Knowledge of pneumococcal resistance rates in Spain by family doctors

Abstract

Aim:

To know the knowledge of Spanish physicians related to pneumococcal resistance rates in an a country known to be one of the places with higher pneumococcal resistance rates and to know as well the choice of antibiotics in cases of suspected high penicillin-resistant pneumococcal pneumonia.

Design:

A cross-sectional survey was set out in November during the Spanish Conference on Medicine Family held in Donosti (Basque).

Methods:

All the participants who filled up a questionnaire were given a present at the Aventis Pharma's stand at the Conference. They were asked about the perception of resistance rates of Streptococcus pneumoniae towards penicillins and macrolides in Spain and whether they agreed on using macrolides and quinolones in cases of suspected high penicillin-resistant pneumococcal infections.

Results:

843 family doctors filled up the questionnaire and 35 inquiries were dropped out because of illegibility or non responses. Out of 750 doctors who answered the question about the pneumococcal resistance towards penicillins, 312 stated to be greater than 30% (41.6) and only 90 thought to be less than 15% (12%). However, 153 doctors stated that pneumococcal resistance to macrolides was greater than 30% (23%) and 28 greater than 45% (4.2%). Respondents prefer the use of penicillins in patients with community-acquired pneumonia (344, 42.6%) but were reluctant to prescribe them in case of pneumonias suspected to be caused by resistant pneumococci (82, 10.3%). In these cases family doctors prefer the use of macrolides (251, 31.5%) and quinolones (321, 40.3%).

Conclusions:

Family doctors are aware of high resistance patterns but they think that higher pneumococcal resistance rates are reported towards penicillins than to macrolides; however, 30% of the Spanish pneumococcal strains isolated are currently resistant to macrolides and only 5% are highly resistant to penicillins. They also think that penicillin still is the first antibiotic choice in pneumococcal infections unless a resistant pneumococcus is suspected. Surprisingly, in suspected penicillin-resistant pneumococcal pneumonias too many doctors recommend the prescribing of macrolides instead of quinolones.