Patients with respiratory tract infections who do not want antibiotics: direct observational study of primary care in Poland.

BACKGROUND: Requests by patients for antibiotics are known to strongly affect doctors' decisions to prescribe them.Objective. The aim of this study was to establish how frequently patients presenting with respiratory tract infections (RTIs) express their expectation not to be treated with antibiotics, which symptoms and physical findings are related to their perception of antibiotics not being helpful, and to what degree their expectations influence doctors' decisions. METHODS: This was a direct observational study set in primary care practices in Bialystok, Poland. The observers completed a checklist while observing a patient with RTI visiting a family doctor. RESULTS: Overall, 80 (5.5%) out of 1456 patients with RTIs openly requested not to be prescribed antibiotics. Patients not wanting antibiotics were prescribed antibiotics significantly less frequently [25/80 (31.3%)] than the remaining patients [765/1376 (55.6%), P < 0.001]. Univariate logistic regression revealed that cough and runny nose significantly increased the odds of patients not wanting antibiotics [odds ratio (OR) 1.8, 95% confidence intervals (CI): 1.01-3.20 and OR 1.6, 95% CI: 1.01-2.6, respectively] while the presence of tonsillar exudates significantly decreased the odds (OR 0.3, 95% CI: 0.08-0.86). Belief in a self-limited course (20%), recent treatments with antibiotics (16.3%), suspected viral aetiology (12.5%), and concerns about possible harm (12.5%) were the principal reasons for not wanting antibiotics. CONCLUSIONS: A patient's wish not to be prescribed antibiotics leads to less frequent antibiotic prescribing. Antimicrobial resistance, though important from a public health viewpoint, is not seen as a priority for individual patients with infections.

Combined assessment of clinical and patient factors on doctors' decisions to prescribe antibiotics.

BACKGROUND: Antibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors. METHODS: In family medicine practices in Bialystok, Poland, family medicine residents directly observed consultations with patients with RTI symptoms. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors. RESULTS: Of 1546 consultations of patients with RTIs, 54.26 % resulted in antibiotic prescription. Antibiotic prescription was strongly associated with rales (OR 26.90, 95 % CI 9.00-80.40), tonsillar exudates (OR 13.03, 95 % CI 7.10-23.80), and wheezing (OR 14.72, 95 % CI 7.70-28.10). The likelihood of antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 % CI 2.80-5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40-6.10), starting self-medication with antibiotics (OR 4.11, 95 % CI 2.30-7.30), and direct request for antibiotics (OR 1.87, 95 % CI 1.30-2.80). Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI 0.27-0.55). CONCLUSION: While clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.

Outpatient use of systemic antibiotics in Poland: 2004-2008.

OBJECTIVES: The goal of this study was to evaluate the quantity and pattern of outpatient antibiotic use in Poland between 2004 and 2008 and to determine the trends in prescribing practice. To investigate the oral and parenteral outpatient antibiotic use in Poland. MATERIAL AND METHODS: Data concerning outpatient use of systemic antibiotics between 2004 and 2008 were obtained from Polish National Health Fund databases expressed as the number of defined daily doses (DDD) per 1000 inhabitants per day (DID) according to the international Anatomical Therapeutic Chemical ATC classification system of the World Health Organization (WHO, version 2009). RESULTS: Total outpatient antibiotic use in Poland varied from the lowest 17.88DID in 2004 to the highest 21.39DID in 2007. Penicillins (J01C) represented the most frequently prescribed antibiotics constituting more than 50% of the total outpatient antibiotic use. The other most popular groups of antibiotics were tetracyclines (J01A), macrolides (J01F). On the fourth and fifth position were cephalosporins (J01D) and quinolones (J01M), respectively. The parenteral antibiotic use did not exceed 1% of the total outpatient antibiotics prescribed with cefuroxime being the most frequently prescribed drug. CONCLUSIONS: Total outpatient use of antibiotics in Poland in 2004-2008 was comparable to the median European level. The consumption of all antibiotics slightly increased from 2004 to 2007, and decreased in 2008. The most often prescribed antibiotics were penicillins, mainly amoxicillin and amoxicillin with enzyme inhibitor. During the study period the use of the older (narrow-spectrum) antibiotics decreased in favour of the newer (broad-spectrum) antibiotics. The results suggest the discrepancy between national recommendations and choice of antibiotics by physicians.

Management of respiratory tract infections in primary care in Poland--results of the happy audit 2 project.

OBJECTIVE: The Polish results of the international Happy Audit 2 project are reported which objective was to present therapeutic decisions made by general practitioners (especially antibiotics prescribed) and diagnostic methods applied to patients with respiratory tract infections (RTI). MATERIAL AND METHODS: [corrected] Following each visit of patient with respiratory tract infection, general practitioners participating in the study completed the questionnaire. The questionnaire included patient's data (age, gender), the duration of disease, clinical symptoms, diagnosis, prescribed antibiotics, additional testing as well as the influence of various factors on therapeutic decision. RESULTS: Having considered the results of HappyAudit in Poland, a total of 5,137 office visits of patients reporting symptoms of RTIs were analyzed. The average duration of symptoms before visiting GP was 4.8 days (compared to average 4.4 in other countries). Worth noting is that additional testing in diagnosis of RTIs was performed less frequently in Poland: rapid streptococcal test was conducted in 0.4% of cases (European average: 4.45%), CRP--in 2.2% of patients (average from other countries: 14.2%) and chest X-ray in 2.3% of cases compared to 14% in other project's participants. In Poland, the most frequently applied antibiotic was amoxicillin, which was used in 28.9% of cases ended with antibiotic prescribing (amoxicillin/pivampicillin were also predominant in other countries, excluding Sweden). In Poland, macrolides (22.4% of all prescriptions for antibiotic) and cephalosporins (12.1%) were frequently used. The results indicate that narrow-spectrum antibiotics are prescribed in Poland less frequently, with the example being penicillin V which was prescribed in 6.7% of patients with RTIs who were given antibiotic. CONCLUSIONS: Comparing the results of Happy Audit 2 in Poland and other project's participants, the major differences consist in rare use of phenoxymethylpenicillin in favour of amoxicillin and macrolides as well as infrequent use of additional testing in diagnosis of RTIs in Poland.

Epidemiological features of patients infected with HCV genotype 4 in Poland: Epidemiology of HCV genotype 4 in Poland.

BACKGROUND: Hepatitis C genotype 4 (HCV-4) is considered to be rare outside northern Africa and southern Europe. OBJECTIVES: To describe the epidemiological characteristics of patients infected with HCV-4 in Poland. PATIENTS AND METHODS: The study group included 290 patients with HCV-related chronic liver disease and intravenous drug users with HCV infection recruited in years 2002-2006 in Podlaskie region, north-eastern Poland. In all cases, HCV infection was confirmed by HCV-RNA detection by qualitative nested RT-PCR. HCV genotype was determined by 5'UTR sequencing and comparison with known genotype-specific sequences. RESULTS: HCV 4 was found in 45 (15.5%) of 290 HCV-infected and HCV RNA-positive individuals. 60% of HCV 4 infections occurred in intravenous drug users; 51% of HCV 4-infected patients were also HIV-positive. Among 119 patients whose source of infection was other than drug use, there were 16 (10.5%) HCV 4 cases. Seven (46%) of 13 HCV 4-positive and HIV-negative patients who received combined antiviral treatment had sustained viral response. CONCLUSIONS: HCV 4 exists in eastern Poland, and the infection is frequently related to intravenous drug use and accompanied by HIV infection. HCV 4 also causes a proportion of non-drug-related HCV infections.

Changing HCV genotypes distribution in Poland--relation to source and time of infection.

BACKGROUND: Understanding the distribution of HCV genotypes has implications for prognosis and therapy of hepatitis C. OBJECTIVES: To describe the distribution of HCV genotypes in Poland in relation to route of transmission and year of infection. STUDY DESIGN: Patients with chronic liver disease were evaluated at the Department of Infectious Diseases, Bialystok (Poland). HCV genotype was determined by means of 5'UTR sequencing and comparison with known sequences of particular genotypes. RESULTS: The genotypes mostly frequently detected were genotype 1 (57.5%); genotype 3 (31.3%); and genotype 4 (8.4%). Genotype 1 constituted the majority of HCV infections caused by blood transfusion (68.8%) and only 34.8% of HCV infections in the intravenous drug use (IVDU) group (p<0.05). In contrast genotype 3 constituted the majority of HCV infections in the IVDU group (56.5%). We observed a significant increase in the proportion of genotype 3 infections detected after 2000--from 19.1% to 38.9%. CONCLUSIONS: The relative proportion of genotype 1b in Poland has decreased and that of genotype 3a has increased, especially among IVDU.

[Detection of HCV infection among clients of an anonymous testing center for HIV infection]. / Wykrywanie zakazen HCV wsród osób zglaszajncych sie do punktu anonimowego testowania zakazenia HIV.

The aim of the study was to determine the prevalence and risk factors for HCV infection among clients of the centre of anonymous testing for HIV infection. Two hundred and eleven clients of anonymous testing centre for HIV infection in Bialystok were additionally tested for anti-HCV antibodies and the relationship between HCV infection and risk factors was analysed Main observations: Anti-HCV were detected in 6/211 individuals (2,4%). Increased risk of HCV infection was observed among intravenous drug users, unemployed, residents of other woiewodships (administrative regions), and in those who had been tested for HIV infection in the past. Centres for anonymous testing for HIV infection is also a feasible place for screening for HCV infection. It is reasonable to limit testing for HCV to patients with risk factors

Respiratory tract infections: diagnosis and use of antibiotics by family physicians in north-eastern Poland.

The aim of our study was to describe the pattern of antibiotic prescribing for respiratory tract infections. Forty-four family physicians from Bialystok (north-eastern Poland) filled in questionnaires regarding 1315 patients with respiratory tract infections. Antibiotics were prescribed in 803 cases (61.1%). The four principle diagnoses associated with prescribing an antibiotic were: bacterial pharyngitis/tonsillitis, acute bronchitis, unspecified bacterial superinfection and acute sinusitis for which a total of 572 antibiotic treatments were given (71.2% of all antibiotic prescriptions). The study shows that Polish family physicians diagnose respiratory tract infections empirically and frequently prescribe wide-spectrum antibiotics. More information is required about the diagnostic value of certain clinical symptoms such as purulent sputum, duration of cough and indications for broad-spectrum antibiotic use.