Nonadherence to guidelines for prescribing antibiotic therapy to patients with tonsillitis or pharyngotonsillitis: a cross-sectional study

Curr Med Res Opin. 2015;31(7):1319-22. doi: 10.1185/03007995.2015.1041896. Epub 2015 May 7.


Objectives: Although previous studies have assessed nonadherence to guidelines for prescribing antibiotic therapy in patients with pharyngotonsillitis (prescription of another antibiotic rather than one of first choice: amoxicillin and/or penicillin V, except in the case of penicillin allergy), none analyzed associated factors. Consequently, we conducted a study to assess the possible factors associated with the problem of nonadherence.

Methods: This cross-sectional study analyzed a sample of 417 patients with tonsillitis or pharyngotonsillitis treated with antibiotics during February 2014 in a Spanish region. The data were obtained through electronic records.

Independent variables: gender, disease (tonsillitis or pharyngotonsillitis), clinical specialty (primary care or pediatrics), age and physician's gender. To identify factors associated with nonadherence, the adjusted odds ratios (ORs) were calculated through a binary logistic regression model with all the independent variables. The confidence interval (CI) was calculated for all relevant parameters.

Results: Of 417 patients, 303 were categorized to the nonadherence group (72.7%, 95% CI: 68.4-76.9%). Two factors associated with the physician were relevant and close to statistical significance: primary healthcare as a clinical specialty (OR = 2.3, p = 0.055) and male gender (OR = 1.5, p = 0.088).

Conclusions: Nonadherence in prescribing first-choice antibiotics to patients with tonsillitis or pharyngotonsillitis is highly prevalent. We emphasize the need to implement measures to help minimize this problem and, thus, antibiotic resistance, such as undertaking qualitative studies to assess the reasons for inappropriate prescription or the incorporation of alert systems in the electronic records.

Limitations: As we analyzed data from all the patients in winter, it would be interesting to replicate this study at another time of the year.

Keywords: Antibacterial agents; Guideline adherence; Inappropriate prescribing; Physicians, primary care; Physician’s practice patterns; Tonsillitis.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Inappropriate Prescribing
  • Logistic Models
  • Male
  • Middle Aged
  • Physicians / statistics & numerical data
  • Practice Patterns, Physicians' / standards*
  • Primary Health Care
  • Respiratory Tract Infections / drug therapy
  • Seasons
  • Tonsillitis / drug therapy*
  • Young Adult


  • Anti-Bacterial Agents