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- André, Malin, et al.
(author)
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Management of urinary tract infections in primary care: : a repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002.
- 2004
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In: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:2, s. 134-138
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Journal article (peer-reviewed)abstract
- A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) (n = 1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice.
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| 2. |
- André, Malin, et al.
(author)
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The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned
- 2004
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In: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:3, s. 192-197
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Journal article (peer-reviewed)abstract
- A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p<0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p<0.001). However, 59% of the patients assigned viral diagnoses with CRP≥25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.
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| 3. |
- André, Malin, et al.
(author)
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Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests
- 2002
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In: Scandinavian Journal of Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 0036-5548 .- 1651-1980. ; 34, s. 880-
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Journal article (peer-reviewed)abstract
- A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.
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| 4. |
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| 5. |
- Axelsson, Inge
(author)
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Acute otitis media in children: to treat or not to treat?
- 2000
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In: Paediatric pulmonology and allergology. - 1392-5261. ; 3:3, s. 1022-1032
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Journal article (other academic/artistic)abstract
- Every day millions of children world-wide take antibiotics against acute otitis media despite the fact that this treatment has not been shown to benefit the otherwise healthy, average AOM patient. Treatment differs greatly between similar, developed countries. These differences do not seem to be based on rational causes but on differences in mentality and culture. An adoptions of Dutch guidelines for AOM in the USA should result in 400.000 fewer US children on antibiotics during one average day! The incidence of severe complications (mastoiditis, meningitis) must be carefully monitored but there is no evidence that these complications are more common in the Netherlands than in the USA. The number of patients who die due to bacteria made antibiotic-resistant by overuse of antibiotics when treating AOM in children is unknown, but is most probably significant (this is never included in "good versus harm" calculations). We know little about what treatment is best for children suffering from AOM in poor countries, but it is probably wise to be more aggressive there and to adapt a freer usage of antibiotics than is advisable in rich countries.
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| 10. |
- axelsson, Inge
(author)
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Cochrane-översikt om att förebygga navelinfektioner : Antiseptisk lösning är onödig i i-länder men livräddande i u-länder; evidensbaserad medicin
- 2002
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In: Läkartidningen. - 0023-7205. ; 99:14, s. 1563-1566
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Journal article (peer-reviewed)abstract
- One million newborn infants die every year by bacterial infections, which often have entered the body via the umbilicus. A Cochrane systematic review on "Topical umbilical cord care at birth" by J Zupan and P Garner is reviewed. Zupan and Garner conclude that simply to keep the umbilical cord dry and clean is sufficient for healthy, term neonates in rich countries; disinfectants do not offer any advantage. However, cleaning the umbilical cord with disinfectants may reduce the risk of serious bacterial infections in babies in poor countries or in neonatal wards. Observational studies in poor countries indicate that the life of numerous infants can be saved if pregnant women are vaccinated against tetanus and disinfectants are substituted for harmful cord care traditions. This Cochrane review is credible, but it should be updated and considered tentative since no data on sepsis are included. The search strategy should be better described and observational studies (case control and cohort studies) from poor countries should be included since there are no randomized control trials from these countries.
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