December 5, 2025Open Access

Prescribing practices for presumptive TB among private general practitioners in South Africa: a cross-sectional, standardized patient study

Puntos clave

High rates of antibiotic use, reaching 76.5%, were recorded among general practitioners for tuberculosis symptoms and may delay diagnosis.
In South Africa, a significant portion of prescriptions, 61.8%, were not on the essential medicines list, indicating potential oversight.
The study utilized a cross-sectional design to assess prescribing practices based on standardized patient presentations in Durban and Cape Town.
The findings raise concerns about antimicrobial misuse, healthcare costs, and diagnostic delays in treating tuberculosis cases.

Resumen

Medicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africas private health sector, where an estimated third of people with TB symptoms first seek care. Sixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB symptoms, HIV-positive; TB symptoms, a positive molecular test for TB, HIV-negative; and TB symptoms, history of incomplete TB treatment, HIV-positive. Prescribing practices were recorded in standardised exit interviews and analysed based on their potential to contribute to negative outcomes, including increased healthcare expenditures, antibiotic overuse or misuse, and TB diagnostic delay. Factors associated with antibiotic use were assessed using Poisson regression with a robust variance estimator. Between August 2018 and July 2019, 511 SP visits were completed with 212 GPs. In 88.5% (95% CI 85.2% to 91.1%) of visits, at least one medicine (median 3) was dispensed or prescribed and most (93%) were directly dispensed. Antibiotics, which can contribute to TB diagnostic delay, were the most common medicine (76.5%, 95%CI 71.7% to 80.7% of all visits). A majority (86.1%, 95%CI 82.9% to 88.5%) belonged to the WHO Access group; fluoroquinolones made up 8.8% (95% CI 6.3% to 12.3%). Factors associated with antibiotic use included if the SP was asked to follow-up if symptoms persisted (RR 1.14, 95%CI 1.04 to 1.25) and if the SP presented as HIV-positive (RR 1.11, 95%CI 1.01 to 1.23). An injection was offered in 31.9% (95% CI 27.0% to 37.2%) of visits; 92% were unexplained. Most (61.8%, 95%CI 60.2% to 63.3%) medicines were not listed on the South African Primary Healthcare Essential Medicines List. Prescribing practices among private GPs for persons presenting with TB-like symptoms in South Africa raise concern about inappropriate antimicrobial use, private healthcare costs and TB diagnostic delay.

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