RESUMO
INTRODUCTION: Antibiotic use drives antibiotic resistance. Reducing antibiotic use through reducing antibiotic course lengths could contribute to the UK national ambition to reduce total antibiotic use. METHODS: Medical notes were reviewed for patients who had received at least 5 days of antibiotic therapy; had been discharged in January 2019; and were from a 750-bed acute secondary care hospital in England. UK national guidelines were used to determine the excess antibiotic use in common medical infections: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), pyelonephritis, cellulitis, infective exacerbation of chronic obstructive pulmonary disease (IECOPD) and cholangitis. RESULTS: Four-hundred and twenty-three patients met the inclusion criteria. Of these, 307 (73%) patient notes were retrieved and reviewed. One-hundred and seventy-three patients met the study case definitions, of which, 137 met short course criteria.Potential antibiotic reductions (measured in defined daily doses) were identified for five of the six infections: 32% in CAP, 20% in HAP, 14% in IECOPD, 11% in cellulitis and 10% in pyelonephritis. These reductions were estimated to reduce total antibiotic use in medical specialties by 12.4%, which equates to 3.6% of the hospital's total antibiotic use. CONCLUSION: Clinical application of the evidence-based guidance for shorter antibiotic course lengths appears to be a valid strategy for reducing total antibiotic consumption.
Assuntos
Antibacterianos , Infecções Comunitárias Adquiridas , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Inglaterra/epidemiologia , Humanos , Prescrições , Atenção Secundária à SaúdeRESUMO
Both older persons and those who have disabilities can encounter discrimination when they seek medical care. Just as ageism and stereotypes about older persons may inappropriately limit medical care for the elderly, limits may be placed on medical care for those who are disabled simply because of the presence of a disability. At the same time death is the natural end of the lifespan for all individuals and there are situations when aggressive medical care is not indicated. It is not right to always insist on "doing everything" for a person even if that person may be at risk otherwise for discrimination. Using the example of the elderly, this paper examines the risks of discrimination and the dangers of overtreatment in caring for older persons and suggests parallels in the appropriate care of those who have disabilities.
