Evidence-based primary care treatment guidelines for skin infections in Europe: A comparative analysis

Abstract

Background:In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment eff ectiveness and control the development of resistance. Objectives: This study reviews primary care treatment guidelines for bacterial skin infections across Europe and assesses to what extent they are based on antibiotic resistance data. Methods: Thirteen primary care treatment guidelines were obtained from eight countries across Europe. Both the treatment recommendations and the underlying evidence were assessed. The class and dose of recommended antibiotics were investigated and compared using the World Health Organisation ' s standardized volume of Defi ned Daily Dose. Furthermore, analysis investigated whether guidelines included references to scientifi c publications about antibiotic resistance data, and whether these were of national origin. Results: Guidelines were included regarding common skin infections in primary care: Impetigo, Cellulitis, Erysipelas, Folliculitis and Furuncle. Results showed a high agreement across Europe: all recommended antibiotics are of the beta-lactam class and mainly in the small spectrum. The advised treatment durations are consistent; the dosages, however, vary considerably, with the highest dosages recommended in Sweden. Seven guidelines (54%) did not include scientifi c references related to resistance. Conclusion:There may be a lack of relevant national data on resistance. This study highlights the need to collect more national resistance data (particularly regarding beta-lactams) to create stronger evidence-based treatment guidelines for skin infections in Europe.

Antibiotic Exposure and Other Risk Factors for Antimicrobial Resistance in Nasal Commensal Staphylococcus aureus: An Ecological Study in 8 European Countries

“…Optimal empirical treatment in primary care should take into account AMR information from community-based patients [ 26 ]. However, AMR patterns vary widely across health care settings and across Europe [ 27 ], and information on relevant AMR patterns is often lacking in treatment guidelines, which could hamper the General Practitioner’s (GPs) choice for an effective antibiotic [ 28 ].…”

Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo

“…New Zealand (NZ) guidelines provide clear definitions, recommending oral antibiotics for systemic symptoms (fever, malaise), high risk of complications, not responding to first line treatment or where there are more than three lesions 19 20. While international guidelines display congruence in recommending oral antibiotics for systemic symptoms and failure of first-line treatment; definitions of severity employ vague terms such as ‘localised, extensive, numerous lesions or widespread’3 20–24 (table 3). This lack of clarity allows room for significant subjectivity and variation in clinical decision-making, potentially compromising antibiotic stewardship.…”

“…Australian early career GPs prescribed both topical and systemic antibiotics in 100/683 (14.6%) of new impetigo cases, despite there being no evidence to support combined use25 and no recommendation in guidelines 3 20–24. This may indicate confusion in the management of impetigo which may be avoided if combined treatment were specifically addressed in guidelines.…”

Alopecias Due to Drugs and Other Skin and Systemic Disorders

“…Follicular pustules usually are located under the beard and on the scalp, trunk, buttocks, and lower extremities [37][38][39].…”