Primary care clinicians perceptions of antibiotic resistance: a multi-country qualitative interview study

Primary care clinicians’ perceptions of antibiotic resistance: a multi-country qualitative interview study

Fiona Wood1,*, Carys Phillips1, Lucy Brookes-Howell2, Kerenza Hood2, Theo Verheij3, Samuel Coenen4, Paul Little5, Hasse Melbye6, Maciek Godycki-Cwirko7, Kristin Jakobsen6, Patricia Worby5, Herman Goossens4 and Christopher C. Butler1

+ Author Affiliations

1Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, UK

2South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, UK

3Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

4University of Antwerp-Campus, Drie Eiken, Vaccine & Infectious Disease Institute–Laboratory of Medical Microbiology, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium

5Faculty of Medicine and Health and Life Sciences, Southampton University, Southampton General Hospital, Southampton, UK

6General Practice Research Unit, Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway

7Department of Family and Community Medicine, Medical University of Łódź, ul. Kopcinskiego 20, 92-740 Łódź, Poland

↵*Corresponding author. Tel: +44-29-2068-7192; Fax: +44-29-2068-7219; E-mail:

Received May 17, 2012.

Revision requested June 27, 2012.

Revision received July 19, 2012.

Accepted July 25, 2012.


Objectives To explore and compare primary care clinicians’ perceptions of antibiotic resistance in relation to the management of community-acquired lower respiratory tract infection (LRTI) in contrasting European settings.

Methods Qualitative interview study with 80 primary care clinicians in nine European countries. Data were subjected to a five-stage analytical framework approach (familiarization; developing a thematic framework from the interview questions and the themes emerging from the data; indexing; charting; and mapping to search for interpretations in the data). Preliminary analysis reports were sent to all network facilitators for validation.

Results Most clinicians stated that antibiotic resistance was not a problem in their practice. Some recommended enhanced feedback about local resistance rates. Northern European respondents generally favoured using the narrowest-spectrum agent, motivated by containing resistance, whereas southern/eastern European respondents were more motivated by maximizing the potential of a rapid treatment effect and so justified empirical use of broad-spectrum antibiotics. Antibiotic treatment failure was ascribed largely to viral aetiology rather than resistant bacteria. Clinicians generally agreed that resistance will become more serious without enhanced antibiotic stewardship or new drug discovery.

Conclusions If current rates of antibiotic resistance are likely to result in important treatment failures, then provision of local resistance data is likely to enhance clinicians’ sense of importance of the issue. Interventions to enhance the quality of antibiotic prescribing in primary care should address perceptions, particularly in the south and east of Europe, that possible advantages to patients from antibiotic treatment in general, and from newer broad-spectrum compared with narrow-spectrum agents, outweigh disadvantages to patients and society from associated effects on antibiotic resistance.

Key words

primary healthcare respiratory tract infections qualitative research

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