Assuntos
Adalimumab/efeitos adversos , Antirreumáticos/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Abscesso Hepático/etiologia , Tuberculose Hepática/etiologia , Tuberculose Miliar/etiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/uso terapêutico , Adulto , Antirreumáticos/uso terapêutico , Antituberculosos/uso terapêutico , Substituição de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Hospedeiro Imunocomprometido , Tuberculose Latente/complicações , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/tratamento farmacológico , Mesalamina/uso terapêutico , Proctocolite/complicações , Proctocolite/tratamento farmacológico , Tuberculose Hepática/tratamento farmacológico , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Tuberculose Esplênica/diagnóstico por imagem , Tuberculose Esplênica/tratamento farmacológico , Tuberculose Esplênica/etiologiaRESUMO
AIM AND METHOD: We assessed the impact of a committed guideline at the end of the first quarter 2008 on the management of urinary tract infection (UTI) with antibiotic prescription (fluoroquinolone, fosfomycin, and nitrofurantoin), by analysing reimbursement data for ambulatory care provided by the regional health insurance agency. RESULTS: During the survey, we observed a 13.2% decrease of norfloxacin prescriptions between the first quarter 2008 and the first quarter 2009. The (fosfomycin+nitrofurantoin)/norfloxacin ratio increased between the third quarter 2007 and the first quarter 2009 from 0.55 to 0.72 and from 0.82 to 1.13 for general practitioners and hospital physicians respectively. The global number of patients treated with these antibiotics remained stable during the period. The number of fluoroquinolone prescription was stable between the first quarter 2008 and the first quarter 2009 with 28,427 DDD and 28,363 DDD, respectively; while the number of single dose rise in the same time from 151 DDD to 427.5 DDD, respectively. DISCUSSION: The three messages which seem to be essential for an optimal use of fluoroquinolones in UTIs are: no treatment for bacterial colonisation (asymptomatic bacteriuria) except for specific cases, no indication for fluoroquinolones in non-complicated acute cystitis and for elderly women, UTI is complicated only if it occurs in women with co-morbidities regardless of age. CONCLUSION: Our indicators suggest that our guideline had an impact on the prescription of fluoroquinolones for uncomplicated acute cystitis.