Quality of antibiotic prescription during office hours and out-of-hours in Flemish primary care, using European quality indicators

Eur J Gen Pract. 2014 Jun;20(2):114-20. doi: 10.3109/13814788.2013.828200. Epub 2013 Sep 2.


Background: European disease-specific antibiotic prescribing quality indicators (APQI) were proposed for seven acute indications (bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media and pneumonia): (a) the percentage of patients prescribed an antibiotic; (b) the percentage of patients receiving the guideline recommended antibiotic; (c) the percentage of patients receiving quinolones.

Objectives: To assess the feasibility of calculating values for these 21 APQI using primary care databases; and to assess the quality of antibiotic prescribing in office hours and out-of-hours general practice.

Methods: Data was extracted from a morbidity registration network ( http://www.intego.be ) and the out-of-hours service centre in Flanders. Within both databases diagnoses are labelled using the revised second edition of International Classification of Primary Care (ICPC-2-R) and antibiotic prescriptions using Anatomical Therapeutic Chemical (ATC) classification.

Results: Both databases allow calculation of APQI values and results are similar. Only for cystitis was the percentage of patients prescribed an antibiotic within the proposed acceptable range. For all indications, the percentage of recommended antibiotics was below the proposed acceptable range (80-100%). The percentage of quinolones was within the proposed acceptable range (0-5%) for otitis media, upper respiratory infection and tonsillitis.

Conclusion: Primary care databases can produce APQI values. These values revealed huge opportunities to improve the quality of antibiotic prescribing in office hours and out-of-hours Flemish general practice, especially the prescription of recommended antibiotics.

Keywords: antibacterials; drug therapy; evidence-based medicine; primary care; quality of care.

MeSH terms

  • Adolescent
  • Adult
  • After-Hours Care / standards*
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchitis / drug therapy
  • Child
  • Child, Preschool
  • Cystitis / drug therapy
  • Databases, Factual
  • Drug Prescriptions / standards*
  • Female
  • Guideline Adherence
  • Humans
  • Infant
  • Middle Aged
  • Netherlands
  • Otitis Media / drug therapy
  • Pneumonia, Bacterial / drug therapy
  • Practice Guidelines as Topic
  • Primary Health Care / standards*
  • Quality Indicators, Health Care
  • Quinolones / therapeutic use
  • Sinusitis / drug therapy
  • Tonsillitis / drug therapy
  • Young Adult


  • Anti-Bacterial Agents
  • Quinolones