, and proportion of non-penicillin V prescriptions for the same groups

		n (%)	aOR	cRR (95% CI)
Patients with a pregnancy in study period (n = 18 890)
Antibiotic prescription	Control	5116 (34.2)	Ref
Antibiotic prescription	Pregnant	1015 (25.9)	0.66	0.74 (0.68 to 0.81)
Non-penicillin V prescriptions	Control	2285 (44.7)	Ref
Non-penicillin V prescriptions	Pregnant	364 (35.9)	0.53	0.67 (0.59 to 0.77)

aOR = adjusted odds ratio. 95% CI = 95% confidence interval. cRR = calculated relative risk. Ref = reference.

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Table 3. Antibiotic prescriptions showing rates of dispension at pharmacy (N = 31 265 RTI contacts with GP resulting in a prescription of an antibiotic)

		n (%)	aOR	RR^a(95% CI)
Prescription dispension	Control	26 053 (86.6)	Ref	0.97 (0.94 to 0.99)
Prescription dispension	Pregnant	974 (83.0)	0.79	0.97 (0.94 to 0.99)
Prescription dispension, individual^b	Control	26 053 (86.6)	Ref	0.96 (0.88 to 1.02)
Prescription dispension, individual^b	Pregnant	974 (83.0)	0.77	0.96 (0.88 to 1.02)

^aCalculated from odds ratio. ^bThe second row shows the rates when random intercept clustering at patient level is also adjusted for.
aOR = adjusted odds ratio. 95% CI = 95% confidence intervals. Ref = reference. RR = relative risk.