GP Silverdale Medical Practice, Silverdale Medical Practice, Salford, United Kingdom.
Professor, Academic Office-312 Second Floor Grove Building Singleton Campus, Swansea University Medical School, Wales, United Kingdom.
Fam Pract. 2023 Dec 22;40(5-6):753-759. doi: 10.1093/fampra/cmad051.
Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics.
This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites.
A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3-89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July.
Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting.
昆虫叮咬引起的炎症可能类似于蜂窝织炎，并导致不必要的抗生素使用，从而助长初级保健中的抗微生物药物耐药性。我们想知道全科医生如何评估和处理昆虫叮咬、诊断蜂窝织炎以及开具抗生素。
这是一项质量改进研究，在该研究中，英格兰和威尔士的 10 家全科诊所调查了 2021 年 4 月至 9 月期间首次因昆虫叮咬就诊的患者，记录了就诊模式、表现、管理计划以及再次就诊或转介情况。将全科医生开出的总氟氯西林剂量与治疗昆虫叮咬的剂量进行了比较。
组合列表大小为 161346 个，得出 355 例昆虫叮咬咨询。近三分之二为女性，年龄 3-89 岁，7 月为高峰月，每周发病率为每 10 万人 8 例。全科医生仍然进行了大多数咨询；大多数为电话咨询，超过一半的咨询提供了照片支持。超过 40%的患者在第 1 天至第 3 天就诊，常见症状为发红、瘙痒、疼痛和发热。生命体征记录并不常见，尽管 45%的患者抱怨瘙痒，但只有 22%的患者已经服用了抗组胺药。近四分之三的患者开了抗生素，主要为口服氟氯西林。12%的患者再次就诊，2%的患者转至医院。治疗昆虫叮咬的氟氯西林占全科医生开出的氟氯西林总剂量的 5.1%，7 月达到峰值 10.7%。
我们的昆虫叮咬治疗中抗生素可能过度使用，患者在就诊前可能更愿意使用抗组胺药治疗瘙痒。
