Diagnostic tests were only performed in 29% of cases. Chest radiographs were performed most frequently (22%), followed by peripheral blood white cell count (15%) and microbiological examination of sputum (7%), with major differences being found in the frequency of these tests both by clinical diagnosis and country. A change in initial antibiotic therapy was made in 12% of cases, with use of investigation being significantly linked to such changes.Second-and third-line antibiotics were significantly different to first-line therapy, with macrolides the most frequently prescribed second-line and quinolones the most frequently prescribed third-line antibiotics. Eur Respir J., 1996Respir J., , 9, 1596 Lower respiratory tract infections (LRTIs) are amongst the commonest illnesses of mankind, with an estimated annual incidence of 40 per 1,000 adults [1]. Of those seeking medical attention, most are managed in the community by general practitioners (GPs). Antibiotics are the mainstay of therapy, the use of which may be directed by the results of simple investigations. How frequently such investigations are performed in the management of LRTIs in the community, whether there are national differences in the use of such investigations, and the impact of their results on therapy, in particular antibiotic prescription, is not known. A multinational European survey of the management of LRTIs was carried out, and the results regarding the use of investigations and second-and third-line antibiotic therapy are presented here.
MethodsThe design of the survey, data collection methods and methods of statistical analysis are detailed in the accompanying paper on first-line antibiotic therapy [2]. Briefly, between December 8, 1993, and January 24, 1994, a standardized questionnaire was administered to a random, but representative sample of GPs in France, Germany, Italy, Spain and the UK, identified by the "method of quotas" [2]. Information was sought about the last three or four adults seen, for whom the GP considered the diagnosis to be community-acquired LRTI. The criteria for this diagnosis were left to the judgement of the GP, since the aim of the study was to investigate normal practice, rather than altering practice by specifying definitions. The time since patient consultation was not recorded, but since the study was performed in the winter the delay between consultation and study is likely to have been short.In addition to questions about patient demographics, symptoms, clinical signs and antibiotic therapy, the questionnaire also sought the GP's presumptive clinical diagnosis. Four clinical categories were provided: community-acquired pneumonia (CAP); acute bronchitis (AB); exacerbation of chronic bronchitis (ECB); and viral LRTI, including influenza (VRTI). Again the criteria for each category were left to the judgement of the GP, but will be analysed as part of a future paper.Details about whether a chest radiograph (CXR), peripheral blood white cell count (WCC) and sputum sample (SPUTUM) had been obtained were recorded...
