Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study

Llor, Carles; Cots, Josep M.; Hernández, Sílvia; Ortega, Jesús; Arranz, Javier; Monedero, María José; Alcántara, Juan de Dios; Pérez, Carolina; García, Guillermo; Gómez, Manuel; Guerra, Gloria; Cid, Marina; Cigüenza, María Luisa; Pineda, Vicenta; Paredes, José Cristo Rey García; Burgazzoli, Juan Luis; Munck, Anders; Córdoba, Gloria; Bjerrum, Lars

doi:10.1016/j.aprim.2014.02.006

Cited by 24 publications

(36 citation statements)

References 21 publications

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“…Varying percentages of patients with RTIs receiving antibiotic therapy in Spain have previously been reported [2,5]. Llor et al [5], similarly to our findings, showed higher proportions of acute tonsillitis, sinusitis and acute otitis episodes being treated in Spanish primary health care compared with acute bronchitis and non-specific URTI episodes.…”

Section: Comparison With Existing Literaturesupporting

confidence: 79%

“…Llor et al [5], similarly to our findings, showed higher proportions of acute tonsillitis, sinusitis and acute otitis episodes being treated in Spanish primary health care compared with acute bronchitis and non-specific URTI episodes. The highest rates of antibiotic prescribing in our study population were found for young adults (aged 15-64 years).…”

Section: Comparison With Existing Literaturesupporting

confidence: 79%

“…Despite the fact that the benefit of antimicrobial treatment is rather low [3,4], a substantial number of patients with RTI are treated with antibiotics [5,6]. Diagnostic uncertainty characterizes the management of RTIs and doubt about the diagnosis and the aetiology may lead to antibiotic over-prescribing.…”

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confidence: 99%

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Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Malo

Bjerrum

Feja

et al. 2014

Basic Clin Pharma Tox

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Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bacterial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evaluating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and antibiotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifaceted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.Antimicrobial resistance is a major concern to the public health and may result from indiscriminate or poor use of antibiotics [1].Infectious diseases are the most frequent reason for encounter in primary care, and respiratory tract infections (RTIs) account for about two-thirds of all infections seen by the general practitioner (GP) [2]. Despite the fact that the benefit of antimicrobial treatment is rather low [3,4], a substantial number of patients with RTI are treated with antibiotics [5,6]. Diagnostic uncertainty characterizes the management of RTIs and doubt about the diagnosis and the aetiology may lead to antibiotic over-prescribing. Other factors such as patient preferences, fears of getting sued and fear of serious complications may influence the GP's prescribing decision [7].Studies have found a substantial gap between recommendations in evidence-based practice guidelines and doctors' actual prescribing behaviour [8].Compared with other European countries, Spain has historically displayed a high outpatient antibiotic use. The majority of antibiotics prescribed are broad-spectrum agents, and there are remarkable seasonal fluctuations reflecting an inappropriate prescribing of antibiotic for RTIs caused by viruses [9]. Consequently, resistance rates of the main respiratory pathogens remain high in Spain, although a decreasing trend has been observed in the last years [10].According to the disease-specific quality indicators for outpatient antibiotic prescribing developed by the European Surveillance Antimi...

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Section: Comparison With Existing Literaturesupporting

confidence: 79%

Section: Comparison With Existing Literaturesupporting

confidence: 79%

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Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Malo

Bjerrum

Feja

et al. 2014

Basic Clin Pharma Tox

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“…De hecho, la sensibilidad del juicio clínico oscila entre el 49 y 74% y la especificidad entre el 58 y 76% (8). Además, los médicos de Atención Primaria evalúan los distintos criterios de Centor de manera diferente; así, en España, los médicos dan mucho más peso al exudado faringoamigdalar en una FAA, ya que prescriben antibióticos 28 veces más si este signo está presente que a los otros 3 criterios (menos de 5 veces más si estos criterios se presentan) (29).…”

Section: Escalas De Predicciónunclassified

Guía clínica para el manejo de la faringoamigdalitis aguda del adulto

Yago¹,

Cortés²,

Caamaño³

et al. 2015

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RESUMENLa faringoamigdalitis aguda (FAA) en el adulto es una de las enfermedades infecciosas más comunes en la consulta del médico de familia. La etiología más frecuente es viral. Dentro de la etiología bacteriana, el principal agente responsable es Streptococcus pyogenes o estreptococo β-hemolítico del grupo A (EBHGA), causante del 5-30% de los casos. En el manejo diagnóstico las escalas de valoración clínica, para predecir la posible etiología bacteriana, son una buena ayuda para seleccionar a qué pacientes se deben practicar las técnicas de detección rápida de antígeno estreptocócico. Es conocido que, en general, sin estas técnicas, se tiende al sobrediagnóstico de FAA estreptocócica, con la consiguiente prescripción innecesaria de antibióticos, muchas veces de amplio espectro. Así, con el manejo de las escalas y la técnica de diagnóstico rápido, elaboramos los algoritmos de manejo de la FAA. Los objetivos del tratamiento son acelerar la resolución de los síntomas, reducir el tiempo de contagio y prevenir las complicaciones supurativas locales y no supurativas. Los antibióticos de elección para el tratamiento de la FAA estreptocócica son penicilina y amoxicilina. La asociación de amoxicilina y clavulánico no está indicada en el tratamiento inicial en la infección aguda. Los macrólidos tampoco son un tratamiento de primera elección; su uso debe reservarse para pacientes con alergia a la penicilina. Es importante en nuestro país adecuar tanto el diagnóstico de la FAA bacteriana y la prescripción de antibióticos a la evidencia científica disponible. La implantación de protocolos de actuación en las farmacias comunitarias puede ser de utilidad para identificar y cribar los casos que no requieran tratamiento antibiótico. ABSTRACTThe acute pharyngotonsillitis (APT) in adults is one the most common infectious diseases in the family physician's surgery. The most frequent etiology is viral. Within the bacterial etiology, the main agent responsible is Streptococcus pyogenes or streptococcus β-GROUP A hemolytic (EBHGA), causing 5-30% of cases. In the diagnostic management, to predict the possible bacterial etiology, clinical evaluation scales are a good help for selecting which patients should undergo quick detection techniques for the streptococcic antigen. It is known that, in general, without these techniques streptococcic APT tends to be overdiagnosed, with the ensuing unnecessary prescription for antibiotics, often broad-spectrum. Thus, with the management of the steps and the quick diagnosis technique, we can draw up algorithms for managing APT. The objectives of the treatment are to accelerate the resolution of symptoms, reduce contagion time and prevent local suppurative and non-suppurative complications. The antibiotics of choice for treating streptococcic APT are penicillin and amoxicillin. The combination of amoxicillin and clavulanic acid is not indicated for the initial treatment of acute infection. Macrolides are not a first-choice treatment either; their use must be reserved for patients with allergy to pe...

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“…Todos los derechos reservados. la prescripción antibiótica; sin embargo, el grupo de médicos que además participó en un taller sobre pruebas rápidas y estas se introdujeron en sus centros de trabajo, la reducción fue mucho más importante, principalmente en las infecciones con una etiología mayoritariamente viral 9 . En un ensayo clínico reciente efectuado en 33 centros de Estados Unidos en el que se comparaba la efectividad de 2 programas de implementación de un soporte de apoyo basado en algoritmos clínicos en la bronquitis aguda, tanto la implementación de estos algoritmos de forma impresa como por ordenador fueron ligeramente más efectivas que el grupo asignado a control, con una reducción de un 12% de prescripción antibiótica (80 a 68%) 10 .…”

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Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study

Abstract: Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.

Cited by 24 publications

References 21 publications

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Guía clínica para el manejo de la faringoamigdalitis aguda del adulto

Utilidad de los programas de intervención para la mejora de la prescripción antibiótica

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