Etienne Cédric, Pulcini Céline
CHU de Nice, hôpital L'Archet, service d'infectiologie, 06200 Nice, France.
CHU de Nancy, service de maladies infectieuses, 54511 Vandœuvre-lès-Nancy cedex, France; Université de Lorraine, université Paris Descartes, EA 4360 Apemac, 54000 Nancy, France.
Presse Med. 2015 Mar;44(3):e59-66. doi: 10.1016/j.lpm.2014.07.022. Epub 2015 Jan 31.
The aim of our study was to assess the quality of antibiotic prescriptions in a sample of general practitioners (GPs) receiving junior doctors in training, whatever the motive of the prescription.
We performed a prospective observational study of all antibiotics prescribed in October 2012 by 21 GPs working in southeastern France. Two specialists (general medicine and infectious diseases) independently assessed the compliance with recommendations of antibiotic prescriptions using a validated algorithm.
Two hundred and thirty-two antibiotic courses were prescribed, mainly for low respiratory tract infections (30%), ENT (26%), urinary tract (22%) or skin (13%) infections. Forty prescriptions were considered as appropriate (17%), 77 as inappropriate (33%; mainly due to a non-recommended molecule choice [77%] or a too long treatment duration [44%]) and 115 prescriptions were unnecessary (50%), due to diagnostic issues. There were wide variations between GPs. An essential laboratory or imaging investigation was missing for 36% of prescriptions: chest X-ray for pneumonia (80% were missing), rapid antigen diagnostic test for acute pharyngitis (23% missing) and urine dipstick for urinary tract infections (80% missing). Fluoroquinolones and macrolides/synergistins accounted for 31% of the prescriptions, and were associated with a lower prevalence of appropriate prescriptions (7% and 2% respectively, P<0.001). There was a co-prescription of anti-inflammatory drugs in 15% of the cases.
The misuse of antibiotics was frequent in this study. Improving the diagnostic workout is of paramount importance. Urgent actions are needed to improve antibiotic use in general practice.
我们研究的目的是评估接收实习医生培训的全科医生样本中抗生素处方的质量，无论处方的动机如何。
我们对2012年10月法国东南部21名全科医生开具的所有抗生素进行了前瞻性观察研究。两名专家（普通医学和传染病专家）使用经过验证的算法独立评估抗生素处方与建议的符合情况。
共开具了232个抗生素疗程，主要用于下呼吸道感染（30%）、耳鼻喉科（26%）、泌尿系统（22%）或皮肤（13%）感染。40份处方被认为是合适的（17%），77份不合适（33%；主要是由于选择了不推荐的药物分子[77%]或治疗时间过长[44%]），115份处方不必要（50%），原因是诊断问题。全科医生之间存在很大差异。36%的处方缺少必要的实验室或影像学检查：肺炎的胸部X光检查（80%缺失）、急性咽炎的快速抗原诊断测试（23%缺失）和泌尿系统感染的尿液试纸检查（80%缺失）。氟喹诺酮类和大环内酯类/增效剂占处方的31%，且合适处方的比例较低（分别为7%和2%，P<0.001）。15%的病例中存在抗炎药物的联合处方。
本研究中抗生素的滥用情况很常见。改善诊断流程至关重要。需要采取紧急行动来改善全科医疗中抗生素的使用。
