Estimated saving of antibiotics in pharyngitis and lower respiratory tract infections if general practitioners used rapid tests and followed guidelines

Carles Llor, Ana Moragas, Josep M Cots, Beatriz González López-Valcárcel, Happy Audit Study Group, Carles Llor, Ana Moragas, Josep M Cots, Beatriz González López-Valcárcel, Happy Audit Study Group

Abstract

Introduction: General practitioners (GP) in Spain do not have access to rapid tests and adherence to guidelines is usually suboptimal. The aim of the study is to evaluate the estimated number of antibiotics that could have been saved if GPs had appropriately used these tests and had followed the guidelines.

Design: Observational study.

Setting: Primary care centres from eight Autonomous Communities in Spain.

Participants: GPs who had not participated in previous studies on rational use of antibiotics.

Intervention: GPs registered all the cases of pharyngitis and lower respiratory tract infections (LRTI) during 15 working days in 2015, by means of a 47-item audit.

Main measurements: Actual GPs' antibiotic prescription and estimated number of antibiotics that could have been saved according to recent guidelines.

Results: A total of 126 GPs registered 1012 episodes of pharyngitis and 1928 LRTIs. Antibiotics were given or patients were referred in 497 patients with pharyngitis (49.1%) and 963 patients with LRTI (49.9%). If GPs had appropriately used rapid antigen detection tests and C-reactive protein tests and had strictly followed current guidelines, antibiotics would have been given to 7.6% and 15.1%, respectively, with an estimated saving of 420 antibiotics in patients with sore throat (estimated saving of 84.5%; 95% CI: 81.1-87.4%) and 672 antibiotics in LRTIs (estimated saving of 69.8%,95% CI: 67.1-72.5%).

Conclusions: GP adherence to guidelines and a correct introduction of rapid tests in clinical practice in Spain could result in a considerable saving of unnecessary prescription of antibiotics in pharyngitis and LRTIs.

Keywords: Antibiotics; Antibióticos; Audit; Auditoría; Infección respiratoria; Point-of-care test; Prueba de diagnóstico rápido; Respiratory tract infections.

Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Figures

Figure 1
Figure 1
Recommended management of both infections. (a) Acute pharyngitis. (b) Lower respiratory tract infection.

References

    1. Spinks A., Glasziou P.P., Del Mar C.B. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013:CD000023.
    1. Bisno A.L., Gerber M.A., Gwaltney J.M., Jr., Kaplan E.L., Schwartz R.H. Infectious Diseases Society of America Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002;35:113–125.
    1. Cots J.M., Alós J.I., Bárcena M., Boleda X., Cañada J.L., Gómez N. Recomendaciones para el manejo de la faringoamigdalitis aguda del adulto. Aten Primaria. 2015;47:532–543.
    1. Smith S.M., Fahey T., Smucny J., Becker L.A. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014:CD000245.
    1. Woodhead M., Blasi F., Ewig S., Garau J., Huchon G., Ieven M. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections – Full version. Clin Microbiol Infect. 2011;17(Suppl. 6):E1–E59.
    1. Metlay J.P., Kapoor W.N., Fine M.J. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278:1440–1445.
    1. Aabenhus R., Jensen J.U., Jørgensen K.J., Hróbjartsson A., Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014:CD010130.
    1. Llor C., Cots J.M., Hernández S., Ortega J., Arranz J., Monedero M.J., Happy Audit Study Group Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study. Aten Primaria. 2014;46:492–500.
    1. Goossens H., Ferech M., Vander Stichele R., Elseviers M., ESAC Project Group Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;65:579–587.
    1. Verlee L., Verheij T.J., Hopstaken R.M., Prins J.M., Salomé P.L., Bindels P.J. Summary of NHG practice guideline ‘Acute cough’. Ned Tijdschr Geneeskd. 2012;156:A4188.
    1. Lervy B., Wareham K., Cheung W.Y. Practice characteristics associated with audit activity: a medical audit advisory group survey. Br J Gen Pract. 1994;44:311–314.
    1. Bjerrum L., Munck A., Gahrn-Hansen B., Hansen M.P., Jarbol D.E., Cordoba G. Health alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY-AUDIT) – impact of a non-randomised multifaceted intervention programme. BMC Fam Pract. 2011;12:52.
    1. Dekker A.R., Verheij T.J., van der Velden A.W. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. Fam Pract. 2015;32:401–407.
    1. Neumark T., Brudin L., Mölstad S. Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare – a 6-y follow-up study. Scand J Infect Dis. 2010;42:90–96.

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