Non–First-Line Antibiotics Are Prescribed Commonly for Respiratory Infections.

[Argirios Argiriou]

Που να βλέπανε οι Αμερικανοί τι γίνεται και στην Ελλάδα, όπου οι κλαριθρομυκίνες και οι κινολόνες (και μάλιστα οι νεότερες) πάνε σύννεφο στις λοιμώξεις του αναπνευστικού...και μάλιστα από "Ειδικούς" οι οποίοι με την σειρά τους διδάσκουν και τους Γενικούς...

November 1, 2016

Non–First-Line Antibiotics Are Prescribed Commonly for Respiratory Infections

Thomas L. Schwenk, MD Reviewing Hersh AL et al., JAMA Intern Med 2016 Oct 24;

Almost half of all antibiotics prescribed for otitis media, sinusitis, and pharyngitis were non–first-line choices.

In response to increasing concerns about antibiotic resistance, researchers used data from the National Ambulatory Medical Care Survey to identify antibiotic prescription choices made by physicians during 5527 office visits (adult and pediatric) for otitis media, sinusitis, and pharyngitis in 2010 and 2011; only visits in which antibiotics actually were prescribed were considered. According to Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος, first-line recommendations for otitis media and sinusitis are amoxicillin or amoxicillin-clavulanate; for pharyngitis, first-line recommendations are penicillin or amoxicillin. For each visit, the actual prescribed antibiotic was rated as first-line or non–first-line.

First-line antibiotics were prescribed for 37% of adults with sinusitis or pharyngitis and for 67%, 51%, and 60% of children with otitis media, sinusitis, or pharyngitis, respectively. Overall, the use rate of first-line agents was 52%.

Comment

The authors estimate that 20% of ambulatory visits are made by patients who have antibiotic allergies or treatment failures that would require antibiotics other than first-line choices, so a reasonable target for first-line antibiotic use would be 80% of encounters (vs. the 52% recorded here). In addition, it's highly likely that antibiotics weren't even indicated for a substantial proportion of these cases. Thus, the overall amount of inappropriate prescribing of non–first-line antibiotics undoubtedly is even worse than these data suggest.

Citation(s):

Hersh AL et al. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Intern Med 2016 Oct 24; [e-pub].
 
(Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος