RESUMO
BACKGROUND: Antimicrobial resistance is a growing concern, and in recent years, there has been increased interest in ambulatory antimicrobial stewardship. Acute rhinosinusitis (ARS) is one of the most common outpatient diagnoses that results in an antibiotic prescription. OBJECTIVE: To determine if a best practice alert (BPA) will affect the percentage of oral antibiotic prescriptions for adults with ARS. METHODS: A prospective, pre/post study was initiated to evaluate the percentage of oral antibiotic prescriptions for ARS in 117 primary care clinics in the Midwest. Included in the study results were 16,570 adults who had an office visit for ARS: 8,106 patients from December 1, 2015, to February 28, 2016, were in the pre-intervention group without an active BPA, and 8,464 patients from December 1, 2016, to February 28, 2017, were in the post-intervention group when the BPA was active. The primary outcome was the number of oral antibiotic prescriptions for ARS compared with the number of office visits for ARS in the pre- and postintervention groups. RESULTS: The percentage of oral antibiotics prescribed for the pre- and postintervention groups were 94.8% and 94.3%, respectively (P = 0.152). The BPA displayed for 7,780 visits, prompting discontinuation of an antibiotic for 10 (0.1%) visits in the postintervention group. CONCLUSIONS: This study suggests that, although an electronic alert may be attractive to facilitate antimicrobial stewardship, it may be ineffective. These results warrant alternative measures to facilitate ambulatory antimicrobial stewardship. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Hansen, D. Leedahl, and N. Leedahl. Hansen and N. Leedahl took the lead in data collection, with assistance from Carson and D. Leedahl. Data interpretation was performed by all the authors. The manuscript was written by Hansen, along with the other authors, and revised by all the authors.
Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/tendências , Benchmarking/tendências , Sistemas de Registro de Ordens Médicas/tendências , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/tendências , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Administração Oral , Adulto , Gestão de Antimicrobianos/normas , Benchmarking/normas , Estudos de Casos e Controles , Prescrições de Medicamentos , Feminino , Fidelidade a Diretrizes/tendências , Humanos , Masculino , Sistemas de Registro de Ordens Médicas/normas , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/epidemiologia , Visita a Consultório Médico/tendências , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Estudos Prospectivos , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/microbiologia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/microbiologia , Fatores de Tempo , Procedimentos Desnecessários/tendênciasRESUMO
The management of leprous rhinitis is discussed. In patients with early changes in the nose it is thought that local treatment is of psychological rather than of any great physical value. There is, however, a group of patients with early lepromatous leprosy whose nasal involvement is severe and out of all proportion to their general clinical state. It is possible that intensive local treatment of the nose in these patients may help to prevent deformity. Patients with advanced nasal changes giving rise to atrophic rhinitis and external deformities gain much physical, as well as psychological, relief from regular local care of the nose, and this is described below.