Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners

El uso excesivo de antibióticos promueve la aparición ydiseminación de bacterias resistentes. Se ha encontrado una tasa de prescripción de antibióticos en infecciones respiratorias (resfrío común, rinosinusitis aguda y bronquitis aguda) del 50 al 70%, aunque la etiología sea viral en la mayoría de los casos. Esta investigación se condujo con el objetivo de identificar cuáles son los predictoresdel uso de antibióticos en las infecciones respiratorias agudas. Se realizó un estudio de corte transversal. Losparticipantes fueron médicos internistas generales y otorrinolaringólogos que atienden pacientes adultos en formaambulatoria en Buenos Aires. Se utilizó un cuestionario con 20 viñetas sobre casos clínicos, que incluían variablesimportantes en la toma de decisiones sobre el tratamiento antibiótico en infecciones respiratorias agudas.Las viñetas fueron construidas según un diseño factorial fraccionado con nueve variables clínicas. Se calculóel peso absoluto y relativo de cada variable clínica que predijo el uso de antibióticos, para cada médico, medianteregresión lineal múltiple. Los predictores con mayor peso para la decisión de prescribir antibióticos, fueron la presencia de secreción nasal y tos (24% y 21% de peso total). La correlación entre los predictores y lasrespuestas individuales fue alta (r2 =0.73). La probabilidad media y el índice de prescripción de antibióticos fueron cercanas al 50%. Los predictores del uso de antibióticos para infecciones respiratorias agudas entre médicosde atención ambulatoria en la muestra estudiada difieren de las guías internacionalmente aceptadas. Laprobabilidad de prescribir antibióticos para estas enfermedades es alta. La puesta en práctica de las recomendaciones internacionales para el uso de antibióticos en infecciones respiratorias agudas podría mejorarel uso de antibióticos y reducir el desarrollo de resistencia bacteriana.

The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis) promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians' practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight). The correlation between predictors and individual physician answers was high (r2 = 0.73). The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.

Antimicrobial activity of extracts of local cough mixtures on upper respiratory tract bacterial pathogens

The punched-hole and the paper disc diffusion methods were used in screening for the antimicrobial activity of six common ingredients used locally in cough mixtures, against the following bacteria: Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus. Enterococcus faecalis, Escherichia coli, Salmonella spp, Salmonella paratyphi, Shigella dysenteria, Shigella sonnei and Candida albicans. The results, evaluated as the diameter of zone of inhibition of microbial growth, showed that lime, garlic onion, onion and honey were active against Staphylococcus aureus, Streptococcus faecalis, Candida albicans, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Salmonella spp and Shigella dysenteriae. Bitter-kola nut extract and palm kernel oil showed no antimicrobial activities against any of the tested organisms. None of the extracts inhibited the growth of Salmonella paratyphi and Shigella sonnei and the most susceptible organisms were Escherichia coli and Salmonella spp

Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis [TB]. The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration for TB control in urban areas are urgently required