ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of ...an uncomplicated urinary tract infection (UTI).Setting16 sites in a primary care setting in Norway, Sweden and Denmark.ParticipantsData from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.MethodsUsing the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.ResultsOf the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).ConclusionWe did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.Trial registration numberClinicalTrials.gov (NCT01849926).
Bakterier er dynamiske organismer som gjennom sin plastisitet og kontinuerlige tilpasning til omgivelsene, illustrerer evolusjon gjennom naturlig utvalg og «survival of the fittest». Økt forekomst av ...antibiotikaresistens er et naturlig og forventet svar på utstrakt bruk av antibiotika. Dette forklarer hvorfor historien om utvikling og utbredelse av antibiotika etterfølges av en parallell historie: historien om antibiotikaresistens. Her i hovedsak omtalt som sett fra et norsk ståsted. I løpet av rundt 90 år med utstrakt bruk av antimikrobielle legemidler, er erkjennelsen om hvordan antibiotikabruk og resistens henger sammen, gradvis blitt mer og mer tydelig. Fra spredte enkelttilfeller på 1930-tallet til dagens globale pandemi av resistente og multiresistente mikrober. Mikrobene har bevist sin evne til å utvikle resistens mot så å si samtlige antimikrobielle midler som er utviklet siden 1930-tallet.1
Oppdagelse og utvikling av antibakterielle legemidler er blant de største triumfene innen moderne medisin og også i menneskehetens historie. Takket være antibiotika og kjemoterapeutika ble leger i ...stand til å behandle alvorlige infeksjonssykdommer og helbrede pasienter som ellers var levnet små sjanser til overlevelse. Ikke rart at antibakterielle midler ble opplevd som mirakelmedisiner da de ble tilgjengelige. Artikkelen gir en historisk framstilling av oppdagelse og utvikling av antibiotika, fra før bakteriologiens gjennombrudd mot slutten av 1800-tallet og fram til vår tid. Dagens situasjon kjennetegnes av økende antibiotikaresistens samtidig som tilgangen på nye og effektive antibiotika langt på vei har stoppet opp.
Objective. To evaluate health care providers’ adherence to management guidelines for acute respiratory infection and diarrhoea in children under 5 years old in Botswana primary health care. Design. ...Cross-sectional prospective field survey. Data collection was carried out through observation of consecutive consultations at 30 randomly assigned clinics and health posts in three purposely chosen districts. Study participants. This study comprises 185 cases of acute respiratory infection and 85 cases of diarrhoea. Main measures. Criteria for acceptable standards of history taking and physical examination for acute respiratory infection and diarrhoea were defined as well as criteria for categorizing the appropriateness of antibiotic prescription. The percentage of oral dehydration salts provided in cases of diarrhoea was calculated. Results. Acute respiratory infection and diarrhoea accounted for 270 (including 15 missing cases) of all main diagnoses (n = 539). In 262 cases (97%) health care providers were nurses or enrolled nurses; in 3% family welfare educators. Acceptable history taking, physical examination, and both combined in acute respiratory infection was found in 113 (63%), 32 (18%), and 28 (16%), and in diarrhoea in 45 (58%), 26 (34%) and 20 (26%) cases, respectively. Antibiotics were prescribed in 76 of 255 (30%) cases. Prescription was assessed as inappropriate in 56 of 76 (74%) of all cases; in 41 of 52 (79%) cases with acute respiratory infection, in none of the pneumonia cases, and in all 15 cases of diarrhoea. Oral rehydration salts were prescribed in 74 (87%) of the diarrhoea cases. Conclusions. Health care providers’ adherence to guidelines on history taking was suboptimal in acute respiratory infection and diarrhoea but poor on examination in both conditions. A high level of inappropriate antibiotic prescription was found in acute respiratory infection and diarrhoea. Overall, there is considerable scope for improving diagnostic and therapeutic management of these major childhood diseases in Botswana primary health care.
Recovery time and treatment effect of oseltamivir in influenza-like illness (ILI) differs between patient groups. A point-of-care test to better predict ILI duration and identify patients who are ...most likely to benefit from oseltamivir treatment would aid prescribing decisions in primary care. This study aimed to investigate whether a C-reactive protein (CRP) concentration of ≥30 mg/L can predict (1) ILI disease duration, and (2) which patients are most likely to benefit from oseltamivir treatment.
Secondary analysis of randomized controlled trial data.
Primary care in Lithuania, Sweden and Norway during three consecutive influenza seasons 2016-2018.
A total of 277 ILI patients aged one year or older and symptom duration of ≤72 h.
Capillary blood CRP concentration at baseline, and ILI recovery time defined as having 'returned to usual daily activity' with residual symptoms minimally interfering.
At baseline, 20% (55/277) had CRP concentrations ≥30mg/L (range 0-210). CRP concentration ≥30 mg/L was not associated with recovery time (adjusted hazards ratio (HR) 0.80: 95% CI 0.50-1.3; p = 0.33). Interaction analysis of CRP concentration ≥30 mg/L and oseltamivir treatment did not identify which patients benefit more from oseltamivir treatment (adjusted HR 0.69: 95% CI 0.37-1.3; p = 0.23).
There was no association between CRP concentration of ≥30 mg/L and recovery time from ILI. Furthermore, CRP could not predict which ILI patients benefit more from oseltamivir treatment. Hence, we do not recommend CRP testing for predicting ILI recovery time or identifying patients who will receive particular benefit from oseltamivir treatment.
Key Points
Predicting disease course of influenza-like illness (ILI), and identifying which patients benefit from oseltamivir treatment is a challenge for physicians.
* There was no association between CRP concentration at baseline and recovery time in patients consulting with ILI in primary care.
* There was no association between CRP concentration at baseline and benefit from oseltamivir treatment.
* We, therefore, do not recommend CRP testing for predicting recovery time or in decision-making concerning oseltamivir prescribing in ILI patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Bakterier er dynamiske organismer som gjennom sin plastisitet og kontinuerlige tilpasning til omgivelsene, illustrerer evolusjon gjennom naturlig utvalg og «survival of the fittest». Økt forekomst av ...antibiotikaresistens er et naturlig og forventet svar på utstrakt bruk av antibiotika. Dette forklarer hvorfor historien om utvikling og utbredelse av antibiotika etterfølges av en parallell historie: historien om antibiotikaresistens. Her i hovedsak omtalt som sett fra et norsk ståsted.
I løpet av rundt 90 år med utstrakt bruk av antimikrobielle legemidler, er erkjennelsen om hvordan antibiotikabruk og resistens henger sammen, gradvis blitt mer og mer tydelig. Fra spredte enkelttilfeller på 1930-tallet til dagens globale pandemi av resistente og multiresistente mikrober. Mikrobene har bevist sin evne til å utvikle resistens mot så å si samtlige antimikrobielle midler som er utviklet siden 1930-tallet.1
Oppdagelse og utvikling av antibakterielle legemidler er blant de største triumfene innen moderne medisin og også i menneskehetens historie. Takket være antibiotika og kjemoterapeutika ble leger i ...stand til å behandle alvorlige infeksjonssykdommer og helbrede pasienter som ellers var levnet små sjanser til overlevelse. Ikke rart at antibakterielle midler ble opplevd som mirakelmedisiner da de ble tilgjengelige.
Artikkelen gir en historisk framstilling av oppdagelse og utvikling av antibiotika, fra før bakteriologiens gjennombrudd mot slutten av 1800-tallet og fram til vår tid. Dagens situasjon kjennetegnes av økende antibiotikaresistens samtidig som tilgangen på nye og effektive antibiotika langt på vei har stoppet opp.
Oppdagelse og utvikling av antibakterielle legemidler er blant de største triumfene innen moderne medisin og også i menneskehetens historie. Takket være antibiotika og kjemoterapeutika ble leger i ...stand til å behandle alvorlige infeksjonssykdommer og helbrede pasienter som ellers var levnet små sjanser til overlevelse. Ikke rart at antibakterielle midler ble opplevd som mirakelmedisiner da de ble tilgjengelige.
Artikkelen gir en historisk framstilling av oppdagelse og utvikling av antibiotika, fra før bakteriologiens gjennombrudd mot slutten av 1800-tallet og fram til vår tid. Dagens situasjon kjennetegnes av økende antibiotikaresistens samtidig som tilgangen på nye og effektive antibiotika langt på vei har stoppet opp.
Objective To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to ...reduce the use of broad spectrum antibiotics.Design Cluster randomised controlled study.Setting Existing continuing medical education groups were recruited and randomised to intervention or control.Participants 79 groups, comprising 382 general practitioners, completed the interventions and data extractions.Interventions The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.Main outcome measures Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.Results In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.Conclusions The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.Trial registration Clinical trials NCT00272155.
Lindbaek et al compared the effectiveness of penicillin V and amoxycillin with placebo in treatment of adult patients with acute sinusitis. Penicillin V and amoxycillin are more effective than ...placebo.
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