Table 7 presents the five indications that were most commonly involved in partial compliance: bronchitis, CAP, pharyngitis, urinary tract infections (UTIs) and sinusitis. Again, we used the criteria of 5% to make that determination. Based on the percentage of deviant prescriptions, UTIs (71%) and pharyngitis (59%) were particularly involved in partial compliance. In the case of pharyngitis, two-thirds of the problems originated from the dose prescribed. It should be specified that the majority of these cases may be explained by the fact that a dose of 300 mg three times daily of oral penicillin is recommended in the Ontario guidelines and that a dose of 300 mg orally, four times daily was prescribed.
TABLE 7 Main indication associated with partial compliance
The other reason was that a 10 day course is recommended in Sanford’s Guide and about one-third of prescriptions failed to respect that recommendation. Concerning uncomplicated UTIs, prescribers selected a length of treatment different from the one recommended in both guidelines in over two-thirds of the deviant cases. The dose prescribed explains the remaining cases, particularly for ciprofloxacin which was prescribed at 500 mg orally twice daily as opposed to the recommended regimen of 250 mg orally twice daily. In the case of sinusitis, half of the prescriptions that were classified as ‘partial compliance’ failed to respect the minimal 10 day course. The other half concerns the dose prescribed, which, in the case of amoxicillin, was lower than the 500 mg orally three times daily recommended in both references. For deviant cases of bronchitis, the dose prescribed was the problem, particularly in the case of erythromycin, which was prescribed at a dose exceeding the 250 mg orally four times daily recommended. Finally, regarding CAP, the antibiotic dose prescribed was different than the recommendations in three of the 32 prescriptions analyzed.