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Miller KM, Barnett TC, Cadarette D, Bloom DE, Carapetis JR, Cannon JW. Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study. EBioMedicine 2023; 98:104864. [PMID: 37950997 PMCID: PMC10663680 DOI: 10.1016/j.ebiom.2023.104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A). METHODS We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines. FINDINGS We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing. INTERPRETATION A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours. FUNDING The Wellcome Trust, grant agreement number 215490/Z/19/Z.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Daniel Cadarette
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Centre for Child Health Research, Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
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Changes in antibiotic prescription following an education strategy for acute respiratory infections. NPJ Prim Care Respir Med 2021; 31:34. [PMID: 34083534 PMCID: PMC8175562 DOI: 10.1038/s41533-021-00247-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to assess the impact of an education intervention for primary health care physicians, based on the knowledge of clinical practice guidelines and availability of rapid antigen detection test for group A streptococci (GAS), on the improvement of antibiotic prescription for patients with acute respiratory tract infections. Before and after the intervention, physicians collected data from ten consecutive patients who attended during a 3-week period. This process was performed twice a year for 6 consecutive years (2012–2017). A total of 18,001 patients were visited by 391 primary care physicians during the study period, 55.6% before intervention and 44.4% after intervention. After intervention, the antibiotic prescription decreased significantly, from 33.0 to 23.4% (p < 0.01). However, there was a statistically significant increase (p < 0.01) in the use of penicillins. This study, carried out in daily practice conditions, confirms that the educational strategy was associated with an overall reduction in the use of antibiotics and an improvement in the antibiotic prescription profile in acute respiratory tract infections.
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Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners. Enferm Infecc Microbiol Clin 2019; 38:21-24. [PMID: 30981454 DOI: 10.1016/j.eimc.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study was aimed at assessing general practitioners' (GP) reliance on patient history, examination findings and the influence of the utilisation of point-of-care tests (POCT) in antibiotic prescribing for sore throat and lower respiratory tract infections (LRTI). METHODS Audit-based study carried out in 2015. A group of GPs received an intervention six years earlier with provision of POCTs and another group of GPs acted as controls. Odds ratios for clinical variables predicting antibiotic prescribing were calculated by logistic regression analyses. RESULTS A total of 238 GPs included 1906 patients with sore throat and 1970 LRTIs. A negative POCT result was negatively associated with antibiotic prescribing, with odds ratios ranging from 0.09 to 0.23. GPs using POCTs attached less weight to clinical criteria. CONCLUSION GPs using rapid tests are mainly influenced by POCT results in the decision to prescribe antibiotics. However, antibiotic prescribing is still observed with negative POCT results.
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Llor C, Moragas A, Cordoba G. [Twenty-five myths in infectious diseases in primary care associated with overdiagnosis and overtreatment]. Aten Primaria 2018; 50 Suppl 2:57-64. [PMID: 30270191 PMCID: PMC6836970 DOI: 10.1016/j.aprim.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Overdiagnosis and overprescribing is common in current clinical practice of infectious diseases in primary care. On the basis of studies published in the medical literature we identify my means of a non-systematic review a total of 25 myths associated with the diagnosis and treatment and present the literature pertaining to each myth. These myths result in extraneous testing (overdiagnosis) and excessive antimicrobial treatment (overtreatment). Most of these myths are ingrained among general practitioners in our country. Not only should these myths be debunked from our clinical practice, but they should also be reversed, and we encourage our readers to critically appraise their practice when it comes down to the misconceptions treated in this manuscript. We attempt to give guidance to clinicians facing these frequent clinical scenarios.
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Affiliation(s)
- Carles Llor
- Centro de Salud Via Roma, Barcelona, España; Grupo de Trabajo de Enfermedades Infecciosas de la semFYC.
| | - Ana Moragas
- Universitat Rovira i Virgili. Centro de Salud Jaume I, Tarragona, España
| | - Gloria Cordoba
- Centro de Investigación y Educación en Medicina Familiar, Instituto de Salud Pública, Universidad de Copenhague, Copenhague, Dinamarca
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Koskinen JM, Soukka JM, Meltola NJ, Koskinen JO. Microbial identification from faces and urine in one step by two-photon excitation assay technique. J Immunol Methods 2018; 460:113-118. [PMID: 30056941 DOI: 10.1016/j.jim.2018.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 01/03/2023]
Abstract
Two-photon excitation fluorometry (TPX) is a separation-free bioaffinity assay technique which enables accurate diagnostic testing in microvolumes. The technology is currently commercially applied in an automated mariPOC® test system for rapid phenotypic multi-microbe detection of pathogen antigens. The first TPX applications for diagnostics were intended for respiratory infection testing from nasopharyngeal and oropharyngeal samples. Feces and urine are more complex sample matrices and contain substances that may interfere with immunoassay binding or fluorescence detection. Our objective was to study the suitability of these complex matrices in the TPX technique. As expected, feces and urine elevated fluorescence levels but the methodology has the unique property of compensating for matrix effects. Compensation allows reliable separation of specific fluorescence from the fluorescence caused by the matrix. The studied clinical samples did not contain immunoassay inhibitors. The results suggest that the methodology is robust and may provide reliable testing of feces and urine samples with high accuracy.
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Affiliation(s)
- Juha M Koskinen
- ArcDia International Ltd, Lemminkäisenkatu 32, 20520 Turku, Finland; Faculty of Medicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland.
| | - Jori M Soukka
- ArcDia International Ltd, Lemminkäisenkatu 32, 20520 Turku, Finland
| | - Niko J Meltola
- ArcDia International Ltd, Lemminkäisenkatu 32, 20520 Turku, Finland
| | - Janne O Koskinen
- ArcDia International Ltd, Lemminkäisenkatu 32, 20520 Turku, Finland
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Llor C, Moragas A. Respuesta de los autores. Aten Primaria 2018; 50:198-199. [PMID: 29373142 PMCID: PMC6836958 DOI: 10.1016/j.aprim.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carles Llor
- Via Roma Primary Health Centre, Barcelona, Spain.
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Beddar Chaib F, Mostaza Gallar P, Rodríguez Adrada E, González del Castillo J. Ahorro de antibióticos prescritos en faringitis e infecciones del tracto respiratorio inferior en Atención Primaria. Aten Primaria 2018; 50:197-198. [PMID: 29317082 PMCID: PMC6837128 DOI: 10.1016/j.aprim.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/17/2017] [Indexed: 11/25/2022] Open
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Llor C, Alkorta Gurrutxaga M, de la Flor I Bru J, Bernárdez Carracedo S, Cañada Merino JL, Bárcena Caamaño M, Serrano Martino C, Cots Yago JM. [Recommendations for the use of rapid diagnosis techniques in respiratory infections in primary care]. Aten Primaria 2017; 49:426-437. [PMID: 28623011 PMCID: PMC6875920 DOI: 10.1016/j.aprim.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/06/2017] [Indexed: 01/22/2023] Open
Abstract
Respiratory tract infections rank first as causes of adult and paediatric infectious morbidity in primary care in Spain. These infections are usually self-limiting and are mainly caused by viruses. However, a high percentage of unnecessary antibiotic prescription is reported. Point-of-care tests are biomedical tests, which can be used near the patient, without interference of a laboratory. The use of these tests, many of which have been recently developed, is rapidly increasing in general practice. Notwithstanding, we must mull over whether they always contribute to an effective and high-quality diagnostic process by primary care clinicians. We present a set of criteria that can be used by clinicians and discuss the pros and cons of the instruments available for the management of respiratory tract infections and how to use them appropriately.
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Affiliation(s)
- Carles Llor
- Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Centro de Salud Via Roma, Barcelona, España.
| | - Miriam Alkorta Gurrutxaga
- Grupo de Estudio de Infección en la Atención Primaria de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP-SEIMC), Servicio de Microbiología, Hospital de Donostia, Osakidetza, Donostia, España
| | - Josep de la Flor I Bru
- Grupo de Trabajo de Tecnologías Diagnósticas de la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud El Serral, Institut Català de la Salut, Sant Vicenç dels Horts, España
| | - Sílvia Bernárdez Carracedo
- Grupo de Trabajo de Tecnologías Diagnósticas de la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud Dr. Robert, Institut Català de la Salut, Badalona, España
| | - José Luis Cañada Merino
- Grupo de Trabajo de Enfermedades Infecciosas, Medicina Tropical y del Viajero de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Sendagile orokorra erretirodun, Osakidetza, Getxo, España
| | - Mario Bárcena Caamaño
- Grupo de Trabajo de Patología Infecciosa del Aparato Respiratorio de la Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud Valdefierro, Zaragoza, España
| | - Carmen Serrano Martino
- Grupo de Estudio de Infección en la Atención Primaria de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP-SEIMC), Hospital San Juan de Dios, Bormujos, Sevilla, España
| | - Josep Maria Cots Yago
- Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Universidad de Barcelona, Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España
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Navas E. Profilaxis antibiótica de endocarditis: más vale un «por si acaso». Rev Clin Esp 2017; 217:99-100. [DOI: 10.1016/j.rce.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/23/2016] [Indexed: 11/26/2022]
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Llor C, Vilaseca I, Lehrer-Coriat E, Boleda X, Cañada JL, Moragas A, Cots JM. Survey of Spanish general practitioners' attitudes toward management of sore throat: an internet-based questionnaire study. BMC FAMILY PRACTICE 2017; 18:21. [PMID: 28193184 PMCID: PMC5307696 DOI: 10.1186/s12875-017-0597-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Background The management of sore throat varies widely in Europe. The objective of this study was to gain insight into clinicians’ perceptions on the current management of sore throat in Spain. Methods Cross-sectional, internet-based questionnaire study answered from July to September 2013. General practitioners (GPs) affiliated with the two largest scientific societies of primary care were invited to participate in the study. Questions were asked about physician knowledge, the use of current national guidelines for sore throat management, and management in two clinical scenarios, depicting a young adult with sore throat and: 1. cough, coriza with or without fever, and 2. fever without cough and coriza. Results The questionnaire was completed by 1476 GPs (5%) and 12.7% declared using rapid antigen detection tests. Antibiotics were considered by 18.8% of the GPs in the first scenario and by 32% in the second scenario (p < 0.001). The antibiotics most commonly mentioned by GPs were amoxicillin and amoxicillin + clavulanate (52.7 and 31.2%, respectively) whereas penicillin V was only prescribed in 11.9% of the cases. The drugs most commonly considered in both scenarios were analgesics and anti-inflammatory drugs. Antitussives, decongestants and expectorants were more commonly prescribed in cases of suspected viral infection (p < 0.001). Conclusions GPs have misconceptions as to the indications for using rapid antigen detection tests and prescribing drugs in the management of sore throat. These results suggest that guidelines are seldom followed since one in five GPs declared giving antibiotics for patients with a suspected viral infection and the use of second-choice antibiotics seems considerable.
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Affiliation(s)
- Carl Llor
- Primary Healthcare Centre Via Roma, Barcelona, Spain.
| | - Isabel Vilaseca
- Department of Otorhinolaringology, Hospital Clínic of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Xavier Boleda
- Pharmacy Arizcun (Group on respiratory diseases, Sociedad Española de Farmacia Comunitaria), Sant Pere de Ribes, Spain
| | - José L Cañada
- Primary Healthcare Centre Algorta (Group on Infectious Diseases SEMERGEN), Getxo, Vizcaya, Spain
| | - Ana Moragas
- Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona, Spain
| | - Josep M Cots
- Primary Healthcare Centre La Marina (Group on Infectious Diseases, semFYC), University of Barcelona, Barcelona, Spain
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