Presented in V. National Congress of Family Medicine in Adana, 27-30 March, 2002.


Cahit OZER, Zekeriya AKTURK, Nezih DAGDEVIREN, Melih E. SAHIN
Trakya University Medical Faculty Department of Family Medicine, Edirne, Turkey

Dr. Cahit OZER
Trakya University Medical Faculty
Department of Family Medicine,
22030 Edirne, Turkey
Mobile Phone: +90 533 4530917
Phone :+902842356380
Fax: +90 284 2357652


Problem: Overprescription of antibiotics for acute respiratory infections results in increased antimicrobial resistance, and adds a significant cost to the health care.
Aim: To see the effectiveness of a semi-structured evaluation tool with one-on-one patient education in reducing patient expectations of antibiotics for the treatment of acute respiratory infections.
Methods: A randomized double-blinded controlled trial in 33 children with acute respiratory symptoms and their parents.
Results: Antibiotic expectation rates of the study and control group for fever (15,1 % versus 64,3 %), cough (30,3 % versus 60 %), and sore throat (71,8 % versus 93,1 %) differed significantly (p<0,05). Symptom-based (3,35 ± 1,14) and total behavior scores (4,38 ± 1,70) were significantly higher in the study group than the control group (p<0,05).
Discussion: Use of an evaluation tool combined with one-on-one patient education was found successful for changing antibiotic related behavior and reducing antibiotic expectations of parents for acute respiratory infections.
Key words:
Antibiotics, patient education, respiratory infections.
Abbreviation: ARIs: Acute Respiratory Infections



Acute Respiratory Infections (ARIs) are quite common in primary care (1). Although they are mild, self-limiting infections, they are a primary reason for school and work absence (2). Lack of effective and widely approved tools or guidelines for the management of ARIs causes great differences across practices of physicians.

Antibiotics neither shorten the course of the illness nor prevent secondary bacterial infection (3). Although they are not indicated, antibiotics are widely used in outpatient practice to treat ARIs (4,5). The overuse has been suggested as a contributing factor in the rise of antimicrobial resistance (6) adding a significant cost to the care of these patients (7).

Parental expectations on drug prescription for mild and simple diseases are most likely dependent on their educational level, socio-economic background and cultural and religious background.

Patient education can be defined as a learning experience using a combination of methods such as teaching, counseling and behavior modification techniques, which influence patient’s knowledge and health behavior. Health information provided by physicians is a type of patient education valued by patients.

In this study we examined the effectiveness of a semi-structured evaluation tool with one-on-one patient education for reducing parental expectations of antibiotics in the treatment of ARIs.


This study was conducted in two stages. In the first stage, children younger than 17 years admitted to Trakya University Family Practice Center with symptoms related to respiratory tract on every Mondays between January and April 2001 were evaluated with a semi-structured examination tool (Figure 1). The same physician practiced all children on every Mondays through the study period for standardization. The attending physician educated the parents orally about ARIs and antibiotics. Evaluation and education time was limited with 15 minutes; education covering about 5 minutes. The parental education was prepared through American Academy of Family Physicians’ recommendations for health information (8).