Education And Debate Controversies in management

Should general practitioners perform diagnostic tests on patients before prescribing antibiotics?ForAgainst

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7186.799 (Published 20 March 1999) Cite this as: BMJ 1999;318:799

Should general practitioners perform diagnostic tests on patients before prescribing antibiotics?

As most antibiotics are prescribed by general practitioners, control of antibiotic resistance depends greatly on rational prescribing behaviour by these doctors. Here a Danish microbiologist argues for near patient testing before prescribing antibiotics, while a British general practitioner contends that there are considerable problems associated with testing and that time is often the best treatment for acute, self limiting infections.

For

  1. Hans J⊘rn Kolmos (hans.joern.kolmos@hh.hosp.dk), consultant microbiologist
  1. Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark
  2. Primary Medical Care, Southampton SO16 5ST

    As 80% of antibiotics are prescribed by general practitioners,1 control of antibiotic resistance depends greatly on rational prescribing behaviour in this group of doctors. Microbiological testing is an important tool in rational prescribing of antibiotics, not only in hospitals but also in general practice. However, the usefulness of laboratory based testing may be limited if it takes too long—particularly in patients who are considered to need immediate antibiotic treatment. These patients will therefore be treated empirically, and test results received afterwards from the laboratory may have little influence on the course of treatment.

    One way of overcoming these problems is to perform near patient microbiological testing. In Denmark, many general practitioners undertake selected microbiological tests using phase contrast microscopy and simple diagnostic kits. 2 3

    Advantages of near patient testing

    Practice based microbiological testing has several advantages. Most importantly, the test result can be available immediately, and this helps to decide whether the patient should be prescribed antibiotics. General practitioners are often under pressure from patients who believe they need antibiotics.4 With a negative test result at hand it is much easier for the doctor to refuse to prescribe an unnecessary antibiotic. Furthermore, if the patient needs treatment immediately, the test result may help in choosing the most appropriate agent.

    Near patient testing also reduces bureaucracy. General practitioners do not have to spend time filling in the forms that have to accompany specimens sent to the laboratory, communication problems with the laboratory are …

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