Antibiotic treatment of gastroenteritis in primary care

Abstract

Gastroenteritis (GE) is a frequent reason for consultating a general practitioner. Yet little is known about antibiotic prescribing in primary care patients with GE. In this study, we quantified empirical and targeted antibiotic treatment of GE, compliance with recommendations from primary care clinical practice guidelines (CPGs) and the degree of antimicrobial resistance in patients receiving diagnostic faeces testing (DFT). Methods: We performed a cohort study using routine care data of 160 general practitioners, including electronic patient records from 2013 to 2014. GE episodes were extracted and linked to microbiological laboratory records to retrieve results of DFT. For each episode, data on patient characteristics, DFT results including antimicrobial resistance testing, and antibiotic prescriptions were collected. Results: We identified 13217 GE episodes. Antibiotic treatment was prescribed in 1163 (8.8%) episodes, most frequently with metronidazole (n646, 4.9%), azithromycin (n254, 1.9%) or ciprofloxacin (n184, 1.4%). Treatment was empirical for 641 (5%) GE episodes, of which 30% (n191) followed the CPG-recommended antibiotic choice. Targeted treatment following DFT results was prescribed for 537 GE episodes (4%), of which 99% (n529) followed CPG recommendations. Non-susceptibility to first- or second-choice antibiotics was demonstrated in three Salmonella isolates (9%-13% of all isolates) and one Campylobacter isolate (1%). Conclusions: Antibiotic treatment of GE in primary care is relatively infrequent, with 1 in 11 episodes treated. Empirical treatment was more frequent compared with targeted treatment and mostly with non-CPGrecommended antibiotics. However, treatment based upon DFT results followed CPG recommendations.