Management of Upper Respiratory Tract Infections by Different Medical Practices, Including Homeopathy, and Consumption of Antibiotics in Primary Care: The EPI3 Cohort Study in France 2007-2008

PLoS One. 2014 Mar 19;9(3):e89990. doi: 10.1371/journal.pone.0089990. eCollection 2014.

Abstract

Background: Prescribing of antibiotics for upper respiratory tract infections (URTI) varies substantially in primary care.

Objectives: To describe and compare antibiotic and antipyretic/anti-inflammatory drugs use, URTI symptoms' resolution and occurrence of potentially-associated infections in patients seeking care from general practitioners (GPs) who exclusively prescribe conventional medications (GP-CM), regularly prescribe homeopathy within a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho).

Method: The EPI3 survey was a nationwide population-based study of a representative sample of 825 GPs and their patients in France (2007-2008). GP recruitment was stratified by self-declared homeopathic prescribing preferences. Adults and children with confirmed URTI were asked to participate in a standardized telephone interview at inclusion, one-, three- and twelve-month follow up. Study outcomes included medication consumption, URTI symptoms' resolution and potentially-associated infections (sinusitis or otitis media/externa) as reported by patients. Analyses included calibration to account for non-respondents and groups were compared using multivate analyses adjusting for baseline differences with a propensity score.

Results: 518 adults and children with URTI (79.3% rhinopharyngitis) were included (36.9% response rate comparable between groups). As opposed to GP-CM patients, patients in the GP-Ho group showed significantly lower consumption of antibiotics (Odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.27-0.68) and antipyretic/anti-inflammatory drugs (OR = 0.54, 95% CI: 0.38-0.76) with similar evolution in related symptoms (OR = 1.16, 95% CI: 0.64-2.10). An excess of potentially-associated infections (OR = 1.70, 95% CI: 0.90-3.20) was observed in the GP-Ho group (not statistically significant). No difference was found between GP-CM and GP-Mx patients.

Conclusion: Patients who chose to consult GPs certified in homeopathy used less antibiotics and antipyretic/anti-inflammatory drugs for URTI than those seen by GPs prescribing conventional medications. No difference was observed in patients consulting GPs within mixed-practice. A non-statistically significant excess was estimated through modelling for associated infections in the GP-Ho group and needs to be further studied.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use*
  • Antipyretics / therapeutic use*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Management
  • Family Practice
  • Female
  • France
  • General Practitioners / psychology
  • Health Care Surveys
  • Homeopathy / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Respiratory Tract Infections / drug therapy*

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Antipyretics

Grant support

This study was funded by Laboratoires Boiron, France. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.