Use of antimicrobials and carriage of penicillin-resistant ... - Hirsla

190 V. A. Arason et al.The incidence of respiratory tract infections mayvary between areas. There may also be a tendency tounder-diagnose AOM in some areas and overdiagnoseAOM in others. Furthermore, the variousareas may have different treatment traditions/culturesin relation to the clinical problem in question.A recent study by Gabbay and Le May addressed thephenomenon of varying clinical ‘‘mindlines’’ amongprimary health care practices in the UK [20].Parents in areas where antimicrobial drug usagewas lowest and broad-spectrum antimicrobialsmost rarely prescribed appeared to be better informedabout the benefits of restrictive use ofantimicrobial drugs for upper respiratory tractinfections. These variations in parental attitudemay be important as primary care physicians maintainthat parental pressure and expectations inrelation to antimicrobial drug prescriptions representan important barrier to a restrictive prescribingpractice [2,21/27].Our results demonstrate an association betweenthe use of antibiotics, parental views about antimicrobialtreatment, and use of tympanostomy tubeplacements. However, it is impossible to say whetherthe associations between antimicrobial use for AOMand tympanostomy tube placements are due todirect causal effects or because of differences inmedical practice. The possibility of a direct positivecorrelation between antimicrobial drug (over) usefor AOM, future episodes of AOM, and tympanostomytube placement later warrants further investigation.AcknowledgementsThe authors would like to thank all the children andparents who participated in the study and the generalpractitioners who assisted in the study areas. 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