Prescripción antibiótica en infecciones respiratorias agudas en atención primaria / Antibiotic prescribing in acute respiratory tract infections in general practice

Introducción: La resistencia a antimicrobianos representa una amenaza para la salud pública mundial. Las infecciones respiratorias agudas son el principal motivo de prescripción antibiótica en la población pediátrica española. El objetivo del estudio fue describir la frecuencia de prescripción y el patrón de utilización de antibióticos en infecciones respiratorias agudas, diagnosticadas en atención primaria, en la población pediátrica de Aragón. Material y método: Se incluyeron los episodios de otitis aguda, faringoamigdalitis aguda, infección respiratoria superior inespecífica y bronquitis aguda, registrados durante un año, en niños de 0-14 años. Se calculó la proporción de episodios que recibieron antibiótico, por diagnóstico y grupo de edad, y describió el patrón prescriptor. Resultados: El 50% de los niños fueron diagnosticados de infección respiratoria aguda durante el periodo de estudio, siendo la infección respiratoria superior inespecífica la más frecuente. Se prescribió un antibiótico en el 75% de las faringoamigdalitis, 72% de otitis, 27% de bronquitis y 16% de infecciones respiratorias superiores inespecíficas. Los antibióticos más prescritos fueron los de amplio espectro, principalmente amoxicilina y amoxicilina-clavulánico. Conclusiones: El uso de antibióticos en infecciones respiratorias agudas pediátricas fue, en general, elevado, y la elección del tipo de antibiótico podría ser inadecuada en un porcentaje elevado de casos. Se considera necesaria una mejora en la práctica prescriptora de antibióticos en niños (AU)

Introduction: Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). Methodology: A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. Results: Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. Conclusions: Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed (AU)

[Antibiotic prescribing in acute respiratory tract infections in general practice]. / Prescripción antibiótica en infecciones respiratorias agudas en atención primaria.

INTRODUCTION: Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). METHODOLOGY: A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. RESULTS: Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. CONCLUSIONS: Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed.

Variability in the prescription of cholinesterase inhibitors and memantine.

BACKGROUND/AIM: To estimate the prevalence of Alzheimer's disease (AD) treatment in Aragon (Spain), analyzing differences according to age, gender and health area. METHODS: Retrospective study on AD treatment prevalence of cholinesterase inhibitors and memantine during 2005, using pharmaco-epidemiological data from prescription refunds transferred monthly from pharmacies to the Health Care Service. RESULTS: Differences between health areas were considerable, with adjusted prescription rates between 121.6 and 248.6/100,000 individuals. Treatment rates for women doubled those of men in each health area. Variability was greater among men than women. Drug prescription distribution was also different between health areas. CONCLUSION: Considerable variability in AD treatment has been detected. More consensus is needed to reduce variability in order to improve the quality of the pharmacotherapy for AD and assure equal treatment opportunities for every patient.

The pelvic plexus and antireflux surgery: topographical findings and clinical consequences.

PURPOSE: Voiding dysfunction and urinary retention are rare complications of antireflux surgery. As mainly reported after bilateral antireflux surgery with extravesical technique, bladder insufficiency has been suspected to be caused by intraoperative damage to neural structures. We studied the topography of the pelvic plexus and assessed the injury to the plexus resulting from antireflux surgery. MATERIALS AND METHODS: Human cadavers fixed with Thiel solution were used for dissection. The superior hypogastric plexus and hypogastric nerves were identified as the pathway to the pelvic plexus. After dissecting the surrounding fatty tissue the S2 to S4 nerves and efferent nerve bundles from the pelvic plexus were identified. RESULTS: The main portion of the pelvic plexus was located about 1.5 cm. dorsal and medial to the ureterovesical junction. The bundles of the pelvic plexus ended at the distal ureter, trigone and rectum. When simulating an antireflux procedure, there was a high risk of injury to the pelvic plexus and its efferent nerves if dissection was performed distal to the ureter and dorsal trigone. CONCLUSIONS: Careful dissection close to the ureter avoids inadvertent injury to the pelvic plexus. To minimize the risk of voiding dysfunction bilateral antireflux surgery should be performed at 2 sessions unless the operative technique allows preservation of the neural structures.

Indices of body fat distribution in Spanish children aged 4.0 to 14.9 years.

BACKGROUND: Reference values for the main indices of body fat distribution in children are not available. METHODS: The study population comprised 1638 Caucasian children and adolescents: 848 boys and 790 girls, with ages ranging from 4.0 to 14.9 years, and living in the central part of Spain (Provincia de Zaragoza). The waist-to-hip circumference ratio and the triceps-to-subscapular skinfold thickness ratio were measured. RESULTS: In boys, mean waist-to-hip circumference ratio ranges from 0.834, at 13.5 years, to 0.896 at 4.5 years. In girls, waist-to-hip circumference ratio ranges from 0.756, at 14.5 years, to 0.877, at 4.5 years. We observed a decrease of waist-to-hip circumference ratio with age, especially in girls. In boys, triceps-to-subscapular skinfold thickness ratio ranges from 1.360, at age 14.5, to 1.704, at age 5.5. In girls, triceps-to-subscapular skinfold thickness ratio ranges from 1.468, at age 13.5, to 1.727, at age 9.5. We observed a decrease with age only in boys. CONCLUSIONS: We present reference values for the main indices of body fat distribution, which could be useful in clinical practice. However, research is needed that will compare these indices with data on body fat distribution obtained by a gold standard method, such as computed tomography or magnetic resonance imaging.