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.
"It also indicated that most of the residents feel quite confident in making an accurate diagnosis, interpreting microbiological results, choosing the correct antibiotic, its dose and duration of treatment. Previous studies have shown misdiagnosis to be a leading cause of unnecessary antibiotic prescriptions  . "
[Show abstract][Hide abstract] ABSTRACT: Objective
To analyze the attitude and perception of junior resident doctors' regarding antibiotic resistance and prescribing.
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.
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.
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.
"A significant decrease (13.5%) in antibiotic consumption was observed over the last 10 years in France , but it is still one of the countries with the highest antibiotic consumption in Europe (4th position for healthcare institutions [HI] and 5th position in community practice [CP]) , and prescriptions are often inappropriate  . The growing issue of bacterial resistance to antibiotics stresses the role infectious disease specialists may play, as well for HI as for family physicians who prescribe antibiotics daily. "
[Show abstract][Hide abstract] ABSTRACT: Objectifs
Conformément au nouveau Plan Antibiotique, MedQual évalue la possibilité d’organiser en Pays-de-la-Loire, un réseau de référents en antibiothérapie afin de répondre aux attentes des professionnels de santé libéraux et des établissements de santé (ES) dépourvus d’infectiologue.
Une enquête, menée en collaboration avec les antibioréférents de la Région, pendant cinq jours, a permis d’évaluer l’activité réelle en antibiologie de liaison. Quatre critères étaient retenus : origine de l’appel (interne/externe à l’ES), type de question (diagnostic/thérapeutique), temps mobilisé pour le conseil prodigué, type de conseil.
Vingt antibioréférents ont participé à l’enquête. Sur les 323 questions, 81 % étaient internes à l’ES, 7,7 % provenaient d’un autre ES et 11,3 % du secteur ambulatoire ; 56,3 % des questions concernaient une stratégie thérapeutique, 21 % une aide au diagnostic et 22,6 % une aide à la fois diagnostique et thérapeutique. Les deux tiers des questions étaient traités en moins de dix minutes. Dans 68,7 % des cas, l’antibioréférent a apporté un conseil ponctuel ; 19,8 % des appels nécessitaient un suivi du patient, 6 % ont conduit à orienter le patient vers une consultation.
Ce travail démontre clairement qu’une mutualisation des antibioréférents serait d’un grand intérêt pour la Région. Près de 20 % des questions étaient externes à l’ES d’origine de l’infectiologue, ce qui démontre un réel besoin d’expertise en infectiologie. Ce réseau permettrait d’améliorer la qualité et la sécurité des soins dans une démarche de maîtrise médicalisée des dépenses de santé.
"Bugnon et al.
 reported that up to 25% of patients admitted to the internal medicine and surgery wards in eight Swiss hospitals were treated with antibiotics. Several other studies – also concluded that more than a third of antibiotic prescriptions were unnecessary. Moreover, when an antibiotic was indicated, the specific treatment was considered incorrect in up to 65%  of the cases. "
[Show abstract][Hide abstract] ABSTRACT: Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used.
We present the design and the evaluation of a tool (KART) that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques.
KART consists of three main modules 1) a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2) a module to normalize clinical recommendations based on automatic text categorizers; and 3) a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough.
KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users.
We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building.
PLoS ONE 05/2013; 8(4):e62874. DOI:10.1371/journal.pone.0062874 · 3.23 Impact Factor
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