Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, 14 University Dr, Robina, QLD, 4229, Australia.
BMC Infect Dis. 2022 Dec 1;22(1):897. doi: 10.1186/s12879-022-07887-1.
Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it's reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care.
A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations.
We identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24).
Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making. Systematic review registration CRD42021247048.
在基层医疗中经常见到的许多急性感染可以自行缓解，有时也可以用抗生素治疗，但抗生素可能并非必需。这些感染的自然病程信息为抗生素管理策略（如延迟处方和共同决策）提供了依据，然而，这些信息是否在指南中报告尚不清楚。我们在临床指南中检查了基层医疗中常见的急性感染的自然病程信息和相关抗生素管理策略的报告情况。
对 2010 年以来可从电子途径获取的管理急性感染（呼吸道、泌尿道或皮肤和软组织）的国家和国际指南进行了系统评价。我们检索了 MEDLINE、CINAHL、EMBASE、TRIP 和 GIN 数据库以及 22 个指南发布组织的网站。
我们确定了 82 项指南，涵盖了 114 种合格的感染。49 项（59.8%）指南和 66 种（57.9%）报告的疾病报告了自然病史信息，最常见的是呼吸道感染。对于 63.5%（n=42）的感染，提供了预期感染持续时间的定量信息。对于其中 34.2%（n=39）的感染，建议采用延迟抗生素处方策略，对于 21%（n=24）的感染，建议采用共同决策。
在基层医疗中经常管理的急性感染的指南中，只有略多于一半的指南包含自然病史信息。由于许多此类感染会自行改善，因此这是一个错失的机会，无法将这些信息传播给临床医生，促进抗生素管理，并促进与患者的对话和知情决策。系统评价注册 CRD42021247048。
