[Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?]. / ¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar?

UNLABELLED: Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%. AIM: To evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. METHODS: Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. RESULTS: Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. CONCLUSION: Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatients.

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

Test rápido de detección de antígeno estreptocócico en faringoamigdalitis: impacto sobre el uso de antibióticos / Rapid streptococcal antigen detection test in pharyngitis: impact in antibiotic use

Objetivo: investigar el impacto de la utilización del test rápido de detección de antígeno estreptocócico sobre la prescripción de antibióticos en niños. Pacientes y métodos: estudio observacional, de cohortes retrospectivo, a partir de los registros clínicos informatizados de 10 cupos de Pediatría de centros de salud de la provincia de Zaragoza (España) en los años 2012 y 2013. Se hace una valoración del tratamiento antibiótico y de las complicaciones en el mes siguiente al episodio de faringoamigdalitis comparando los episodios en los que se realizó test rápido de detección de antígeno estreptocócico con los que no se realizó. Resultados: de 17 455 episodios registrados, se seleccionaron 851 que cumplían los criterios de inclusión (tres o cuatro criterios de Centor). En los episodios en los que se realizaron test rápidos de detección de antígeno, la reducción en la prescripción antibiótica fue del 42% (reducción absoluta de riesgo: 42%; intervalo de confianza del 95% [IC 95]: 37 a 48; p < 0,001). Comparando el abordaje entre los pediatras que disponían y utilizaban el test (4), con los que no (6), la reducción absoluta de riesgo fue del 29% (IC 95: 24 a 34; p < 0,001). Se presentaron complicaciones infecciosas en el 12% de los tratados y en el 8% de los no tratados (riesgo relativo: 1,49; IC 95: 0,88 a 2,52; p = 0,178). Se prescribió significativamente más penicilina V que amoxicilina cuando se realizó test diagnóstico (riesgo relativo: 1,30; IC 95: 1,10 a 1,55; p = 0,004). Conclusiones: en la práctica clínica, el uso de una prueba rápida de detección de antígeno en pacientes pediátricos preseleccionados por criterios clínicos de faringoamigdalitis estreptocócica contribuye de forma determinante al uso racional de antibióticos (AU)

Objective: to investigate the impact of rapid streptococcal antigen detection test use on antibiotic prescription in children. Patients and methods: observational, retrospective cohort study, based on the computer data from 10 pediatric health centre cohorts in Zaragoza (Spain) from 2012 and 2013. The prescription of antibiotics and complications in the ensuing month are compared according to whether a rapid antigen diagnostic test was carried out or not. Results: 851 cases met the inclusion criteria (3-4 Centor criteria) from a pre-selection of 17,455. In those cases where the rapid antigen test was performed a reduction in prescriptions of 42% (absolute risk reduction 42%; 95% confidence interval [95 CI]: 37 to 48; p < 0.001) was observed. On comparing the approach among pediatricians who had the test available (4) and those who did not (6) a decrease of 29% (absolute risk reduction 29%; 95 CI: 24 to 34; p < 0.001) was noted. Ensuing infectious complications did not vary (12% in treated, 8% in untreated; relative risk 1.49; CI 95: 0.88 to 2.52; p 2 0.178). The prescription of penicillin V was significantly more likely than that of amoxicillin when a diagnostic test was used (relative risk 1.30; 95 CI: 1.10 to 1.55; p 2 0.004). Conclusions: in clinical practice the use of the rapid antigen test in pediatric patients pre-selected through clinical criteria was a determining factor in the reduction of the inappropriate use of antibiotics (AU)

¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar? / Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?

El consumo excesivo de antibióticos genera altas tasas de resistencia. En Aragón, los valores máximos de prescripción de antibióticos se alcanzan en los niños de 1 a 4 años, con una utilización que supera el 60%.ObjetivoEvaluar si una intervención multidisciplinar sobre pediatras de atención primaria reduce la utilización de antibióticos y mejora su perfil de prescripción. Método Se analizaron datos de prescripción de antibióticos antes y después de un proyecto de intervención sobre pediatras de atención primaria. La intervención consistió en un taller formativo sobre diagnóstico y tratamiento de las enfermedades infecciosas más prevalentes en pediatría, habilidades en entrevista clínica y adecuada utilización de test rápido de detección de estreptococo en faringe. Se aportaron guías de práctica clínica y documentos de consenso en patología infecciosa pediátrica y material divulgativo para padres. Se utilizó grupo control con pediatras no participantes. Resultados El consumo de antibióticos bajó de 19,17 dosis diarias definida por 1.000 habitantes/día (DHD) a 14,36 DHD entre los pediatras participantes y de 19,84 DHD a 16,02 DHD en controles, aunque la diferencia no fue significativa. Se produjo una disminución de la utilización de macrólidos y penicilinas de amplio espectro en ambos grupos. Conclusión La prescripción de antibióticos de los pediatras disminuyó, no observándose diferencias estadísticamente significativas entre los grupos de estudio. Dado el alto grado de satisfacción de los pediatras participantes, sería necesario continuar con este tipo de actividades para mejorar la utilización de antibióticos en nuestro ámbito

Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%.AimTo evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. Methods Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. Results Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. Conclusion Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatient