[Evaluation of primary health care physicians' knowledge on rational antibiotic use]. / Saglik ocaklarinda çalisan hekimlerinin akilci antibiyotik kullanimi ile ilgili bilgi düzeylerinin degerlendirilmesi.

Physicians' prescribing practices impact greatly on rational drug use and expenditure. The aim of this cross-sectional study is to determine primary health care physicians' knowledge on rational antibiotic use in Izmir. A total of 475 physicians from primary health care centres (response rate: 100%) participated in this study. Prescription information of physicians was collected with a standardized questionnaire. It was detected that 48.4% of the physicians have prescribed antibiotics in one of each three (30%) prescriptions, while 19.4% in one of each five prescriptions. The most frequent reason for antibiotic prescription was the upper respiratory tract infections (URTI). The rate of prescribing antibiotics for URTI according to the results of throat culture or blood count was 11.8%. The most commonly prescribed antibiotics were penicillins for URTI, quinolones for urinary tract infections and trimethoprim-sulphametoxazole for gastrointestinal tract infections. The rate of appropriate prescribing practices was high among physicians in the age group 25-29 in comparison to older age groups (X2: 14.855; p: 0.01). Only 32.2% of the physicians correctly indicated the antibiotics with drawbacks in newborn period. 6.5% of the participants gave no correct antibiotic choices for any of the infections indicated. It was stated by 89.6% of the participants that they would benefit from continuous education on rational antibiotic use. The data obtained revealed that primary health care physicians who had high antibiotic prescription rates, lacked information about rational antibiotic use and continuous professional education and development programmes related to this topic is a prerequisite.

Accuracy of consultations performed by infectious diseases trainees and factors associated with adherence to them.

OBJECTIVES: Infectious diseases (ID) trainees should be familiar with duties relevant to consultation practice. In this study we aimed to analyze the ID trainee night/weekend shift consultation process in terms of consultant characteristics, types of recommendations, and compliance with recommendations. METHODS: All consultations performed by ID trainees on the night shift and at the weekends between 10 June and 10 August 2004 were recorded prospectively on standardized forms. Infectious diseases specialists assessed the appropriateness of recommendations the day after each consultation. Recommendations were considered complied with if they were carried out within 72 hours of the consultation. RESULTS: Of 440 consultations, 163 were for a clinically diagnosed infection (without specific antibiotic request) and 79 were for treatment continuation. Overall, 152 consultations were for requesting specific antibiotic(s), and 327 antibiotics were recommended or approved in 270 consultations. Eight of these recommendations were inappropriate. Overall compliance to ID recommendations was 75.3% (418/555). In univariate analysis, the compliance rate to non-treatment recommendations (microbiologic cultures, radiology, biochemistry, etc.) was found to be lower than the rate of compliance to antibiotic recommendations (186/308 vs. 232/247, p<0.05). In addition, compliance to recommendations made by the first-year trainees was lower than to the recommendations made by the other trainees. In logistic regression analysis only recommendations including antibiotic treatment was associated with higher compliance (p=0.0001, odds ratio=10.2, 95% CI=5.7-18.3). CONCLUSIONS: ID trainees are capable of evaluating patients and recommending appropriate antibiotics. Methodologies to improve the compliance to non-treatment-based recommendations and optimizing antibiotic selection seem to be necessary.