Managing patients who expect antibiotic treatment for RTIs
The likelihood of a patient receiving an antibiotic increases 10-fold when GPs think that the patient expects one.1
If a patient attends a consultation expecting a prescription for an antibiotic when one is not appropriate, use communication strategies to manage the patient's beliefs and expectations.
Evidence from general practice shows that good communication influences patient satisfaction more than a prescription for an antibiotic.1-3
Communication strategies you can use to manage patient beliefs and expectations on antibiotics:
Explain that many common RTIs are self-limiting. Provide realistic advice about the duration of various self-limiting RTIs — e.g. common cold, 1.5 weeks; acute otitis media, 4 days; acute sore throat/tonsillitis, 1 week.4
Explain why antibiotics are rarely needed:
- ear, nose, throat, sinus and chest infections are commonly caused by viruses
- self-limiting bacterial infections rarely develop complications.4
Encourage self-management of symptoms:
- use the NPS symptomatic management pad to aid communication.
Explain the importance of immunisation for vaccine-preventable RTIs (e.g. influenza and pneumonia).
- Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations – a questionnaire study. BMJ 1997;315:520–3.
- Welschen I, Kuyvenhoven M, Hoes A, et al. Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction. Fam Pract 2004;21:234–7.
- Kallestrup P, Bro F. Parents' beliefs and expectations when presenting with a febrile child at an out-of-hours general practice clinic. Br J Gen Pract 2003;53:43–4.
- National Institute for Health and Clinical Excellence (NICE). Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Clinical guideline CG69 2008. 2008. (accessed 15 May 2012).