Article

Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance

National Institute for Health and Clinical Excellence, Manchester M1 4BD.
BMJ (online) (Impact Factor: 16.38). 07/2008; 337(jul23 3):a437. DOI: 10.1136/bmj.a437
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Available from: Paul Little, Jul 28, 2015
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    • "Although the available evidence has shown that antibiotics probably provide little benefit for a large proportion of respiratory tract infections, antibiotics are still largely inappropriately used in clinic [3– 5]. Antibiotic treatment to prevent suppurative and nonsuppurative complications may be inappropriate nowadays with generally low rates of major complications [3]. More effective approaches to control infections and relieve symptoms in AURTIs are in a great need. "
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    ABSTRACT: To evaluate the efficacy and safety of new drugs of traditional Chinese medicine (TCM) for acute upper respiratory tract infection (common cold). Reports regarding randomized controlled trials of Chinese medicine for common cold were reviewed. Related reports were selected and the methodological quality of the trials was assessed by the Jadad scale. Meanwhile, the stratified analysis was made according to different TCM syndrome types of common cold. Thirteen randomized controlled trials consistent with the inclusion criteria were selected and reviewed. As TCM treatment group was compared with control group, the meta analysis indicated that the relative risk (RR) for obviously effective rate was 1.10, and the 95% confidence interval (CI) was [1.05, 1.16]; the weighted mean difference (WMD) of the onset time of lowering body temperature was -1.70, and the 95% CI was [-2.76, -0.65]. There were significant differences in the above evaluation indexes between the two groups (P=0.000 2, P=0.002). The WMD of disappearing time of fever was -1.32, and the 95% CI was [-3.14, 0.49], while there was no significant difference between the two groups (P=0.15). As the common cold patients with wind-heat syndrome in the TCM treatment group were compared with those in the control group, the meta analysis indicated that the RR for obviously effective rate was 1.11, the 95% CI was [1.05, 1.19], and there was significant difference between the two groups (P=0.000 7). As the common cold patients with wind-cold syndrome in the TCM treatment group were compared with those in the control group, the meta analysis indicated that the RR for obviously effective rate was 1.07, the 95% CI was [0.99, 1.16], and there was no significant difference between the two groups (P=0.10). Serious adverse reactions had not been reported in the trials. TCM new drugs developed in recent years for preventing and treating common cold have better therapeutic effects than the old ones. They can accelerate the onset time of lowering body temperature and improve the symptoms of common cold without any significant adverse reactions. Because of lacking of placebo-controlled and blank-controlled studies, further high-quality trials are still needed.
    Journal of Chinese Integrative Medicine 09/2009; 7(8):706-16. DOI:10.3736/jcim20090802
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    • "Bei den bakteriellen Racheninfekten überwiegen jene, die durch GAS hervorgerufen werden. Bei geringen Beschwerden besteht keine Notwendigkeit für eine antibiotische Therapie [4] [5] [6] und Komplikationen bei Erkrankungen der oberen Atemwege können durch Antibiotika nicht vermindert werden [7]. Bei entsprechend starken Beschwerden (Centor-Score 3–4) und einem positiven Nachweis von GAS wird hingegen eine antibiotische Therapie empfohlen [5] [8] [9]. "
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    ABSTRACT: GRUNDLAGEN: Racheninfekte mit Gruppe-A-Streptokokken sind wegen ihrer Häufigkeit ein beträchtliches Gesundheitsproblem. Eine GRUNDLAGEN: Racheninfekte mit Gruppe-A-Streptokokken sind wegen ihrer Häufigkeit ein beträchtliches Gesundheitsproblem. Eine klare Differenzierung zu viralen Infekten ist daher wünschenswert. Wir berichten über den Einsatz eines immunologischen Schnelltests klare Differenzierung zu viralen Infekten ist daher wünschenswert. Wir berichten über den Einsatz eines immunologischen Schnelltests auf Gruppe-A-Streptokokken sowie dessen medizinische und ökonomische Auswirkungen. METHODIK: In einer Querschnittsstudie wandten auf Gruppe-A-Streptokokken sowie dessen medizinische und ökonomische Auswirkungen. METHODIK: In einer Querschnittsstudie wandten 30 Burgenländische Ärzte für Allgemeinmedizin den Test an und dokumentierten den Einsatz bei 519 Patienten an Hand eines Dokumentationsbogens. 30 Burgenländische Ärzte für Allgemeinmedizin den Test an und dokumentierten den Einsatz bei 519 Patienten an Hand eines Dokumentationsbogens. Als Kohortenstudie angelegt, wurden die Folgekosten mit 109 Ärzten für Allgemeinmedizin, denen der Test nicht zur Verfügung Als Kohortenstudie angelegt, wurden die Folgekosten mit 109 Ärzten für Allgemeinmedizin, denen der Test nicht zur Verfügung stand, verglichen. ERGEBNISSE: 40,27 % der durchgeführten Tests auf Streptokokken waren positiv. Von diesen Patienten erhielten stand, verglichen. ERGEBNISSE: 40,27 % der durchgeführten Tests auf Streptokokken waren positiv. Von diesen Patienten erhielten 99 % ein Antibiotikum – überwiegend Penicillin. Bei einem negativen Testergebnis erhielten nur 18,4 % der Patienten ein Antibiotikum. 99 % ein Antibiotikum – überwiegend Penicillin. Bei einem negativen Testergebnis erhielten nur 18,4 % der Patienten ein Antibiotikum. Sowohl Ärzte als auch Patienten zeigten eine positive Einstellung gegenüber der Durchführung des Tests. Bezüglich der ökonomischen Sowohl Ärzte als auch Patienten zeigten eine positive Einstellung gegenüber der Durchführung des Tests. Bezüglich der ökonomischen Konsequenzen ergab sich kein signifikantes Resultat. SCHLUSSFOLGERUNGEN: Die Durchführung eines immunologischen Schnelltests Konsequenzen ergab sich kein signifikantes Resultat. SCHLUSSFOLGERUNGEN: Die Durchführung eines immunologischen Schnelltests auf Gruppe-A-Streptokokken bei der akuten Pharyngitis verbessert die therapeutische Sicherheit und das leitlinienkonforme auf Gruppe-A-Streptokokken bei der akuten Pharyngitis verbessert die therapeutische Sicherheit und das leitlinienkonforme Vorgehen bei der Verschreibung von Antibiotika. Potentielle Nebenwirkungen durch unnötigen Antibiotikagebrauch sollten dadurch Vorgehen bei der Verschreibung von Antibiotika. Potentielle Nebenwirkungen durch unnötigen Antibiotikagebrauch sollten dadurch reduziert werden. reduziert werden. BACKGROUND: Throat infections with Group A Streptococci have a high incidence and are, therefore, a considerable health problem. BACKGROUND: Throat infections with Group A Streptococci have a high incidence and are, therefore, a considerable health problem. It is, therefore, desirable to distinguish this bacterial infections from viral infections of the upper respiratory tract. It is, therefore, desirable to distinguish this bacterial infections from viral infections of the upper respiratory tract. We report about the application of an immunologic rapid antigen detection test for Group A Streptococci and its medical and We report about the application of an immunologic rapid antigen detection test for Group A Streptococci and its medical and economic implications. METHODS: In a cross-sectional cohort study, 30 family physicians documented the application of the economic implications. METHODS: In a cross-sectional cohort study, 30 family physicians documented the application of the test in 519 patients. Follow-up costs were compared with 109 family physicians who did not have access to the test. RESULTS: test in 519 patients. Follow-up costs were compared with 109 family physicians who did not have access to the test. RESULTS: 40.27% of tests performed were positive for Streptococci. 99% of those patients received antibiotic treatment – predominantly 40.27% of tests performed were positive for Streptococci. 99% of those patients received antibiotic treatment – predominantly with Penicillin. From those patients who had shown a negative test result, only 18.4% received antibiotic treatment. Both with Penicillin. From those patients who had shown a negative test result, only 18.4% received antibiotic treatment. Both patients and physicians welcomed the availability of the test. We did not find any significant difference regarding the economic patients and physicians welcomed the availability of the test. We did not find any significant difference regarding the economic effect of the test. CONCLUSIONS: The employment of a rapid antigen detection test for Group A Streptococci in patients with effect of the test. CONCLUSIONS: The employment of a rapid antigen detection test for Group A Streptococci in patients with acute pharyngitis increases therapeutic certitude and guideline-conform prescription of antibiotics among family physicians. acute pharyngitis increases therapeutic certitude and guideline-conform prescription of antibiotics among family physicians. We, therefore, assume that potential side effects of unnecessary antibiotic treatments could be minimized. We, therefore, assume that potential side effects of unnecessary antibiotic treatments could be minimized.
    Wiener Medizinische Wochenschrift 04/2009; 159(7):202-206. DOI:10.1007/s10354-009-0672-x
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    • "Bei den bakteriellen Racheninfekten überwiegen jene, die durch GAS hervorgerufen werden. Bei geringen Beschwerden besteht keine Notwendigkeit für eine antibiotische Therapie [4] [5] [6] und Komplikationen bei Erkrankungen der oberen Atemwege können durch Antibiotika nicht vermindert werden [7]. Bei entsprechend starken Beschwerden (Centor-Score 3–4) und einem positiven Nachweis von GAS wird hingegen eine antibiotische Therapie empfohlen [5] [8] [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Throat infections with Group A Streptococci have a high incidence and are, therefore, a considerable health problem. It is, therefore, desirable to distinguish this bacterial infections from viral infections of the upper respiratory tract. We report about the application of an immunologic rapid antigen detection test for Group A Streptococci and its medical and economic implications. In a cross-sectional cohort study, 30 family physicians documented the application of the test in 519 patients. Follow-up costs were compared with 109 family physicians who did not have access to the test. 40.27% of tests performed were positive for Streptococci. 99% of those patients received antibiotic treatment - predominantly with Penicillin. From those patients who had shown a negative test result, only 18.4% received antibiotic treatment. Both patients and physicians welcomed the availability of the test. We did not find any significant difference regarding the economic effect of the test. The employment of a rapid antigen detection test for Group A Streptococci in patients with acute pharyngitis increases therapeutic certitude and guideline-conform prescription of antibiotics among family physicians. We, therefore, assume that potential side effects of unnecessary antibiotic treatments could be minimized.
    Wiener Medizinische Wochenschrift 02/2009; 159(7-8):202-6.
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