Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo
| Autor: | Parker Magin, Amanda Tapley, Mieke L van Driel, Andrew Davey, Kristen FitzGerald, Jean Ball, Clare Heal, Josh Davis, Neil Spike, Nashwa Najib, L Holliday, Hilary Gorges |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Impetigo Adolescent medicine.drug_class Cross-sectional study General Practice Antibiotics impetigo antibiotic stewardship Skin infection Cohort Studies Antimicrobial Stewardship Young Adult 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Practice Patterns Physicians' Medical prescription Child Aged Original Research Response rate (survey) business.industry Australia Infant Newborn Infant General Medicine Middle Aged medicine.disease Anti-Bacterial Agents Cross-Sectional Studies Infectious Diseases Child Preschool Antibiotic Stewardship Female business Cohort study |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2019-031527 |
| Popis: | ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.SettingReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.ParticipantsRegistrars participating in ReCEnT from 2010 to 2017.Outcome measuresManagement of impetigo with systemic antibiotics.Results1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; pConclusionsAustralian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further. |
| Databáze: | OpenAIRE |
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