Antibacterial Use in Community Practice

Carrie, Anita; Zhanel, George G.

doi:10.2165/00003495-199957060-00004

Cited by 33 publications

(6 citation statements)

References 36 publications

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“…Compared with European countries [40-43], Hong Kong’s public primary care appears to exhibit low antibiotic prescribing behaviour for symptoms of upper respiratory tract infections. On the other hand, the prescription rate for non-antibiotic medications is exceptionally high.…”

Section: Discussionmentioning

confidence: 99%

Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Kung

Wong

et al. 2014

BMC Fam Pract

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BackgroundUpper respiratory tract infection (URTI) has a significant healthcare burden worldwide. Considerable resources are consumed through health care consultations and prescribed treatment, despite evidence for little or no effect on recovery. Patterns of consultations and care including use of symptomatic medications and antibiotics for upper respiratory tract infections are poorly described.MethodsWe performed a retrospective review of computerized clinical data on patients presenting to all public primary care clinics in Hong Kong with symptoms of respiratory tract infections. International Classification of Primary care (ICPC)codes used to identify patients included otitis media (H71), streptococcal pharyngitis (R72), acute URTI (R74), acute sinusitis (R75), acute tonsillitis (R76), acute laryngitis (R77), and influenza (R80). Sociodemographic variables such as gender, age, chronic illness status, attendance date, type and duration of drug prescribed were also collected.ResultsOf the 5,529,755 primary care consultations for respiratory symptoms from 2005 to 2010, 98% resulted in a prescription. Prescription patterns of symptomatic medication were largely similar across the 5 years. In 2010 the mean number of drugs prescribed per consultation was 3.2, of which the commonly prescribed medication were sedating antihistamines (79.9%), analgesia (58.9%), throat lozenges (40.4%) and expectorant cough syrup (33.8%). During the study period, there was an overall decline in antibiotic prescription (8.1% to 5.1%). However, in consultations where the given diagnosis was otitis media (H71), streptococcal pharyngitis (R72), acute sinusitis (R75) or acute laryngitis (R76), over 90% resulted in antibiotic prescription.ConclusionThere was a decline in overall antibiotic prescription over the study period. However, the use of antibiotics was high in some conditions e.g. otitis media and acute laryngitis a. Multiple symptomatic medications were given for upper respiratory tract infections. Further research is needed to develop clinical and patients directed interventions to reduce the number of prescriptions of symptomatic medications and antibiotics that could reduce costs for health care services and iatrogenic risk to patients.

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Section: Discussionmentioning

confidence: 99%

Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Kung

Wong

et al. 2014

BMC Fam Pract

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“…To assess the appropriateness of prescribing antibiotics in primary care, knowledge about likely aetiological agents and their resistance patterns is required [14]. When General Practitioners (GPs) are provided with data about the types and prevalence of resistant pathogens in their own region or country, antibiotic prescription could be optimised [15].…”

Section: Introductionmentioning

confidence: 99%

The appropriateness of prescribing antibiotics in the community in Europe: study design

et al. 2011

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BackgroundOver 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the appropriateness of antibiotic prescribing in primary care in Europe by collecting and combining patterns of antibiotic resistance patterns and antibiotic prescription patterns in primary care. We will also evaluate the appropriateness of national antibiotic prescription guidelines in relation to resistance patterns.Methods/DesignAntibiotic resistance will be studied in an opportunistic sample from the community in nine European countries. Resistance data will be collected by taking a nose swab of persons (N = 4,000 per country) visiting a primary care practice for a non-infectious disease. Staphylococcus aureus and Streptococcus pneumoniae will be isolated and tested for resistance to a range of antibiotics in one central laboratory. Data on antibiotic prescriptions over the past 5 years will be extracted from the electronic medical records of General Practitioners (GPs). The results of the study will include the prevalence and resistance data of the two species and 5 years of antibiotic prescription data in nine European countries.The odds of receiving an effective antibiotic in each country will be calculated as a measure for the appropriateness of prescribing. Multilevel analysis will be used to assess the appropriateness of prescribing. Relevant treatment guidelines of the nine participating countries will be evaluated using a standardized instrument and related to the resistance patterns in that country.DiscussionThis study will provide valuable and unique data concerning resistance patterns and prescription behaviour in primary care in nine European countries. It will provide evidence-based recommendations for antibiotic treatment guidelines that take resistance patterns into account which will be useful for both clinicians and policy makers. By improving antibiotic use we can move towards controlling the resistance problem globally.

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“…If the dosages used over time are increased with the same number of prescriptions and without changing the DDD, then the total consumption expressed in DDD/1000 inhabitants/day will decline [13]. This can be misleading, since a decline in consumption of the substance or therapeutic class can occur even if the number of prescriptions does not show any fluctuation.…”

Section: Defined Daily Dose (Ddd)mentioning

confidence: 99%

The crucial question of standardisation when measuring drug consumption

et al. 2001

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-The reliability of drug consumption studies will depend on agreement on an international unit of measurement and the provision of accurate descriptions of patterns of use. This measurement unit should permit comparisons between countries and periods of time. Different units have been proposed and published. Consumption may be expressed in terms of pharmaceutical firm turnover, therapeutic costs, weight (total weight or dose equivalent), treatment doses such as defined daily dose and prescribed daily dose, or as number of items or packages sold. The advantages and disadvantages of the different evaluation units used in veterinary medicine are reviewed. drug consumption / unit of measurement / veterinary medicine / drug statistics / DDD Résumé -Évaluation de la consommation médicamenteuse : le problème de la standardisation. L'étude des consommations médicamenteuses requiert une unité de mesure internationale applicable aux différentes méthodes de recueil des données et permettant une description la plus complète possible des consommations. Les comparaisons géographiques, temporelles et entre usages doivent également être possibles. Différents systèmes unitaires ont été développés selon ces différents critères et impératifs. Ces unités peuvent être économiques (chiffres d'affaire des firmes pharmaceutiques ou coûts thérapeutiques), pondérales (poids total ou converti en dose active), liées au traitement (dose définie journalière, dose quotidienne prescrite) ou pratiques (nombre de conditionnements vendus). Une revue des différentes unités utilisées en médecine vétérinaire est ici présentée. consommation médicamenteuse / unité de mesure / médecine vétérinaire / DDD Vet. Res. 32 (2001) 533-543 533

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Antibacterial Use in Community Practice

Cited by 33 publications

References 36 publications

Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

The appropriateness of prescribing antibiotics in the community in Europe: study design

The crucial question of standardisation when measuring drug consumption

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