Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections J.-C. Peche `re a, *, C. Cenedese b , O. Mu ¨ ller c , B. Perez-Gorricho d , M. Ripoll e , A. Rossi f , J.-P. Stahl g , R. Stahlmann h , A. Tramarin i a Department of Microbiology, University of Geneva, 19 Krieg, 1208 Geneva, Switzerland b Department of Psychology, University of Padua, Padua, Italy c Private office, Lambrecht, Germany d Hospital Nino Je ´sus, Madrid, Spain e Private office, Avila, Spain f Italian College of General Practioners, Terni, Italy g CHU, Grenoble, France h University Franklin, Berlin, Germany i Hospital S. Bartolo, Vicenza, Italy Received 28 May 2002; accepted 18 July 2002 Abstract The aim of this study was to determine patients’ perceptions of antibiotic therapy and the doctor’s skill in the management of ambulatory respiratory tract infections. Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries. Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%). Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P B/0.01). They also scored more highly on the accurate use of antibiotics, with 80%/80% vs. 38%/62%, respectively (P B/0.01), understanding dosing intervals and 77%/77% vs. 36%/60% (P B/0.01), understanding the course length. Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs. 86% of the Ignored and Critical claiming to have taken every dose (P B/0.001) and 92%/87% vs. 84%/85% claiming to have finished the course (P B/0.001 for Involved only). Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs. 20%/31%, P B/0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs. 21%/15%, P B/0.001). By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient’s involvement in disease management, for a more appropriate use of antibiotics in common infections. # 2002 Published by Elsevier Science B.V. and International Society of Chemotherapy. Keywords: Antibiotic use; Patients; Clinical practice; Compliance 1. Introduction The majority of studies investigating physician  /pa- tient relationships have focused on the attitude of the doctor, the most common complaint being that doctors do not listen to their patients [1]. Studies on physician  / patient communication have focused primarily on the doctor’s communication style [2  /5], the type and extent of information provided [6] and how this impacts patient satisfaction with treatment [6  /9] and compliance with therapeutic regimens [10  /16]. Patient characteris- tics have also been shown to influence the attitude to the physician and satisfaction with therapy [17]. A previous pan-European survey of patient attitudes to antibiotics and antibiotic use was conducted in 1993 in five EU countries and Turkey [18] and extended to a total of nine countries and some 5379 subjects [19]. The results highlighted some interesting inter-country differ- ences in terms of antibiotic use and misuse, with some * Corresponding author. Tel.:  /41-227895815; fax:  /41-227025702 E-mail address: pechere@cmu.unige.ch (J.-C. Peche `re). International Journal of Antimicrobial Agents 20 (2002) 399  /406 www.isochem.org 0924-8579/02/$ - see front matter # 2002 Published by Elsevier Science B.V. and International Society of Chemotherapy. PII:S0924-8579(02)00247-9