Antibiotic Prescribing for Acute Lower Respiratory Tract Infections (LRTI) - Guideline Adherence in the German Primary Care Setting: An Analysis of Routine Data

PLoS One. 2017 Mar 28;12(3):e0174584. doi: 10.1371/journal.pone.0174584. eCollection 2017.


Objectives: Antibiotic overprescribing in primary care has major impacts on the development of antibiotic resistance. The objective of this study is to provide insight in antibiotics prescriptions for patients suffering from cough, acute bronchitis or community acquired pneumonia in primary care.

Methods: Data from 2009 to 2013 of electronic health records of 12,880 patients in Germany were obtained from a research database. The prescription of antibiotics for acute lower respiratory tract infections was compared to the national S3 guideline cough from the German Society of General Practitioners and Family Medicine.

Results: Antibiotics were prescribed in 41% of consultations. General practitioners' decision of whether or not to prescribe an antibiotic was congruent with the guideline in 52% of consultations and the antibiotic choice congruence was 51% of antibiotic prescriptions. Hence, a congruent prescribing decision and a prescription of recommendation was found in only 25% of antibiotic prescriptions. Split by diagnosis we found that around three quarters of antibiotics prescribed for cough (73%) and acute bronchitis (78%) were not congruent to the guidelines. In contrast to that around one quarter of antibiotics prescribed for community acquired pneumonia (28%) were not congruent to the guidelines.

Conclusions: Our results show that there is a big gap between guideline recommendation and actual prescribing, in the decision to prescribe and the choice of antibiotic agent. This gap could be closed by periodic quality circles on antibiotic prescribing for GPs.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchitis / drug therapy
  • Community-Acquired Infections / drug therapy
  • Cough / drug therapy
  • Drug Prescriptions / standards
  • Drug Prescriptions / statistics & numerical data
  • Family Practice / standards
  • Family Practice / statistics & numerical data
  • Female
  • General Practitioners / standards
  • General Practitioners / statistics & numerical data
  • Germany
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Pneumonia / drug therapy
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / standards
  • Primary Health Care / methods
  • Primary Health Care / standards*
  • Respiratory Tract Infections / drug therapy*
  • Young Adult


  • Anti-Bacterial Agents

Grant support

This work was supported by Bundesministerium für Bildung und Forschung,, Grant Number BMBF 01GK0601. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.