Antibiotic Prescribing in General Practice

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Antibiotic Prescribing in General Practice

• Sarah McMorran

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Why a Hot Topic?

• Drug and Therapeutics Bulletin-April 07
• -Avoiding Antibiotic Overuse in Primary Care
• BMJ August 2007
• -Effect of Antibiotic prescribing on Antibiotic
  resistance in individual children in primary
  careprospective cohort study

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So when should we prescribe an antibiotic?
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Sore Throat
Whats worse than a giraffe with a sore throat? A
Centipede with blisters!
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Sore Throat

• Approx 85 will self resolve within 1 week
• Usually viral
• Serious complications rare
• Symptomatic relief
• Phenoxymethylpenicillin 10days tx
• Delayed prescriptions for use after 3 days

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Antibiotic use in Sore Throat

• Cochrane review- 26 studies-12,669 patients
• Significant reduction in incidence of
  complications
• Compared with placebo 71 patients would need to
  be treated with antibiotics to prevent one
  patient from suffering AOM and 50 patients to
  prevent one case of quinsy.
• Significant reduction in symptoms of sore throat
  and fever at day 3 with antibiotic use.

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Centor Criteria

• Tonsillar exudate
• Tender anterior cervical lymph nodes
• Absence of cough
• History of fever

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Sore Ear
Common AOM OME ¾ occur in children under 10
years old AOM- viral or bacterial 80 recover
within 3 days without Antibiotic Complications
rare
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Antibiotic use in AOM

• Cochrane Review 8 RCTs -2287 cases
• 2/3 no pain after 24 hours whether Antibiotic or
  Placebo given.
• Use of delayed scripts
• 5 days treatment

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Interventions to help Inappropriate Antibiotic
prescribing

• Patient and prescriber education
• -questionnaire study in Australia
• Strongest determinants of prescribing were
  the doctors opinions about the patients
  expectations regarding medication
• Communication tools for avoiding inappropriate
  antibiotic prescribing

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Any Questions?
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References

• Del Mar C. Prescribing antibiotics in Primary
  Care. BMJ 2007 335407-408
• Harnden A, Perera R, Brueggemann A et al.
  Respiratory infections for which general
  practitionerls consider prescribing an
  antibiotica prospective study. Arh Dis Child
  200792594-597.
• Malmvall B, Molstad S, Darelid J et al. Reduction
  of antibiotic sales and sustained low incidence
  of bacterial resistanceReport on a broad
  approach during 10years to implement
  evidence-based indications for antibiotic
  prescribing in Jonkoping County,Sweden. Quality
  Management in Health Care 200716(1)60-7.
• Mangione-Smith R, Stivers T, Elliott M et al.
  Online commentary during physical examinationa
  communication tool for avoiding inappropriate
  antibiotic prescribing. Social Science Medicine
  200356(2)313-320.

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References continued

• 5. Antibiotic prescribing practices in
  ambulatory care.
• Cochrane Database of Systematic Reviews 2007
  Issue 3.
• 6. Little P. Delayed Prescribing of antibiotics
  for upper
• respiratory tract infection BMJ
  2005331301-302
• 7. Sore Throat.MeReC Bulletin. Dec 06Volume
  17no 3
• 8. Acute Otitis Media.MeReC Bulletin.Dec
  06Volume 17no 3.
• 9. Kenealy T. Sore Throat. Clinical evidence May
  2006.
• 10. NICE draft scope for guideline on respiratory
  tract infection
• -antibiotic prescribing July 2007
• 11. Chung A, Perera R, Brueggemann A. Effect of
  antibiotic prescribing on antibiotic resistance
  in individual children in primary
  careprospective cohort study. BMJ 2007335429.