Rapid diagnostics and targeted physician education can help to further reduce inappropriate use of antibiotics more effectively. The author of the doctoral research study “Prescribing Patterns of Antibacterial Therapy for Children with Acute Infections in Primary Care in Latvia and the Impact of Multifactorial Interventions on Antibiotic Prescribing”, Zane Līkopa, emphasizes:
“In primary care, decisions often have to be made immediately, and without diagnostic tools there is a risk of prescribing antibiotics ‘just in case’.”
Why is this topic important for every family?
Zane Līkopa works daily at the Emergency Department of the Children’s Clinical University Hospital, where she often encounters cases of unjustified initiation of antibacterial therapy. It was precisely this experience that prompted her to focus on the primary care level — the place where the first and often decisive decisions are made.
“In the hospital, we have broader diagnostic possibilities. I wanted to understand how to help doctors earlier — in the family doctor’s office,” the researcher explains.
Antibiotics are one of the most significant achievements of medicine, but their excessive and inappropriate use contributes to antimicrobial resistance — a situation in which bacteria become insensitive to treatment. This is a global public health challenge, and Latvia is no exception.
Children are a particularly sensitive group in this context. In preschool age, most acute illnesses are caused by viruses and resolve on their own; however, in practice, antibiotics are still often prescribed in such cases. This is precisely why it is important to understand how family doctors make decisions about antibacterial therapy and whether these decisions can be changed.
A two‑phase study in family doctor practices: education and C‑reactive protein testing at the point of care
The doctoral thesis analysed data from 80 family doctor practices in different regions of Latvia. The study was conducted in two phases, comparing routine practice with a situation in which doctors received a multifactorial intervention — educational seminars and the opportunity to use a rapid C‑reactive protein (CRP) test at the point of patient care. This test makes it possible to determine the level of inflammation in the body already during the visit, using a small capillary blood sample. It is particularly suitable for children and can help distinguish between viral and bacterial infections, which often appear clinically similar.
29% of children receive antibiotics, but often in cases of viral infections
The study data show that 29% of children received antibiotics, which is a relatively low figure in the international context. However, a problematic trend was also identified — antibacterial therapy was often prescribed in cases of rhinopharyngitis or bronchitis, where viral infections predominate, and already in the first days of illness. Approximately one third of the prescribed antibiotics were broad‑spectrum preparations that do not comply with guidelines and may contribute to the development of resistance in the long term.
Do education and testing change doctors’ habits?
Interestingly, the interventions did not reduce the overall frequency of antibiotic prescribing to a statistically significant extent. One of the reasons is the already relatively cautious use of antibiotics at baseline, as well as a possible lack of clear guidelines for the interpretation of CRP tests in children. However, several positive changes were observed. For example, doctors more often used the delayed prescription approach, where the doctor prescribes antibiotics but agrees with the patient’s parents not to start using the medication immediately, but only if the previously agreed conditions occur. Likewise, family doctors’ decisions were less frequently based solely on clinical assessment, and the use of diagnostic tests in regional family doctor practices increased significantly. This indicates that rapid diagnostics can be an important support in everyday practice, especially in regions with limited access to laboratory testing.
Zane Līkopa’s study reveals that whether antibiotics are prescribed is significantly influenced by the individual habits and professional experience of the physician.
For more experienced doctors, changes may be more difficult to implement; therefore, targeted, personalised professional development and feedback on practice data are particularly important. At the same time, the study highlights the need to improve guidelines for children, especially regarding the use of the CRP test at the point of care.
“Only by combining education, diagnostics, and clear recommendations is it possible to achieve lasting change,” the researcher is convinced.
The summary of Zane Līkopa’s doctoral thesis is available in the RSU e-resource repository.
