Antibiotic misuse: a prospective clinical audit in a French university hospital
ABSTRACT The aim of the study presented here was to prospectively audit antibiotic prescriptions given to patients attending L'Archet Hospital in Nice, France, with details of the initial medical examination included in the audit procedure. A total of 122 antibiotic treatments were evaluated, i.e. 31% of all antibiotic therapies initiated in the eight participating departments over the 9-week study period. Forty-two (34%) treatments were found to be unnecessary due to misdiagnosis, and 36 (30%) other treatments were inappropriate. Misdiagnosis, due to the misinterpretation or lack of clinical, microbiological and/or imaging data is thus a major cause of antibiotic misuse. Improvement in the diagnostic process should become part of antibiotic policy.
SourceAvailable from: Vishal Sharma[Show abstract] [Hide abstract]
ABSTRACT: Objective To analyze the attitude and perception of junior resident doctors' regarding antibiotic resistance and prescribing. Methods This cross-sectional study was conducted in two tertiary care centres in the New Delhi during the months of May-June 2012. An email based questionnaire was emailed to all the junior residents (JRs) working in the clinical setting and all the responses obtained within 2 months were included in the study. Statistical analysis was done using SPSS v.17. Results This email based questionnaire was forwarded to 80 JRs. 53 responses were deemed appropriate for analysis with response rate of 66.25%. Forty-nine JRs (92.45%) believed that antibiotic resistance is a problem in India while 38 JRs (71.7%) believed it is a problem in their hospital. 28 JRs (52.83%) had received training regarding antibiotic prescription in last 6 months while 25 (47.17%) had not received any training. 47 JRs (88.7%) believed that Medical Council should take strict actions prohibiting irrational use of antibiotics. Only 18 JRs (33.96%) said that Government of India should go ahead with proposed plan of restricting junior doctors from prescribing third and fourth generation antibiotics without Head of Department's permission. Conclusions Most of the junior residents believe that antibiotic resistance is an emerging problem in their hospital as also nationally. There is a large unmet need of providing education to these residents.01/2014; 3(1):6–9. DOI:10.1016/S2221-6189(14)60002-0
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ABSTRACT: Objectives: Urinary tract infections (UTIs) are one of the leading reasons for antibiotic prescriptions in emergency departments (EDs), with half of these antibiotics being inappropriately prescribed. Our objective was to assess the impact of a computerized decision support system (CDSS) on compliance with guidelines on empirical antibiotic prescriptions (antibiotic and duration) for UTIs in EDs. Methods: A multicentre prospective before-and-after controlled interventional study was conducted from 19 March to 28 October 2012. All adults diagnosed with community-acquired UTIs (cystitis, pyelonephritis or prostatitis) at three French EDs were included. The antibiotic therapy was considered compliant with guidelines if the antibiotic and the duration prescribed were in accordance with the national guidelines. Data were collected using electronic medical records. Paired tests were used when comparing periods within each ED and global analyses used multivariate logistic mixed models. Results: Nine hundred and twelve patients were included during the 30 week study period. The CDSS was used in 59% of cases (182/307). The CDSS intervention improved the compliance of antibiotic prescriptions in only one ED in a bivariate analysis (absolute increase + 20%, P = 0.007). The choice of the antibiotic was improved in multivariate analyses but only when the CDSS was used [OR = 1.94 (95% CI 1.13-3.32)]. The CDSS also changed the initial diagnosis in 23% of cases, in all three EDs. Conclusions: The CDSS only partially improved compliance with guidelines on antibiotic prescriptions in UTIs.Journal of Antimicrobial Chemotherapy 06/2014; 69(10). DOI:10.1093/jac/dku191 · 5.44 Impact Factor
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ABSTRACT: Objectives: This study aimed to evaluate knowledge of primary care physicians regarding the use of antibiotics for the upper respiratory tract infections (URTIs) and the specific outcomes of a health educational meeting in two cities using a self -administered questionnaire. Materials and methods: A standard questionnaire was filled by the participants before and after the meeting. The questionnaire had seven questions about definition, epidemiology, diagnosis and treatment of URTIs. The knowledge and approaches of practitioners concern about diagnosis and antibiotic use in URTIs were evaluated. The proportion of overall satisfied answers before and after the meeting was compared. Results: Totally 110 primary care physicians joined into the study. Before the educational meeting, more than 30% of participants stated that the at least 50% of the causative agents of the URTIs are bacteria. Eighty-eight percent declared that anaerobes or Neisseria are not the plausible causative agents in URTIs. Only 14% of them indicated that procaine penicillin is the primary agent for the treatment of Streptococcus pyogenes. On the other hand, 95% of survey participants considered that penicillin is the first choice for URTI with Beta-hemolytic Streptococcus. After the educational meeting, most of participants' knowledge showed a significant improvement in knowledge. There were a significantly more correct answers to all questions after the educational meeting compared to before the meeting. (27.7% of doctors before vs.92.7% after, p<0.001). Conclusion: As a conclusion, attending the educational meetings helps primary care physicians’ to increase their knowledge and it provides to gain a standard approach in their professional life.