Rational use of anti-tuberculosis drugs in the EU: better patient care and less drug resistance

Zumla, Alimuddin; Blasi, Francesco; Raviglione, Mario

doi:10.1183/09031936.00171611

Cited by 13 publications

(10 citation statements)

References 26 publications

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“…linezolid, meropenem and co-trimoxazole) [17][18][19][20][137][138][139]. On top of adequate public health attention aimed at protecting these new drugs from irrational use [11,140,141], research on how to include these new molecules into new, effective and shorter new LTBI regimens (also able to sterilise MDR-TB strains) facilitating adherence need to be intensified involving producers, regulatory authorities and national programmes under the WHO's coordination.…”

Section: Discussionmentioning

confidence: 99%

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Diel

Loddenkemper

Zellweger³

et al. 2013

Eur Respir J

159

133

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The introduction of new rapid diagnostic tools for tuberculosis (TB) and the promising TB drugs pipeline together with the development of a new World Health Organization Strategy post 2015 allows new discussions on how to direct TB control. The European Respiratory Society's European Forum for TB Innovation was created to stimulate discussion on how to best take advantage of old and new opportunities, and advances, to improve TB control and eventually progress towards the elimination of TB.While TB control is aimed at reducing the incidence of TB by early diagnosis and treatment of infectious cases of TB, TB elimination requires focus on sterilising the pool of latently infected individuals, from which future TB cases would be generated.This manuscript describes the three core components that are necessary to implement the elimination strategy fully. 1) Improve diagnosis of latent TB infected individuals. 2) Improve regimens to treat latent TB infection. 3) ensure public health commitment to make both 1) and 2) possible. Old and new evidence is critically described, focusing on the European commitment to reach elimination and on the innovative experiences and best practices available. @ERSpublications Diagnosis and treatment of latent TB infection is the core intervention to reach elimination

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Section: Discussionmentioning

confidence: 99%

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Diel

Loddenkemper

Zellweger³

et al. 2013

Eur Respir J

159

133

View full text Add to dashboard Cite

show abstract

“…3 4 Prescribing unnecessary antibiotics can be a drain on the National Health Service (NHS) resources, and can have serious consequences to patient health, including the risk of side effects and the antimicrobial resistance (AMR). 5 6 AMR has been described by the WHO as a serious issue that must be addressed with some urgency, 7 as well as being cited as a 'catastrophic threat' by the UK's Chief Medical Officer. 8 The delayed prescribing of antibiotics for RTI is a technique that can be used by health professionals to reduce unnecessary prescribing in primary care.…”

Section: Introductionmentioning

confidence: 99%

Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

et al. 2016

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ObjectiveTo identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care.DesignQualitative semistructured telephone interview study.SettingPrimary care general practices in England.Participants32 GPs from identified high-prescribing and low-prescribing general practices in England.MethodSemistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes.ResultsAll GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient–practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK.ConclusionsDelayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient–practitioner relationship.

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“…A cost-effective and rational introduction of new diagnostics and drugs in national programmes is needed, so that TB disease and infection are correctly diagnosed and new drugs preserve their efficacy [35].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis elimination: theory and practice in Europe

et al. 2014

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Although Europe identified the pathway to tuberculosis (TB) elimination in 1990, no information on programmes for country preparedness is available.A questionnaire investigating TB elimination activities was submitted to 38 national TB programme representatives of low TB incidence (,20 cases per 100 000 population) European countries/territories of the World Health Organization European region.Out of 31 providing a complete answer, 17 (54.8%) reported to have a dedicated national TB programme, 20 (64.5%) a national plan including TB elimination (13 (41.9%) including targets), 22 (71%) guidelines, 14 (45.2%) a specific budget for TB activities, and 23 (74.2%) TB reference centres. All countries reported having case-based electronic TB surveillance, 19 (61.3%) perform regular supervision, 12 (38.7%) have a monitoring and evaluation plan and five (16.1%) perform modelling. In three countries (9.7%), TB health services are free for insured individuals only. In 22 countries/territories (71%) not all TB drugs were available, while in 12 (38.7%) drug stock-outs have been described. Although high-risk group screening for latent TB infection is performed by the majority of countries, only 6 (19.4%) provided figures on preventive treatment completion rates.Not all elements identified as essential for country preparedness to achieve TB elimination are available in the countries surveyed. @ERSpublications As TB elimination interventions are sub-optimally applied, more training, awareness and political commitment are necessary

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Rational use of anti-tuberculosis drugs in the EU: better patient care and less drug resistance

Cited by 13 publications

References 26 publications

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

Tuberculosis elimination: theory and practice in Europe

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