Are insect bites responsible for the rise in summer flucloxacillin prescribing in United Kingdom general practices?

BACKGROUND: Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics. METHOD: This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites. RESULTS: A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3-89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July. CONCLUSIONS: Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting.

It can be difficult to know if redness, heat, swelling, and pain from insect bites are due to inflammation or infection. Prescribing unnecessary antibiotics may result in germs becoming resistant to antibiotics when needed. Ten general practices in England and Wales investigated their management of insect bites in the 6 months of April to September 2021 inclusive. There were 355 bites; women presented more often than men, and ages were from 3 to 89 years old, half of them were 30­69 years old. People mainly consulted their GP by phone with photos of their bites. Key symptoms were redness, itchness, heat, and pain. More people had itch than were taking antihistamines or using steroid cream. Most people (nearly 7 out of 10) were prescribed an oral antibiotic, usually flucloxacillin, which accounted for about 5% of total flucloxacillin prescribed in the practices. Only 2 in 100 people needed further hospital care. It is likely that general practice clinicians are over-using antibiotics for insect bites and that home management before seeking medical help with painkillers, antihistamines, and steroid creams could be used more. Now that we have baseline data, there is a need to set up studies to prove that these reduce antibiotic usage.

Do callers to the NSW Sexual Health Infoline attend the services they are referred to?

BACKGROUND: The NSW Sexual Health Infoline (SHIL) is a free and confidential sexual health information and referral line. The ability of Australian sexual health helplines to facilitate successful referrals has not been studied. In the present study, we sought to determine whether callers were successful in accessing the publicly funded sexual health services (PFSHS) or general practitioners (GP) they were referred to. METHODS: Callers to SHIL who were directly referred to a PFSHS or GP for HIV and/or sexually transmissible infection testing from 3 January to 31 March 2012 were offered a follow-up phone call 1 week later. RESULTS: Of 474 eligible callers, 190 (40%) agreed to disclose a first name and contact details and to be contacted by a study nurse on an agreed-upon date. One hundred and twenty (63%) callers were successfully contacted 1 week later; of these, 85% had attended or had a future appointment booked for testing. CONCLUSIONS: We conclude that among the study sample that was successfully followed up, most callers to the SHIL had attended or booked appointments to the services they were referred to.

The transaxillary, totally endoscopic approach for head and neck endocrine surgery in children.

PURPOSE: The purpose of this study was to assess the safety, efficacy, and learning curve for transaxillary, totally endoscopic (TATE) head and neck endocrine surgery in children. MATERIALS AND METHODS: Between June 2005 and October 2009, 31 children with head and neck endocrine problems were subjected to the TATE approach. Safety, efficacy, complications, and time of operation were assessed. DATA: Thirty-one children (mean age, 12.7 years; F:M, 5:1) underwent a TATE approach. Glands ranged in size from 10 g (in a small 5-year-old) to 63 g (in one 16-year-old). No cervical incisions were required and there were no conversions to open surgery. Three patients in our early experience underwent a robot-assisted procedure. Two patients suffered from hyperparathyroidism and had adenomas removed, using rapid PTH in the operating room to confirm immediate success. Of the remaining 29 children, 2 girls had an adenoma of the right thyroid lobe removed uneventfully, and the reminder all had Graves disease, which was treated successfully. Complications included transient hypocalcemia in 3 patients who were also on steroids for unrelated medical problems; transient neuropraxia in 3 patients with very large glands; 1 postoperative, lateral, subcutaneous hematoma that resolved uneventfully; and 1 asthmatic with a spontaneous apical pneumothorax that presented as subcutaneous gas in the neck, 6 hours after the surgery and which resolved with chest tube placement. Average operative time for the first 10 patients was 288 minutes and for the subsequent patients was 155 minutes (range, 92-210 minutes). CONCLUSIONS: The TATE approach appears to be as safe and effective as open surgery for cervical endocrinopathies in children. Only transient, minor complications were observed. Operative time significantly decreases with experience, making the length of surgery comparable to its open counterpart.