Showing posts with label antibiotic use. Show all posts
Showing posts with label antibiotic use. Show all posts

Thursday, December 27, 2012

Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections.

Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections.

Dec 2021

Source

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.

Abstract


BACKGROUND:

Antibiotic use and concomitant resistance are increasing. Literature reviews do not unambiguously indicate which interventions are most effective in improving antibiotic prescribing practice.

AiM:

To assess the effectiveness of physician-targeted interventions aiming to improve antibiotic prescribing for respiratorytract infections (RTIs) in primary care, and to identify intervention features mostly contributing to intervention success.


DESIGN AND SETTING:

Analysis of a set of physician-targeted interventions in primary care.

METHOD:

A literature search (1990-2009) for studies describing the effectiveness of interventions aiming to optimise antibiotic prescription for RTIs by primary care physicians. Intervention features were extracted and effectiveness sizes were calculated. Association between intervention features and intervention success was analysed in multivariate regression analysis.

RESULTS:

This study included 58 studies, describing 87 interventions of which 60% significantly improved antibioticprescribing; interventions aiming to decrease overall antibiotic prescription were more frequently effective than interventions aiming to increase first choice prescription. On average, antibiotic prescription was reduced by 11.6%, and first choice prescription increased by 9.6%. Multiple interventions containing at least 'educational material for the physician' were most often effective. No significant added value was found for interventions containing patient-directed elements. Communication skills training and near-patient testing sorted the largest intervention effects.

CONCLUSION:

This review emphasises the importance of physician education in optimising antibiotic use. Further research should focus on how to provide physicians with the relevant knowledge and tools, and when to supplement education with additional intervention elements. Feasibility should be included in this process.

PubMed

Monday, November 12, 2012

What parents should know about antibiotics


What parents should know about antibiotics


Nov 12, 2012

Staff Writer
This week marks Get Smart About Antibiotics Week, an annual effort to educate people about antibiotic resistance and the importance of appropriate antibiotic use.
Each year, tens of millions of antibiotics prescribed in doctors’ offices are for viral infections, which cannot effectively be treated with antibiotics, according to the Centers for Disease Control and Prevention.
We asked Dr. Navjyot K. Vidwan , a pediatric infectious diseases physician at Dayton Children’s and an assistant professor at the Wright State University Boonshoft School of Medicine, to talk about the proper use of antibiotics for children, who have the highest rates of antibiotic use, according to the CDC.
Q: From Nov. 12-18, Dayton Children’s is promoting Get Smart About Antibiotics Week. What is the main mission of this week?
A: “We want to promote the message to be smart with our use of antibiotics. Antibiotics should be used to treat bacterial infections but are not effective against viral infections like the common cold, most sore throats and the flu. Widespread and/or incorrect use of antibiotics promotes the spread of antibiotic resistance.”
Q: When is it appropriate for children to take an antibiotic?
A: “Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria, not viruses. If your child is ill, seek guidance with your health care provider. Your health care provider will discuss the history of illness, clinical symptoms, and possibly do some lab tests to help determine if your child has a viral or bacterial illness.”
Q: When is it not appropriate for children to take an antibiotic?
A: “Do not take an antibiotic for a viral infection with symptoms such [as] a runny nose, sore throat, sneezing and coughing. Keep in mind that over 200 viruses can cause the common cold and that symptoms can last for up to two weeks. Also, you should not save some of your antibiotic from a past illness and use it for a new illness on your child. We recommend you discard any leftover medication once you have completed any prescribed courses of treatment. In addition, please complete the prescribed course of treatment even if you are feeling better. If your pediatrician concludes that you do not have a bacterial infection, feel free to ask about ways to help relieve your symptoms.”
Q: How can parents determine whether their children are suffering from a bacterial infection or a viral infection?
A: “Viral infections typically have cold-like symptoms, including runny nose, sneezing, sore throat and fever. Other family members may also have similar symptoms. Parents should consider seeking medical attention if their child starts to appear clinically worse, has consistently elevated temperatures higher than 100.4 degrees F, has symptoms lasting more than 10 days and has symptoms that are not relieved by over-the-counter medicines. Feel free to seek help from your pediatrician when you are concerned about your child’s condition. If your child is younger than 3 months of age and has a fever, it’s important to always call your health care provider right away.”
Q: According to the Centers for Disease Control and Prevention, tens of millions of antibiotics are prescribed in doctors’ offices annually for viral infections that are not treatable with antibiotics. Why are antibiotics often mistakenly prescribed for viral infections?
A: “Some bacterial and viral infections can both present with fever. Sometimes, it is difficult to distinguish between the two presentations. Sometimes, the health care provider is not able to perform a full exam on a child if not fully cooperative. In addition, parent pressure also makes a difference. In regards to pediatrics, a study showed that doctors prescribe antibiotics 62 percent of the time if they perceive parents expect them [to] and 7 percent of the time if they feel parents do not expect them [to].”
Q: If a child does not have a bacterial infection and takes an antibiotic, what possible negative effects may result?
A: “The term ‘antibiotic resistance’ means that when a person takes an antibiotic, the sensitive bacteria to the antibiotic is killed. However, it is important to understand that there is always a potential that resistant germs may be left over to grow and replicate and become more difficult to treat with the antibiotics available. The main reasons for an increase of antibacterial resistance are repeated and improper uses of antibiotics. The Centers for Disease Control states, ‘When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.’”
  • “Be informed about what antibiotics are and why they are used. Viruses cannot be treated with antibiotics.”
  • “Seek medical attention to help determine if your child has a virus or a bacterial infection.”
    • “Do not push for antibiotics when they are not needed.”
    • “You should not save some of your antibiotic from a past illness and use it for a new illness on your child. We recommend you discard any leftover medication once you have completed any prescribed courses of treatment.”
    • “Complete the prescribed course of treatment even if you are feeling better.”
    • “If your pediatrician concludes that you do not have a bacterial infection, feel free to ask about ways to help relieve your symptoms.”
    • “Practice good hand hygiene.”
    • “Get vaccinated for vaccine preventable infections.”

    Sunday, September 20, 2009

    Rational antibiotic use.

    ItalicRational antibiotic use.

    J Infect Dev Ctries. 2009 Mar

    Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H.
    Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
    otunger@hotmail.com

    BACKGROUND: Development of resistance to antimicrobial agents and increase of cost as the result of unnecessary and inappropriate use of antibiotics has become a global health problem. Therefore many strategies, which are aimed at optimizing antibiotic therapy, have been developed until now. In Turkey, an antibiotic restriction policy as a governmental solution was applied to decrease the antibiotic use and especially costs by Ministry of Health in 2003. The aim of this study is to evaluate the rational antibiotic use and the impact of the implementation of new restriction policy, with their reinforcement by infectious disease specialist, on the hospital wide use of antibiotics.

    METHODOLOGY: The data of the inpatients received antibiotics (n=495) during January-June 2006 were compared with our previous study performed by the same methodology before the restriction policy in 1998. In both studies, prospective active daily surveillance of patients was performed by three infectious disease specialists. The appropriateness of antibiotic therapy was determined using the criteria described by Kunin and Jones. The data were analyzed by using SPSS for Windows.

    RESULTS: Thirty-seven patients were treated for burn cellulitis, 26 (70%) of whom were treated initially with continuous-infusion oxacillin. Other initial antibiotics were chosen because of concomitant infections, penicillin allergy, or development of cellulitis during treatment with a beta-lactam antibiotic. Oxacillin treatment was successful in 19 patients (73%). Success required an average of 5.16 days, with 1.53 days required for fever resolution and 0.89 days for resolution of leukocytosis. Seven patients who did not respond rapidly were switched to intravenous vancomycin an average of 2.4 days after starting oxacillin, leading to a 100% success rate. There were no deaths, and only one suspected case of allergic reaction to oxacillin. In eleven patients treated with other antibiotics, the success rate was 75%. Success with these drugs required a longer treatment course of 6.45 days. Leukocytosis resolved significantly more slowly at 4.45 days -p equals 0.02-, and fever resolution was also slower at 3.18 days.

    CONCLUSIONS: Continuous-infusion oxacillin was successful in the treatment of 73% of patients, a success rate that might have been higher with clinical patience, and leukocytosis resolved faster than with other antibiotics. Failure of continuous-infusion oxacillin can be managed without clinical consequence by conversion to intravenous vancomycin.


    PubMed