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A 10-year follow-up study of penicillin-non-susceptible S. pneumoniae during an intervention programme in Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature80473
Source
Scand J Infect Dis. 2006;38(10):838-44
Publication Type
Article
Date
2006
Author
Nilsson Percy
Laurell Martin H
Author Affiliation
Department of Pediatrics, Malmö University Hospital, Lund University, Malmö, Sweden. percy.nilsson@pediatrik.mas.lu.se
Source
Scand J Infect Dis. 2006;38(10):838-44
Date
2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Drug Utilization
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Middle Aged
Penicillin resistance
Physician's Practice Patterns
Pneumococcal Infections - drug therapy - epidemiology - microbiology
Practice Guidelines
Streptococcus pneumoniae - drug effects
Sweden - epidemiology
Abstract
Changes in the proportion of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) isolates during an intervention programme were evaluated by phenotypic analysis of all initial isolates with penicillin MIC > or =0.5 microg/ml (n=1248) collected 1995-2004. During the study period, the proportion of such isolates was fairly constant (12-19%), and there was no statistically significant variation in the proportion of total PNSP cases (MIC > or =0.12 microg/ml) or PNSP with MIC > or =0.5 microg/ml, with the exception of an increase in 2004. Analysis restricted to clinical cases revealed no statistically significant changes. 23 different serogroups were found, and serogroup 9 isolates accounted for almost half of the PNSP cases. Only minor changes in phenotypic characteristics occurred in the other serogroups, which indicates that the increase in PNSP in 2004 was not due to import of a new resistant clone. Antibiotic consumption is considered to be an important risk factor for penicillin resistance in S. pneumoniae. After initiation of the intervention programme in Malmö, overall prescribing of antibiotics decreased 28%, and the reduction was even greater among children (52%). In conclusion, the proportion of PNSP isolates in Malmö has remained stable, despite the intervention programme and decreased consumption of antibiotics.
PubMed ID
17008226 View in PubMed
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Acute management and secondary prophylaxis of esophageal variceal bleeding: a western Canadian survey.

https://arctichealth.org/en/permalink/ahliterature167625
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Publication Type
Article
Date
Aug-2006
Author
Justin Cheung
Winnie Wong
Iman Zandieh
Yvette Leung
Samuel S Lee
Alnoor Ramji
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton.
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - therapeutic use
Anti-Bacterial Agents - therapeutic use
Canada
Endoscopy
Esophageal and Gastric Varices - complications - diagnosis - therapy
Gastroenterology - statistics & numerical data
Gastrointestinal Agents - therapeutic use
Gastrointestinal Hemorrhage - etiology - therapy
Guideline Adherence - trends
Health Care Surveys
Humans
Octreotide - therapeutic use
Physician's Practice Patterns
Questionnaires
Abstract
Acute esophageal variceal bleeding (EVB) is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.
Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire.
The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%).
Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences.
Notes
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PubMed ID
16955150 View in PubMed
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Antibiotic prescribing patterns in out-of-hours primary care: a population-based descriptive study.

https://arctichealth.org/en/permalink/ahliterature263171
Source
Scand J Prim Health Care. 2014 Dec;32(4):200-7
Publication Type
Article
Date
Dec-2014
Author
Linda Huibers
Grete Moth
Morten Bondo Christensen
Peter Vedsted
Source
Scand J Prim Health Care. 2014 Dec;32(4):200-7
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
After-Hours Care - trends
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Denmark
Drug Prescriptions - statistics & numerical data
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Observational Study as Topic
Physician's Practice Patterns
Primary Health Care
Retrospective Studies
Young Adult
Abstract
To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service.
Population-based observational registry study using routine registry data from the OOH registration system on patient contacts and ATC-coded prescriptions.
The OOH primary care service in the Central Denmark Region.
All contacts with OOH primary care during a 12-month period (June 2010-May 2011).
Descriptive analyses of antibiotic prescription proportions stratified for type of antibiotic, patient age and gender, contact type, and weekdays or weekend.
Of the 644 777 contacts registered during the study period, 15.0% received an antibiotic prescription: 26.1% resulted from clinic consultations, 10.7% from telephone consultations, and 10.9% from home visits. The prescription proportion was higher for weekends (17.6%) than for weekdays (10.6%). The most frequently prescribed antibiotic drugs were beta-lactamase sensitive penicillins (34.9%), antibiotic eye drops (21.2%), and broad-spectrum penicillins (21.0%). Most antibiotic eye drops (73%) were prescribed in a telephone consultation. Most antibiotics were prescribed at 4-6 p.m. on weekdays. Young infants received most antibacterial eye drops (41.3%), patients aged 5-17 years and 18-60 years received most beta-lactamase sensitive penicillins (44.6% and 38.9%, respectively), while patients aged 60 + years received most broad-spectrum penicillins (32.9% of all antibiotic prescriptions).
Antibiotics were most often prescribed in clinic consultations, but, in absolute terms, many were also prescribed by telephone. The high prescription proportion, particularly antibacterial eye drops for young infants, suggests room for improvement in rational antibiotic use.
Notes
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PubMed ID
25350313 View in PubMed
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Antibiotics for lower respiratory tract infections. Still too frequently prescribed?

https://arctichealth.org/en/permalink/ahliterature180328
Source
Can Fam Physician. 2004 Apr;50:569-75
Publication Type
Article
Date
Apr-2004
Author
Warren J McIsaac
Teresa To
Author Affiliation
Ray D Wolfe Department of Family Medicine, Mt Sinai Hospital, Toronto, Ont. wmcisaac@mtsinai.on.ca
Source
Can Fam Physician. 2004 Apr;50:569-75
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Bronchitis - drug therapy
Canada
Drug Utilization
Family Practice - standards
Female
Humans
Male
Middle Aged
Physician's Practice Patterns
Prospective Studies
Respiratory Tract Infections - diagnosis - drug therapy
Abstract
To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs).
Prospective assessment of adults with symptoms of LRTIs.
Offices of 120 community-based members of the College of Family Physicians of Canada.
Four hundred seven adults (16 years and older).
Clinical findings, diagnoses, tests ordered, and prescriptions for antibiotics were documented on a standardized form.
Antibiotics were prescribed to 58.4% of patients presenting with symptoms of LRTIs. Prescribing was higher (77.9%) for those diagnosed with acute bronchitis, which accounted for 70.3% of prescriptions. Physicians were often uncertain about the need for antibiotics, were concerned that patients could become sicker, and felt pressured by patients to prescribe antibiotics. Macrolides were most frequently prescribed; no tests were ordered in 85.0% of encounters.
The number of antibiotic prescriptions for adults with LRTIs remains high in Canada. Rates of prescribing are increased by diagnosis of acute bronchitis, clinical uncertainty, pressure from patients to receive antibiotics, and concern that patients will deteriorate if left untreated.
Notes
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PubMed ID
15116802 View in PubMed
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Antibiotic treatment of acute otitis media. Criteria and performance in Danish general practice.

https://arctichealth.org/en/permalink/ahliterature33876
Source
Scand J Prim Health Care. 1998 Mar;16(1):18-23
Publication Type
Article
Date
Mar-1998
Author
P M Jensen
J. Lous
Author Affiliation
Institute for General Practice, University of Aarhus, Denmark.
Source
Scand J Prim Health Care. 1998 Mar;16(1):18-23
Date
Mar-1998
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Denmark
Family Practice
Guideline Adherence
Humans
Infant
Infant, Newborn
Logistic Models
Odds Ratio
Otitis Media - drug therapy
Physician's Practice Patterns
Practice Guidelines
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To assess implicit criteria (i.e. what the general practitioner (GP) considers good clinical practice) for and performance (i.e. what the GP actually does) with regard to antibiotic treatment of acute otitis media in Danish general practice. DESIGN: a) Criteria assessed by survey among general practitioners. b) Performance assessed by prospective registration of consultations with general practitioners related to otitis media. SETTING: General practices in three Danish counties. SUBJECTS: a) All the GPs in the three countries (n = 790). b) 368 children with acute otitis media. MAIN OUTCOME MEASURES: a) Criteria for timing of treatment and first drug of choice for acute otitis media; b) prescribed antibiotics and multivariate analysis of factors predicting antibiotic prescription. RESULTS: a) The response rate was 72%. Only 51% (95% CI 47-55) of GPs would give antibiotics to all children with acute otitis media, and 79% (95% CI 76-82) of GPs would use penicillin-V as first drug of choice. b) Seventy-four per cent (95% CI 68-81) of children with acute otitis media were given antibiotics. Factors predicting the GPs' decision to prescribe antibiotics were the general condition of the child and the factors that are normally used in diagnosing the condition. CONCLUSION: Danish general practitioners' criteria for antibiotic treatment of acute otitis media are restrictive, with non-antibiotic treatment in cases of short duration and penicillin-V as first drug of choice. Performance suggests a less restrictive pattern.
PubMed ID
9612874 View in PubMed
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Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden.

https://arctichealth.org/en/permalink/ahliterature117601
Source
Scand J Prim Health Care. 2013 Mar;31(1):50-5
Publication Type
Article
Date
Mar-2013
Author
Ingeborg Björkman
Johanna Berg
Nina Viberg
Cecilia Stålsby Lundborg
Author Affiliation
Department of Public Health and Caring Sciences, Health Service Research, Uppsala University, Uppsala, Sweden. ingeborgbjorkman@hotmail.com
Source
Scand J Prim Health Care. 2013 Mar;31(1):50-5
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Attitude of Health Personnel
Drug Resistance, Microbial
Family Practice - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Physician's Practice Patterns
Qualitative Research
Sweden
Urinary Tract Infections - drug therapy - microbiology
Abstract
To improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs' views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden.
Qualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis.
Primary care in Kronoberg, a county in southern Sweden. Subjects. A purposeful sample of 20 GPs from 15 of 25 health centres in the county.
The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs.
Three different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs' perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice.
There was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.
Notes
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PubMed ID
23281925 View in PubMed
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Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155].

https://arctichealth.org/en/permalink/ahliterature168800
Source
BMC Health Serv Res. 2006;6:75
Publication Type
Article
Date
2006
Author
Svein Gjelstad
Arne Fetveit
Jørund Straand
Ingvild Dalen
Sture Rognstad
Morten Lindbaek
Author Affiliation
Department of General Practice and Community Medicine, University of Oslo, PO Box 1130 Blindern, 0317 Oslo, Norway. svein.gjelstad@medisin.uio.no
Source
BMC Health Serv Res. 2006;6:75
Date
2006
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Cluster analysis
Drug Utilization Review
Education, Medical, Continuing
Family Practice - education
Humans
Norway
Physician's Practice Patterns
Practice Guidelines as Topic
Program Evaluation - methods
Quality Indicators, Health Care
Randomized Controlled Trials as Topic - methods
Software
Abstract
More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved.
Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention.
Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.
Notes
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PubMed ID
16776824 View in PubMed
Less detail

Changes in prescription of antibiotics in general practice in relation to different strategies for drug information.

https://arctichealth.org/en/permalink/ahliterature225945
Source
Dan Med Bull. 1991 Aug;38(4):380-2
Publication Type
Article
Date
Aug-1991
Author
H. Friis
F. Bro
C E Mabeck
R. Vejlsgaard
Author Affiliation
Department of Clinical Microbiology, Herlev Hospital.
Source
Dan Med Bull. 1991 Aug;38(4):380-2
Date
Aug-1991
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Denmark
Drug Information Services
Drug Utilization - trends
Education, Medical, Continuing
Evaluation Studies as Topic
Family Practice - education - standards
Humans
Physician's Practice Patterns
Teaching - methods
Abstract
The worldwide use of antibiotics is increasing with increasing costs and resistant bacteria as a consequence. The Danish use of antibiotics is one of the lowest in DDD/1,000 inhabitants/year; however, the use of ampicillin and co-trimoxazole has been found to be too high. An information campaign in the beginning of 1987, using written material, stressed the importance of reducing the ampicillin and co-trimoxazole and increasing the penicillin usage in Denmark. This campaign was followed up by 10 lectures given by the same person in two (I and II) of the five counties of Zealand, Denmark. In county I, the lectures were given in meetings arranged by the local department of clinical microbiology. In county II, the lectures were given at meetings sponsored by a pharmaceutical company. The prescribing habits were generally changed significantly. In county I, the changes were significantly higher compared with counties only receiving written material. In county II, the prescribing habits did not change further compared with the counties only receiving written material. It is concluded that face-to-face information can improve the efficacy of written information, but sponsorship by pharmaceutical companies may weaken this efficacy.
PubMed ID
1914537 View in PubMed
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Current therapy of bacterial sepsis and meningitis in infants and children: a poll of directors of programs in pediatric infectious diseases.

https://arctichealth.org/en/permalink/ahliterature233243
Source
Pediatr Infect Dis J. 1988 Apr;7(4):267-70
Publication Type
Article
Date
Apr-1988

[Diagnosis and treatment of gonorrhea in Copenhagen and Frederiksberg].

https://arctichealth.org/en/permalink/ahliterature182793
Source
Ugeskr Laeger. 2003 Oct 27;165(44):4224-7
Publication Type
Article
Date
Oct-27-2003

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