Antibiotic Prescribing in General Practice

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					Antibiotic Prescribing in General

          Sarah McMorran
        Why a Hot Topic?
• Drug and Therapeutics Bulletin-April 07
 -Avoiding Antibiotic Overuse in Primary
• BMJ August 2007
 -Effect of Antibiotic prescribing on
  Antibiotic resistance in individual
  children in primary care:prospective
  cohort study
So when should we
prescribe an
Sore Throat

         What’s worse
         than a giraffe
         with a sore
         A Centipede
         with blisters!
             Sore Throat
• Approx 85% will self resolve within 1
• Usually viral
• Serious complications rare
• Symptomatic relief
• Phenoxymethylpenicillin –10days tx
• Delayed prescriptions for use after 3
           Antibiotic use in Sore Throat

• Cochrane review- 26 studies-12,669 patients
• Significant reduction in incidence of
• 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.
            Centor Criteria
• Tonsillar exudate

• Tender anterior cervical lymph nodes

• Absence of cough

• History of fever
     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
       Antibiotic use in AOM
• Cochrane Review 8
  RCT’s -2287 cases

• 2/3 no pain after 24
  hours whether
  Antibiotic or Placebo
• Use of delayed
• 5 days treatment
   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
• Communication tools for avoiding
  inappropriate antibiotic prescribing
Any Questions?

1.   Del Mar C. Prescribing antibiotics in Primary Care. BMJ 2007;
2.   Harnden A, Perera R, Brueggemann A et al. Respiratory
     infections for which general practitionerls consider prescribing
     an antibiotic:a prospective study. Arh Dis Child 2007;92:594-
3.   Malmvall B, Molstad S, Darelid J et al. Reduction of antibiotic
     sales and sustained low incidence of bacterial
     resistance:Report on a broad approach during 10years to
     implement evidence-based indications for antibiotic
     prescribing in Jonkoping County,Sweden. Quality
     Management in Health Care 2007;16(1):60-7.
4.   Mangione-Smith R, Stivers T, Elliott M et al. Online
     commentary during physical examination:a communication
     tool for avoiding inappropriate antibiotic prescribing. Social
     Science & Medicine 2003;56(2):313-320.
          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 2005;331:301-302
7. Sore Throat.MeReC Bulletin. Dec 06;Volume 17:no 3
8. Acute Otitis Media.MeReC Bulletin.Dec 06:Volume 17:no 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 care:prospective cohort study. BMJ 2007;335;429.

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