Antibiotics in the treatment of upper respiratory tract infections in Poland. Is there any improvement?

WHAT IS KNOWN: Acute upper respiratory tract infections are among the most frequent reasons for encounters in primary health care. Relevant data about antibiotics use in respiratory tract infections in Poland are scarce. AIMS AND OBJECTIVES: To evaluate the frequency of use and choice of antibiotics in empirical first-line treatment of upper respiratory tract infections in adults in eastern Poland. METHODS: An analysis of the medical records of 4047 adult patients from 47 health centres in Lublin region (eastern Poland) within the period of 1 year (1 September 2005 to 31 August 2006). RESULTS AND DISCUSSION: In 1267 patient visits, the reasons for encounter were classified by physicians as acute infections of the upper respiratory tract. Most frequently diagnosed were acute pharyngitis and tonsillitis, acute upper respiratory infections of multiple and unspecified sites and the common cold. Overall, antibiotics were used as empirical first-line therapy in 78·7% of cases. Amoxicillin, amoxicillin with clavulanic acid, macrolide and doxycycline were most commonly prescribed. Physician's specialty was not associated with antibiotic use. WHAT IS NEW AND CONCLUSIONS: There is still considerable overuse of antibiotics in primary care patients with respiratory tract infections in Poland. Campaigns aiming at changing prescribing behaviour of primary care physicians and informing the public should be undertaken.

Which factors hinder the decision of Polish HIV-positive patients to take up antiretroviral therapy?

The implementation of highly active antiretroviral therapy (HAART) in 1996 has significantly reduced mortality and morbidity for HIV-positive patients worldwide. However not all eligible persons start HAART. To identify reasons for therapy refusal by HIV-positive persons we performed a questionnaire study. The investigation was conducted among 321 HIV-positive individuals and focused on the decision to take up antiretroviral treatment. Out of 71 untreated patients, 34 (47.9%) admitted that in their case the therapy was not indicated, whereas 20 (28.3%) were afraid of potential side effects that might change their appearance, e.g. face lipoatrophy. Only the treated patients had been prepared to take up therapy, although 17 patients (6.0%) had not received any explanation of the therapy principles, aims or necessity to comply with medication regime. The therapy is generally not discussed with the patients for whom it is not currently indicated, which may contribute to the fixation of fears and prejudices. Doctors who treat HIV-positive patients should be aware of the prejudices and fears their patients have towards antiretroviral therapy in order to react properly and by means of the available antiretroviral drugs help prolong life and improve its quality.

Management of sore throat in Polish primary care facilities: an example from the country with rare use of microbiological testing.

OBJECTIVE: To describe sore throat management by primary care physicians in Poland. METHODS: We sent questionnaires to all primary care doctors in Podlaskie voievodship (north-eastern Poland) with clinical vignettes depicting patients with symptoms of sore throat. The probability of bacterial (streptococcal) infection was estimated using Centor's scale (assessment of four items--presence of tonsillar exudates, fever, lymphadenopathy and absence of cough--scores 0 and 1 indicate low probability of streptococcal infection). The respondents were asked for the suspected diagnosis (viral or bacterial pharyngitis), choose additional tests (if required to decide on management), and finally to decide on whether an antibiotic should be prescribed. RESULTS AND DISCUSSION: Two-hundred and twenty-five of 610 doctors surveyed provided usefull answers. In cases with a very low probability of bacterial infection and a score of '0', antibiotics were prescribed by 1.8-43.7% of physicians. Only 1.8% would prescribe an antibiotic to an adult with a 1-day history of sore throat and a '0' score but as many as 43.7% when the patient consulted with the same symptoms and signs again (P < 0.05). Younger age of the patient was also significantly associated with higher rate of the antibiotic prescribing--7.6% would prescribe an antibiotic to a 5-year-old child with a '0' score while only 1.8% would prescribe an antibiotic for an adult with a similar score, P < 0.05. CONCLUSIONS: Primary care physicians in Poland tend to prescribe antibiotics for sore throats even for patients with a low risk of bacterial infection when influenced by factors like repeat visits of the patient or young age. Avoiding antibiotics in such low risk of bacterial infection patients is an important and achievable goal.

Medical procedures and the risk of iatrogenic hepatitis C infection: case-controlled study in north-eastern Poland.

Many hepatitis C virus (HCV)-infected individuals do not have any obvious risk factors and one of the putative sources of infection may be inadvertent exposure to infected blood or body fluids in the clinical setting. The aim of this study was to assess the role of medical procedures in transmission of hepatitis C in north-eastern Poland. In total, 194 patients with chronic hepatitis C were eligible for the study. The control group consisted of 275 age- and sex-matched individuals. Patients with a history of intravenous drug use were excluded. On multivariate analysis, transfusions [odds ratio (OR) = 3.7, 95% confidence interval (CI) 2.2-6.3], minor surgery (OR = 3.2, 95% CI 1.5-6.7) and dental care (OR = 2.3, 95% CI = 1.4-4.0) were independently associated with HCV infection. We conclude that apart from transfusion, minor medical procedures and dental care may carry a significant risk of hepatitis C infection. Improvements in basic hygiene routines and strict adherence to universal precautions may be essential to prevent iatrogenic transmission of the infection.

[Chronic hepatitis C and risk for hepatitis A infection]. / Przewlekle zapalenie watroby typu C A ryzyko zakazenia wirusem zapalenia watroby typu A.

The aim of this study was to determine the prevalence of anti-HAV antibodies and factors associated with HAV infection amongst patients with chronic hepatitis C. The prevalence of anti-HAV antibodies in hepatitis C patients was 69.2% and did not differ significantly from 63.3% observed in the group of healthy controls. In patients with chronic hepatitis C the occurrence of HAV antibodies was not associated with the duration of HCV infection, history of transfusions and surgeries. There was a tendency towards higher prevalence of anti-HAV in persons with history of numerous hospitalizations (60.8% of persons with the history of up to 5 hospitalizations were positive for anti-HAV and more than 84.6% of those with more than 5 hospitalizations). Only 38.5% of patients under 35 years had anti-HAV antibodies. In conclusion immunization against hepatitis A should be recommended for hepatitis C patients under 35 years of age, most of whom are not immune to HAV. Testing for anti-HAV prior to vaccination should be performed in individuals older than 35 because natural immunity is common.

High prevalence of genotype 4 among hepatitis C virus-infected intravenous drug users in north-eastern Poland.

The aim of this study was to describe the distribution of hepatitis C genotypes among intravenous drug users in north-eastern Poland. The study group included intravenous drug users recruited at a drug treatment center and a clinic for HIV-infected patients. HCV infection was confirmed by qualitative nested RT-PCR to test for the presence of HCV RNA. Genotypes were determined by 5'UTR sequencing and comparing the results with known genotype sequences. Among 111 HCV-infected and HCV-RNA-positive intravenous drug users, the most prevalent genotypes were 1 (38.7%), 3 (37.8%), and 4 (23.4%). Most infections with genotype 4 (88.5%) were found among HCV-HIV-coinfected drug users. The study demonstrated a high prevalence of genotype 4 (23.4%) among HCV-infected Polish drug users.

Improvement in the accessibility and organization of services of family physicians in a small town in Poland: a comparison of patient opinions between 1998 and 2002.

PURPOSE: The institution of a family physician was introduced in Poland to improve organization and quality of primary health care. Thus, it seems important to find out how the time factor (4 years) and the organizational changes that took place during that time have affected patients' views on primary health service accessibility. The aim of the study was to compare patients' opinions on selected aspects of the access and organization of health care provided by family physicians between the years 1998 and 2002. MATERIAL AND METHODS: Two independent surveys conducted in 1998 and 2002 using face-to-face interviews with structured questionnaires. The study was carried out in a small town in Poland. The study group consisted of two samples of patients randomly selected. Altogether 1000 interviews were obtained in survey I (1998) and 1000 from another sample in survey II (2002). RESULTS: The surveys carried out at a 4-year interval showed that the accessibility of family physician services improved between 1998 and 2002. This was reflected by: more common use of registration by phone and better overall evaluation of the registration system, shorter time spent in the waiting room to see a family physician, making an appointment for a definite hour, better opinion of the visit duration and more frequent use of phone consultations. CONCLUSIONS: The results our study show that primary health care reform in Poland has a positive impact on the patients' opinions about access and organization of services of family physicians.

The role of the therapeutic team in shaping eating habits and lifestyle in children with dietary calcium deficiency.

PURPOSE: Assessment of the effect of low-calcium diet on bone mineral content in children and adolescents. MATERIAL AND METHODS: The study involved 89 children (49 girls and 40 boys) aged 5-18 years, in whom diseases affecting bony metabolism had been excluded. Children with a history of dietary calcium content below 500 mg/day were recruited. The study group was divided according to age: group I, age 5-9 years (children before puberty); group II, age 9-15 years (early puberty); group III, 15-18 years (late puberty). Dual energy X-ray absorptiometry (DEXA) was used for densitometric measurements. Bone mineral density (BMD) was assessed in the whole skeleton (total BMD), in vertebrae L2-L4 (spine BMD) in g/cm2 and as Z-score. Concentrations of Ca, Ca2, P, activity of alkaline phosphatase (AP) and its bony isoenzyme were determined in the serum. RESULTS: Total bone mass below 5th percentile (according to the norm for age and gender) was found in 56.98% of the children involved in the study. A significant reduction was noted in the spine mineral mass in boys (p < 0.01) as compared to girls (0.731 +/- 0.17 g/cm2 and 0.835 +/- 0.19 g/cm2, respectively). The lowest mean Z-score (-1.850) was observed in group III as compared to group I (-1.194) (p < 0.01) and group II (-1.201) (p < 0.05). There were statistically significantly positive correlations between total and spine BMD and BMI. The correlation coefficient was r = 0.56 and r = 0.41 (p < 0.001), respectively. CONCLUSIONS: In the majority of the children (c. 60%), a reduction in bone mineral content was found. The lowest Z-score (-1.850) was revealed in the oldest children, which may disturb the process of reaching the optimum level of the peak bone mass.

Prevalence of hepatitis B markers in patients with hepatitis C infection in north-eastern Poland: risk factors and vaccine use.

We evaluated the prevalence of hepatitis B virus (HBV) markers and established HBV vaccination status among 111 patients with hepatitis C virus (HCV) infection. A history of HBV immunisation was recorded in 30 patients (27.0%) and only 17/30 (66.7%) had anti-HBs level > or =10 mIU/ml. All patients were HBsAg-negative and 22.2% of nonvaccinated subjects had evidence of HBV infection as determined by anti-HBc presence. Among patients with anti-HBc in 7/18 cases (38.9%) anti-HBc was the only marker of HBV infection (without anti-HBs). The prevalence of anti-HBc was significantly higher among patients who reported a history of acute hepatitis. In conclusion the prevalence of HBV markers in patients with HCV infection in north-eastern Poland is similar to the prevalence in general population, which suggests no increased risk for nosocomial HBV infection among those individuals. HCV infection seems to favour unusual serological pattern of HBV infection with anti-HBc as the only marker. HBV vaccine use is low among patients with HCV infection in north-eastern Poland.

Hepatitis B virus vaccine for patients with hepatitis C virus infection.

Hepatitis C is a disease with varying rates of progression. The role of hepatitis B virus (HBV) as a cofactor in the development of hepatitis C virus (HCV)-related cirrhosis and hepatocellular carcinoma (HCC) has been suggested and the use of HBV vaccine in all HCV-infected patients has been advocated. This review presents the implications of HBV and HCV coinfection and addresses the issues of HBV vaccine immunogenicity and safety in patients with chronic HCV infection.

Clinical picture of tick-borne encephalitis among patients hospitalized in 1994 in the Department of Infectious Diseases Medical School Bialystok.

In 1994 20 patients of the Department of Infectious Diseases, Medical School Bialystok were diagnosed to have tick-borne encephalitis. The etiologic agent was identified by serologic studies of the serum and cerebrospinal fluid (FSME IgM ELISA Immuno Austria). 12 patients (60%) reported a tick bite preceding the disease. Following clinical manifestations were found in the analyzed groups of patients: fever > 37.5 degrees C-20 patients (100%), headache--20 patients(100%), nuchal rigidity-14 patients (70%), abdominal pain -3 patients (15%), arthralgia and myalgia-3 patients (15%), drowsiness and mental confusion -3 patients(15%). Total cell count in CSF ranged from 18 to 348 cells (mean-175). Lymphocytes predominated in 13 cases (68%). The FSME-IgM antibodies were present in serum of 19 patients (95%) and in CSF of only 4 patients (20%). The hospitalization lasted 12-58 days (mean 24 days). In one case the disease was complicated by acute psychosis requiring psychiatric treatment. Severe neurologic complications have been not observed. The prognosis in all cases was good. Our study confirms that tick-borne encephalitis is a current problem in north-eastern Poland. Noteworthy is the fact that only a part of patients give the history of tick bite.

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B.

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.

[Prophylaxis after occupational exposure to human immunodeficiency virus (HIV)]. / Profilaktyka po zawodowej ekspozycji na ludzki wirus uposledzenia odpornosci (HIV).

Reasons for seeking consultation among health care workers due to potential or supposed risk of HIV infection were analyzed. From August 1990 till July 1996 41 health care providers were consulted including: 22 nurses, 1 student of nursing college, 3 midwives, 4 laboratory workers and 7 physicians (surgeons and gynaecologist). Type of exposure to HIV and applying of safety precautions were evaluated in each case. In 10 cases the offer of postexposure prophylaxis with zidovudine was accepted (6 nurses, 1 student of nursing college, 3 surgeons). Exposure to HIV was described as: needlestick immediately after it was used in a HIV/AIDS patient, injury with a surgical needle while operating on an HIV infected blood. In the remaining cases the fear of HIV infection was due to work without protective gloves (nurses, laboratory workers), performing surgery on HIV (+) patient, (surgeons, nurses) or short-time contact of HIV infected blood with undamaged skin (nurses). Following conclusions can be drawn from our study: 1. Health care workers undertake safety precautions only when they are informed about HIV seropositivity of the patient. 2. Patients whose HIV serologic status is not known are considered not to create health risk for medical staff. 3. The level of knowledge of health care workers about risk of acquiring HIV infection, lack of risk and ways of diminishing the risk is poor. 4. None of followed health care workers was HIV-seropositive after occupational exposure to HIV.

[Multiorgan changes in AIDS in a reported case]. / Wielonarzadowe zmiany w AIDS na podstawie obserwowanego przypadku.

The clinical course of HIV infection and results of autopsy examination in 49 years old patient was shown. The attention was paid to difficulties of diagnosis of opportunistic infections in a patients with advanced HIV disease. Variety of infectious factors, that could affect a patient with significant immunodeficiency was outlined.