{
  "abstract": "Objectives Inappropriate diagnosis of common infections is a widespread issue, with diagnostic errors frequently occurring in infectious diseases, particularly in primary care. Benign viral infections, especially lower respiratory tract infections (LRTIs), are commonly misdiagnosed, leading to unnecessary antibiotic prescriptions, even though most infections are viral and self-limiting. This study was aimed at exploring the diagnoses of LRTIs across five European countries. and highlights issues relevant to antibiotic prescription.Method As part of the HAPPY PATIENT project, a study was conducted across four settings in five European countries (France, Greece, Lithuania, Poland, and Spain) to evaluate the impact of a multifaceted intervention designed to guide healthcare professionals in reducing inappropriate antibiotic use. For the purpose of this study, clinicians in two settings—primary care consultations and out-of-hours services—recorded LRTI diagnoses, symptoms, antibiotic prescriptions, and other details using a paper-based self-registry template over two periods from February to April in 2022 and 2023.Results A total of 196 clinicians (133 in general practice, 63 in out-of-hours services) registered 2,215 LRTI cases. The mean percentage of community-acquired pneumonia varied among countries, ranging from 17.8% in Spain to 46.4% in Lithuania. Acute bronchitis episodes also showed wide variation, with Poland, Spain, and France reporting over 60% of cases, while Greece and Lithuania reported less than 50%. Symptom presentation varied significantly: 75.3% of pneumonia cases in Spain presented with fever, while Lithuania had the highest proportion of fever in acute bronchitis cases (49.4%). Antibiotic prescribing also varied widely, with 61.3% of LRTI patients receiving antibiotics, ranging from 46.5% in Spain to 77.4% in Poland. The variation was even greater for acute bronchitis, ranging from 20% in France to 80.4% in Greece. France and Spain, which labelled fewer LRTIs as pneumonia, had the lowest rates of antibiotic prescribing overall.Conclusions We observed that the proportion of labelled pneumonia can vary significantly, with rates nearly three times higher in one country compared to another. There is no reason to believe that pneumonias account for a higher proportion of LRTIs in one country over another. Cross-country differences in diagnosing LRTI symptoms—potentially driven by diagnostic uncertainty and varying medical practices—contribute to the overprescription of antibiotics. There is no single symptom or sign that definitively indicates pneumonia, making it difficult to distinguish from acute bronchitis in primary care. While point-of-care tests and chest X-rays could aid diagnosis, the use of C-reactive protein rapid testing is not widespread in these countries, and routine X-rays for every case of cough and fever are not recommended due to high costs and radiation risks. Valid diagnostic tools are essential to mitigate overdiagnosis and unnecessary antibiotic use.",
  "authors": [
    {
      "affiliations": [
        "University Primary Care Research Institute Jordi Gol, Barcelona, Spain"
      ],
      "name": "Ana García"
    },
    {
      "affiliations": [
        "University Primary Care Research Institute Jordi Gol, Barcelona, Spain"
      ],
      "name": "Carl Llor"
    },
    {
      "affiliations": [
        "University Primary Care Research Institute Jordi Gol, Barcelona, Spain"
      ],
      "name": "Ana Moragas"
    },
    {
      "affiliations": [
        "Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark",
        "Center for General Practice, Aalborg University, Aalborg, Denmark"
      ],
      "name": "Malene Plejdrup Hansen"
    },
    {
      "affiliations": [
        "Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Norway"
      ],
      "name": "Jesper Lykkegaard"
    },
    {
      "affiliations": [
        "Department of General Practice, Inst. of Health and Society, University of Oslo, Oslo, Norway"
      ],
      "name": "Bent Håkan Lindberg"
    },
    {
      "affiliations": [
        "NORCE Norwegian Research Centre AS, Bergen, Bergen, Norway"
      ],
      "name": "Ingrid Rebnord"
    },
    {
      "affiliations": [
        "Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece"
      ],
      "name": "Christos Lionis"
    },
    {
      "affiliations": [
        "Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece"
      ],
      "name": "Marilena Anastasaki"
    },
    {
      "affiliations": [
        "Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland"
      ],
      "name": "Anna Kowalczyk"
    },
    {
      "affiliations": [
        "Ltd Mano Seimos Gydytojas (My Family Doctor), Klapeida, Lithuania"
      ],
      "name": "Ruta Radzeviciene"
    },
    {
      "affiliations": [
        "Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania"
      ],
      "name": "Lina Jaruseviciene"
    },
    {
      "affiliations": [
        "Department of Public Health, Nice University Hospital, Nice, France"
      ],
      "name": "Pascale Bruno"
    },
    {
      "affiliations": [
        "Department of Public Health, Nice University Hospital, Nice, France"
      ],
      "name": "Pia Toubol Lundgren"
    },
    {
      "affiliations": [
        "Department of Quantitative Methods for Economics and Management, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Laura Vallejo-Torres"
    },
    {
      "affiliations": [
        "Department of Quantitative Methods for Economics and Management, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Beatriz González López-Valcárcel"
    },
    {
      "affiliations": [
        "Department of Clinical Microbiology, Copenhagen University Hospital – Herlev and Gentofte Hospital, Copenhagen, Denmark"
      ],
      "name": "Jette Nygard Jensen"
    }
  ],
  "title": "086 Potential overdiagnosis of community-acquired pneumonia in primary care. Comparison across five European countries",
  "uid": "5e8c2115-337e-58b8-8930-20071b0ce3e7"
}