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- Butler, C.C., et al.
(författare)
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Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care : Prospective study in 13 countries
- 2009
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Ingår i: BMJ. - : BMJ. - 0959-8146 .- 0959-8138 .- 1468-5833. ; 338:7710, s. 1545-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery. Design: Cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries. Setting: Primary care. Participants: Adults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection. Main outcome measures: Prescribing of antibiotics by clinicians and total symptom severity scores over time. Results: 3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18, 95% confidence interval 0.11 to 0.30) to Slovakia (11.2, 6.20 to 20.27) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics (coefficient -0.01, Pless than0.01) once clinical presentation was taken into account. Conclusions: Variation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery. Trial registration: Clinicaltrials.gov NCT00353951.
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| 2. |
- Stahlgren, G. S., et al.
(författare)
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Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study
- 2019
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Ingår i: Bmj-British Medical Journal. - : BMJ. - 1756-1833 .- 0959-8138. ; 367
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. 17 primary healthcare centres in Sweden between September 2015 and February 2018. Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever >= 38.5 degrees C, tender lymph nodes, coatings of the tonsils, and absence of cough). Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The noninferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. Penicillin V four times daily for five days was noninferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.
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| 6. |
- Melander, Eva, et al.
(författare)
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Limited spread of penicillin-nonsusceptible pneumococci, Skane County, Sweden
- 2004
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Ingår i: Emerging Infectious Diseases. - 1080-6040. ; 10:6, s. 1082-1087
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Tidskriftsartikel (refereegranskat)abstract
- In response to increasing frequencies of penicillin-non-susceptible pneumococci (PNSP), for which the MIC of penicillin was greater than or equal to0.12 mg/L, in Sk (a) over circle ne County, southern Sweden, national recommendations were initiated in 1995 to limit the spread of pneumococci with high MICs (greater than or equal to0.5 mg/L) of penicillin (PRP), especially among children of preschool age. Traditional communicable disease control measures were combined with actions against inappropriate antimicrobial drug use. During the first 6 years that these recommendations were applied in Sk (a) over circle ne County, the average frequency of penicillin-resistant pneumococci has been stable at approximate to2.6%, as has the average PNSP frequency (7.4%). However, PNSP have been unevenly distributed in the county, with the highest frequencies in the southwest. Simultaneously, the rate of antimicrobial drug use for children <6 years of age was reduced by 20%. Thus the spread of PNSP between and within the municipalities in the county has been limited.
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| 9. |
- Vekic, T. T., et al.
(författare)
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Effect of calcareous and siliceous amendments on N2O emissions of a grassland soil
- 2023
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Ingår i: Soil Use and Management. - 0266-0032. ; 39:3, s. 1082-1095
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Tidskriftsartikel (refereegranskat)abstract
- Liming of acidic agricultural soils has been proposed as a strategy to mitigate nitrous oxide (N2O) emissions, as increased soil pH reduces the N2O/N-2 product ratio of denitrification. The capacity of different calcareous (calcite and dolomite) and siliceous minerals to increase soil pH and reduce N2O emissions was assessed in a 2-year grassland field experiment. An associated pot experiment was conducted using homogenized field soils for controlling spatial soil variability. Nitrous oxide emissions were highly episodic with emission peaks in response to freezing-thawing and application of NPK fertilizer. Liming with dolomite caused a pH increase from 5.1 to 6.2 and reduced N2O emissions by 30% and 60% after application of NPK fertilizer and freezing-thawing events, respectively. Over the course of the 2-year field trial, N2O emissions were significantly lower in dolomite-limed than non-limed soil (p < .05), although this effect was variable over time. Unexpectedly, no significant reduction of N2O emission was found in the calcite treatment, despite the largest pH increase in all tested minerals. We tentatively attribute this to increased N2O production by overall increase in nitrogen turnover rates (both nitrification and denitrification) following rapid pH increase in the first year after liming. Siliceous materials showed little pH effect and had no significant effect on N2O emissions probably because of their lower buffering capacity and lower cation content. In the pot experiment using soils taken from the field plots 3 years after liming and exposing them to natural freezing-thawing, both calcite (p < .01) and dolomite (p < .05) significantly reduced cumulative N2O emission by 50% and 30%, respectively, relative to the non-limed control. These results demonstrate that the overall effect of liming is to reduce N2O emission, although high lime doses may lead to a transiently enhanced emission.
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