[Etiology and treatment of choice of respiratory infections in primary care. Opinion of the physicians of the URANO Group].

OBJECTIVE

To find the opinion of primary care doctors on the aetiology of respiratory infections and their treatment of choice.

DESIGN

Crossover study, through interview with structured questionnaire.

SETTING

Primary care.

PARTICIPANTS

400 PC doctors distributed by area in direct proportion to the number of doctors in each area.

MEASUREMENTS AND MAIN

RESULTS

Most doctors thought that S. pyogenes was the main cause of pharyngitis and tonsillitis; and H. influenzae or S. pneumoniae, of otitis media, sinusitis and exacerbation of acute bronchitis. 78% thought that pneumococci were the main causal agent of pneumonia. 20.5% and 19.8% thought that viruses were the main cause of pharyngitis and acute bronchitis. The treatment of choice depended on the clinical profile and what was thought the most likely cause. For pharyngitis, tonsillitis and acute bronchitis, first choice was aminopenicillins and second was amoxicillin/clavulanic acid. For otitis media, sinusitis and exacerbation of chronic bronchitis, cephalosporins were first choice, followed by amoxicillin/clavulanic acid. For pneumonia, it was aminopenicillins or penicillin, followed by macrolides.

CONCLUSIONS

Spanish primary care doctors underestimate the viral aetiology of pharyngo-tonsillitis and acute bronchitis, which may lead to frequent and unnecessary use of antibiotics in these clinical cases. The cause of other infections is well-known, although there are some discrepancies as to the treatment of choice with what is recommended in several medical hand-books.