RESUMO
Background and Aim: excessive use or misuse of antibiotics leads to important consequences such as increased cost of treatment, bacterial resistance, treatment failure, drug toxicity and increased morbidity and mortality. Use of guidelines can result in increased knowledge of the physicians and decreased prescription of antibiotics with resultant change in the attitudes of the physicians towards this policy
Materials and Methods: this cross-sectional study included 356 physicians and was conducted in Sanandaj in 2015. The sampling method was census. The final questionnaire included 7 questions to assess knowledge, 18 questions to measure attitudes, [by means of a 5-point Likert Scale from very strong agreement to very strong disagreement], and 12 questions to assess performance. The reliability of the questionnaire was 54%. Using SPSS20 software, frequency and mean score of the questions were calculated
Results: among 356 questionnaires, 44.2% were filled out by specialists and 45.2% by the physicians who had graduated more than seven years ago. 56% of the physicians chose the correct answer for the questions on knowledge, and 25% of the physicians had knowledge about antibiotic resistance. 97.3% of the physicians agreed that antibiotics in our country have been used in excess. In this study, 233 [65.5%] physicians had high knowledge and selfconfidence and 19.7% expressed low or lack of self-confidence about antibiotic prescription. WHO guideline and antibiotic guideline had been considered useful by 56% and 54.5% of the participants respectively. 49.9% of the physicians had not participated in any training course on antibiotic prescription. The highest and lowest frequency rates about sources of knowledge on antibiotic prescription belonged to internet [63.2%] and information provided by pharmaceutical companies [30.3%] respectively
Conclusion: considering the average level of knowledge of the doctors on antibiotic prescription and lack of participation of half of the subjects in training courses on antibiotic prescription after, attention to training courses with proper planning is recommended
RESUMO
Opportunistic infections are common in patient with cell mediated immunodeficiency. We report here a case of multiple opportunistic infections and lymphoproliferative disease in patient eith idiopathic cd4+ lymphocy topenia. A 45 years old man was admitted in our hospital due to respiratory distress and diffuse skin lesions
BX of skin lesions and cdture of synovied fluid contained TB infection and prepared smear of synovid fluid contained aspergilus. The white blood cde count was 1000/ml with pmn [63%] and lymphocyte[28%] and cd4 [10.4%]. persistent cd4+ lymphocy to penia below 300/ml and lack of evidence for HIV1, 2 infection and also HTLV1, 2 infection svggests that immunosupression was due to idiopathic cd4+ lymphocytopenia [ICL] the paticnt was treated with antifungal and antibiotics and clinically improved. One years lates he almittes due to left side paresis. In brain MRI a lesion was seen in frontal. Also there was multiple lymph in inguinal region. Biopsy of lymph node showed lympo proliferative disordes. Unfortunately despite treatmen he died