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Macrolide overuse for treatment of respiratory tract infections in general practice.

INTRODUCTION
High consumption of macrolides has been linked to increased macrolide resistance in the common pathogens of respiratory tract infections (RTIs). According to Danish recommendations, penicillin is the first-choice treatment for RTIs and macrolides should only be prescribed when a patient is allergic to penicillin or for treatment of mycoplasma pneumonias. The aim of the present study was to explore the prescription of macrolides for different RTIs to patients without penicillin allergy in general practice in Denmark.


MATERIAL AND METHODS
This was a cross-sectional study. Data were collected during a three-week period in January 2008 as part of the EU-funded project Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). A total of 102 Danish general practitioners participated and registered patients with RTIs according to the Audit Project Odense method.


RESULTS
A total of 3,904 patients with RTIs were registered and 1,351 patients received antibiotics. Among these, 198 patients received a macrolide. In all, 136 patients received a macrolide without being allergic to penicillin. This proportion was highest for patients diagnosed with acute otitis media (71%), acute bronchitis (71%) or pneumonia (76%).


CONCLUSION
Overall, there was a considerable overuse of macrolide for treatment of all types of RTIs. The macrolide overuse found in this study cannot be explained by the aetiology of Mycoplasma pneumoniae since there was no epidemic in 2008.


FUNDING
Data for the macrolide study were collected from the HAPPY AUDIT study which was funded by the EU. The two first-authors each received DKK 30,000 from the PLU foundation for their work on the article.


TRIAL REGISTRATION
The HAPPY AUDIT method was registered and published in the BioMed Central.