Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis / Impacto de una intervención a largo plazo del uso de una prueba antigénica rápida en la faringitis aguda

OBJECTIVE: This study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention. DESIGN: Before-and-after audit-based study. LOCATION: Primary care centres in eight autonomous Communities. PARTICIPANTS: General practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015). METHOD: RADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used. RESULTS: A total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P < .001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P < .001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73-2.89). CONCLUSIONS: This study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing

OBJETIVO: Evaluar la adecuación del uso e interpretación de las técnicas antigénicas rápidas (TAR) y la prescripción antibiótica en la faringitis aguda 6 años después de haber realizado una intervención multifacética. DISEÑO: Estudio antes-después basado en una auditoria. EMPLAZAMIENTO: Centros de salud en 8 comunidades autónomas. PARTICIPANTES: Se invitaron a médicos de familia (MF) que ya habían participado en el estudio de intervención HAPPY AUDIT en 2008 y 2009 a un nuevo AUDIT 6 años después (2015). MÉTODO: Se proporcionaron TAR a los centros participantes, y se pidió a los MF que registraran consecutivamente a todos los adultos con faringitis aguda. Usamos un registro diseñado específicamente para este estudio. RESULTADOS: Ciento veintiuno MF de los 210 que participaron en los primeros registros (57,6%) aceptaron a participar en el tercer registro. Se registraron 3.394 episodios de faringitis agudas en las 3 auditorías. Se usaron TAR en el 51,7% de los casos inmediatamente después de la intervención y en el 49,4%, 6 años después. Se prescribieron antibióticos en el 21,3%y 36,1%, respectivamente (p < 0,001), principalmente cuando había exudado amigdalar y en el 5,3 y 19,2% de los resultados de TAR negativos (p < 0,001). Después de ajustar por las distintas covariables, comparado con la prescripción antibiótica observada justo después de la intervención, prescribieron significativamente más antibióticos 6 años más tarde (odds ratio: 2,24 [IC 95%: 1,73-2,89]). CONCLUSIONES: Este estudio muestra que se reduce el impacto de una intervención multifacética a largo plazo enfocada al uso e interpretación de TAR en pacientes con faringitis aguda

Dual Antibiotic Therapy for Outpatient Management of Community-acquired Pneumonia? / ¿Tratamiento antibiótico dual en el manejo ambulatorio de la neumonía adquirida en la comunidad?

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Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis.

OBJECTIVE: This study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention. DESIGN: Before-and-after audit-based study. LOCATION: Primary care centres in eight autonomous Communities. PARTICIPANTS: General practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015). METHOD: RADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used. RESULTS: A total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P<.001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P<.001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73-2.89). CONCLUSIONS: This study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing.

Coronavirus y atención primaria / Coronavirus and primary care

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Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners / Uso de pruebas de diagnóstico rápido y prescripción antibiótica en la faringitis y las infecciones del trato respiratorio inferior por parte de los médicos de atención primaria

INTRODUCTION: This study was aimed at assessing general practitioners' (GP) reliance on patient history, examination findings and the influence of the utilisation of point-of-care tests (POCT) in antibiotic prescribing for sore throat and lower respiratory tract infections (LRTI). METHODS: Audit-based study carried out in 2015. A group of GPs received an intervention six years earlier with provision of POCTs and another group of GPs acted as controls. Odds ratios for clinical variables predicting antibiotic prescribing were calculated by logistic regression analyses. RESULTS: A total of 238 GPs included 1906 patients with sore throat and 1970 LRTIs. A negative POCT result was negatively associated with antibiotic prescribing, with odds ratios ranging from 0.09 to 0.23. GPs using POCTs attached less weight to clinical criteria. CONCLUSION: GPs using rapid tests are mainly influenced by POCT results in the decision to prescribe antibiotics. However, antibiotic prescribing is still observed with negative POCT results

INTRODUCCIÓN: El objetivo fue evaluar la influencia de la historia clínica, exploración y uso de pruebas de diagnóstico rápido (PDR) por los médicos de familia (MF) en la prescripción antibiótica en la faringitis e infecciones del tracto respiratorio inferior (ITRI). MÉTODOS: Estudio de auditoría realizado en 2015. Un grupo de MF recibió una intervención 6 años antes con provisión de PDR y otro grupo de médicos actuó como control. Se calcularon odds ratios de predicción de prescripción antibiótica para las variables clínicas mediante análisis de regresión logística. RESULTADOS: Un total de 238 MF incluyeron 1.906 faringitis y 1.970 ITRI. Un resultado negativo de PDR se asoció negativamente con prescripción antibiótica, con odds ratios entre 0,09 y 0,23. Los médicos asignaron menos peso a los criterios clínicos cuando usaron PDR. CONCLUSIÓN: Los MF que usan PRD dan más importancia a sus resultados a la hora de prescribir antibióticos. Sin embargo, aún sigue observándose prescripción antibiótica con resultados negativos de las PDR

Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners.

INTRODUCTION: This study was aimed at assessing general practitioners' (GP) reliance on patient history, examination findings and the influence of the utilisation of point-of-care tests (POCT) in antibiotic prescribing for sore throat and lower respiratory tract infections (LRTI). METHODS: Audit-based study carried out in 2015. A group of GPs received an intervention six years earlier with provision of POCTs and another group of GPs acted as controls. Odds ratios for clinical variables predicting antibiotic prescribing were calculated by logistic regression analyses. RESULTS: A total of 238 GPs included 1906 patients with sore throat and 1970 LRTIs. A negative POCT result was negatively associated with antibiotic prescribing, with odds ratios ranging from 0.09 to 0.23. GPs using POCTs attached less weight to clinical criteria. CONCLUSION: GPs using rapid tests are mainly influenced by POCT results in the decision to prescribe antibiotics. However, antibiotic prescribing is still observed with negative POCT results.

Phase-contrast microscopy in the diagnosis of urinary tract infections in the outpatient setting: A diagnostic validity study / Microscopía de contraste de fases en el diagnóstico de la infección urinaria en la comunidad: un estudio de validez diagnóstica

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General practitioners' opinions and perceptions about antibiotic use for respiratory tract infections in primary care / Opiniones y percepciones de los médicos de familia en torno al uso de antibióticos en infecciones respiratorias en atención primaria

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Veinticinco mitos en enfermedades infecciosas en atención primaria que se asocian con sobrediagnóstico y sobretratamiento / Twenty-five myths in infectious diseases in primary care associated with overdiagnosis and overtreatment

El sobrediagnóstico y el sobretratamiento son comunes en la práctica clínica de las enfermedades infecciosas en atención primaria. A partir de estudios publicados en la literatura médica, identificamos mediante una revisión no sistemática un total de 25 mitos asociados al diagnóstico y tratamiento de las enfermedades infecciosas más frecuentemente manejadas en atención primaria y repasamos la literatura referente a cada mito. Estos mitos generan un uso inapropiado de pruebas diagnósticas (sobrediagnóstico) y prescripción innecesaria de antibióticos (sobretratamiento). La mayoría de estos mitos están arraigados entre los médicos de familia en nuestro país. Estos mitos no solo deben desacreditarse de nuestra práctica clínica, sino que tienen que ser revertidos y animamos a nuestros lectores a evaluar críticamente su práctica cuando se trata de los conceptos erróneos tratados en este artículo. Intentamos dar una guía a los profesionales clínicos que se enfrentan con estos cuadros clínicos frecuentes

Overdiagnosis and overprescribing is common in current clinical practice of infectious diseases in primary care. On the basis of studies published in the medical literature we identify my means of a non-systematic review a total of 25 myths associated with the diagnosis and treatment and present the literature pertaining to each myth. These myths result in extraneous testing (overdiagnosis) and excessive antimicrobial treatment (overtreatment). Most of these myths are ingrained among general practitioners in our country. Not only should these myths be debunked from our clinical practice, but they should also be reversed, and we encourage our readers to critically appraise their practice when it comes down to the misconceptions treated in this manuscript. We attempt to give guidance to clinicians facing these frequent clinical scenarios

[Twenty-five myths in infectious diseases in primary care associated with overdiagnosis and overtreatment]. / Veinticinco mitos en enfermedades infecciosas en atención primaria que se asocian con sobrediagnóstico y sobretratamiento.

Overdiagnosis and overprescribing is common in current clinical practice of infectious diseases in primary care. On the basis of studies published in the medical literature we identify my means of a non-systematic review a total of 25 myths associated with the diagnosis and treatment and present the literature pertaining to each myth. These myths result in extraneous testing (overdiagnosis) and excessive antimicrobial treatment (overtreatment). Most of these myths are ingrained among general practitioners in our country. Not only should these myths be debunked from our clinical practice, but they should also be reversed, and we encourage our readers to critically appraise their practice when it comes down to the misconceptions treated in this manuscript. We attempt to give guidance to clinicians facing these frequent clinical scenarios.

Saving antibiotics prescribed in pharyngitis and lower respiratory tract infections in Primary Care: Author's reply / Ahorro de antibióticos prescritos en faringitis e infecciones del tracto respiratorio inferior en Atención Primaria: Respuesta de los autores

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Surveillance of antibiotic consumption in Spain: The importance of the DHD indicator. Author's reply / Vigilancia del consumo de antibióticos en España: la importancia del indicador DHD. Respuesta de los autores

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Sensibilidad antibiótica de Staphylococcus aureus y Streptococcus pneumoniae en personas portadoras nasales sanas en atención primaria en el área de Barcelona / Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area

Introducción: La información existente sobre la resistencia a los antibióticos se basa habitualmente en muestras de personas hospitalizadas. El objetivo fue evaluar la prevalencia de resistencia antibiótica de cepas de Staphylococcus aureus y Streptococcus pneumoniae de personas portadores nasales atendidas en las consultas de atención primaria según edad y sexo. Diseño: Estudio transversal. Emplazamiento. Siete centros de salud del área de Barcelona. Participantes. Personas portadoras nasales a partir de 4 años de edad, sin signos de enfermedad infecciosa y que no habían tomado antibióticos ni habían estado hospitalizados en los 3 meses anteriores. Mediciones principales: Se recogieron 3.969 frotis nasales válidos para identificación entre 2010 y 2011 y fueron enviados a un laboratorio central de microbiología para el aislamiento de ambos gérmenes. La resistencia a los antibióticos se estableció según los puntos de corte actuales de la guía del European Committee on Antimicrobial Susceptibility Testing. Resultados: La prevalencia de S. aureus resistente a meticilina fue del 1,3% (IC 95%: 0,5-2,1%), con porcentajes de resistencia frente a fenoximetilpenicilina del 87,1% y a azitromicina del 11,6%, sin observar diferencias significativas según edad y sexo. Un 2,4% (IC 95%: 0,1-4,7%) de las cepas de neumococo fueron altamente resistentes a fenoximetilpenicilina y macrólidos, mientras que las mayores resistencias se observaron frente a cefaclor (53,3%), tetraciclina (20%) y cefuroxima (12,1%). Conclusiones: Estos patógenos tienen resistencias más bajas en la comunidad que las que se observan en el medio hospitalario. Es importante que se conozca la resistencia antibiótica actual para poder hacer un uso más prudente de los antibióticos (AU)

Introduction: The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). Design: Cross-sectional study. Setting: Seven PCC in the Barcelona area. Participants: Healthy nasal carriers aged 4 years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3 months. Main measurements: A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. Results: The prevalence of methicillin-resistant S.aureus was 1.3% (95% CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95 CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). Conclusions: These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics (AU)

Selling antimicrobials without prescription - Far beyond an administrative problem.

INTRODUCTION: Selling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. MATERIAL AND METHODS: A prospective study was carried out in January 2013 - February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. RESULTS: The actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. CONCLUSION: It is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population.

[Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area]. / Sensibilidad antibiótica de Staphylococcus aureus y Streptococcus pneumoniae en personas portadoras nasales sanas en atención primaria en el área de Barcelona.

INTRODUCTION: The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). DESIGN: Cross-sectional study. SETTING: Seven PCC in the Barcelona area. PARTICIPANTS: Healthy nasal carriers aged 4years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3months. MAIN MEASUREMENTS: A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. RESULTS: The prevalence of methicillin-resistant S.aureus was 1.3% (95%CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). CONCLUSIONS: These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics.