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Kanagasabai A, Evans C, Jones HE, Hay AD, Dawson S, Savović J, Elwenspoek MMC. Systematic review and meta-analysis of the accuracy of McIsaac and Centor score in patients presenting to secondary care with pharyngitis. Clin Microbiol Infect 2024; 30:445-452. [PMID: 38182052 DOI: 10.1016/j.cmi.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/11/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Centor and McIsaac scores are clinical prediction rules for diagnosing group A streptococcus (GAS) infection in patients with pharyngitis. Their recommended thresholds vary between guidelines. OBJECTIVES To estimate the sensitivity and specificity of the McIsaac and Centor scores to diagnose GAS pharyngitis and evaluate their impact on antibiotic prescribing at each threshold in patients presenting to secondary care. DATA SOURCES MEDLINE, Embase, and Web of Science were searched from inception to September 2022. STUDY ELIGIBILITY CRITERIA Studies of patients presenting with acute pharyngitis to emergency or outpatient clinics that estimated the accuracy of McIsaac or Centor scores against throat cultures and/or rapid antigen detection tests (RADT) as reference standards. TESTS Centor or McIsaac score. REFERENCE STANDARD Throat cultures and/or RADT. ASSESSMENT OF RISK OF BIAS Quality Assessment of Diagnostic Accuracy Studies. METHODS OF DATA SYNTHESIS The sensitivities and specificities of the McIsaac and Centor scores were pooled at each threshold using bivariate random effects meta-analysis. RESULTS Fourteen studies were included (eight McIsaac and six Centor scores). Eight studies had unclear and six had a high risk of bias. The McIsaac score had higher estimated sensitivity and lower specificity relative to Centor scores at equivalent thresholds but with wide and overlapping confidence regions. Using either score as a triage to RADT to decide antibiotic treatment would reduce antibiotic prescription to patients with non-GAS pharyngitis relative to RADT test for everyone, but also reduce antibiotic prescription to patients with GAS. DISCUSSION Centor and McIsaac scores are equally ineffective at triaging patients who need antibiotics presenting with pharyngitis at hospitals. At high thresholds, too many true positive cases are missed, whereas at low thresholds, too many false positives are treated, leading to the over prescription of antibiotics. The former may be compensated by adequate safety netting by clinicians, ensuring that patients can seek help if symptoms worsen.
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Affiliation(s)
| | - Callum Evans
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Martha M C Elwenspoek
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Bakhit M, Gamage SK, Atkins T, Glasziou P, Hoffmann T, Jones M, Sanders S. Diagnostic performance of clinical prediction rules to detect group A beta-haemolytic streptococci in people with acute pharyngitis: a systematic review. Public Health 2024; 227:219-227. [PMID: 38241903 DOI: 10.1016/j.puhe.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To assess and compare the diagnostic performance of Clinical Prediction Rules (CPRs) developed to detect group A Beta-haemolytic streptococci in people with acute pharyngitis (or sore throat). STUDY DESIGN A systematic review. METHODS We searched PubMed, Embase and Web of Science (inception-September 2022) for studies deriving and/or validating CPRs comprised of ≥2 predictors from an individual's history or physical examination. Two authors independently screened articles, extracted data and assessed risk of bias in included studies. A meta-analysis was not possible due to heterogeneity. Instead we compared the performance of CPRs when they were validated in the same study population (head-to-head comparisons). We used a modified grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess certainty of the evidence. RESULTS We included 63 studies, all judged at high risk of bias. Of 24 derived CPRs, 7 were externally validated (in 46 external validations). Five validation studies provided data for head-to-head comparison of four pairs of CPRs. Very low certainty evidence favoured the Centor CPR over the McIsaac (2 studies) and FeverPain CPRs (1 study) and found the Centor CPR was equivalent to the Walsh CPR (1 study). The AbuReesh and Steinhoff 2005 CPRs had a similar poor discriminative ability (1 study). Within and between study comparisons suggested the performance of the Centor CPR may be better in adults (>18 years). CONCLUSION Very low certainty evidence suggests a better performance of the Centor CPR. When deciding about antibiotic prescribing for pharyngitis patients, involving patients in a shared decision making discussion about the likely benefits and harms, including antibiotic resistance, is recommended. Further research of higher rigour, which compares CPRs across multiple settings, is needed.
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | | | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Sharon Sanders
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
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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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Tadesse M, Hailu Y, Biset S, Ferede G, Gelaw B. Prevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia. Infect Drug Resist 2023; 16:1637-1648. [PMID: 36992964 PMCID: PMC10040342 DOI: 10.2147/idr.s402292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Background Streptococcus pyogenes (S. pyogenes) or group A streptococcus is a common cause of bacterial pharyngitis in children. Since it is difficult to distinguish between viral and bacterial pharyngitis using solely signs and symptoms, culture-based diagnosis and treatment are critical for avoiding serious complications. Therefore, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of S. pyogenes among pediatric patients with acute pharyngitis. Methods A hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from April to June 2021. Standard microbiological procedures were used to collect and process throat swabs and to isolate and identify S. pyogenes. The disc diffusion method was used for antimicrobial susceptibility testing (AST). Results A total of 215 children with acute pharyngitis were included in this study. Of these, 23 (10.7%) were culture positive for S. pyogenes. The presence of an inflamed tonsil, tonsillar exudate, scalariform rash, and dysphagia were associated with streptococcal pharyngitis. Children aged 5 to 15 were more susceptible to streptococcal throat infection than younger children. Penicillin, vancomycin, chloramphenicol, clindamycin, and ceftriaxone were effective against 100%, 95.7%, 95.7%, 91%, and 87% of isolates, respectively. In contrast, 56.5%, 39.1%, and 30.4% of isolates showed at least reduced susceptibility to tetracycline, erythromycin, and azithromycin, respectively. Conclusion Streptococcus pyogenes is responsible for 10.7% of acute pharyngitis cases among pediatric patients in the study area. Although all isolates remain sensitive to penicillin, many showed reduced susceptibility to tetracycline and macrolides. Therefore, prior to antibiotic prescription, screening children with acute pharyngitis for S. pyogenes and testing the antibiotic susceptibility of isolates is recommended.
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Affiliation(s)
- Molla Tadesse
- Department of Medical Microbiology, Jigjiga University, Jigjiga, Ethiopia
| | - Yohanes Hailu
- Department of Pediatrics and Child Health, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of BioMedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Sirak Biset, Tel +251-911-598-568, Email
| | - Getachew Ferede
- Department of Medical Microbiology, School of BioMedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of BioMedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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A Study on Acute Membranous Tonsillitis, Its Different Etiologies and Its Clinical Presentation in a Tertiary Referral Centre. Indian J Otolaryngol Head Neck Surg 2022; 74:4543-4548. [PMID: 33907680 PMCID: PMC8061714 DOI: 10.1007/s12070-021-02572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
Membranous tonsillitis is the infection of the palatine tonsils where the exudation from the crypts coalesce to form a membrane over the tonsillar surface. It is a stage ahead of the acute follicular tonsillitis. There are different etiologies for membrane formation over the tonsils. The commonest cause in the present scenario is still Corynebacterium diphtheriae. A one year prospective study was conducted on patients presenting with membranous tonsillitis in a tertiary referral centre in North-East India. Proper history was taken, clinical examination and all the necessary investigations were done. The patients were managed conservatively, while a few patients required tracheostomy. In our one year study, we found that majority of the patients presenting with acute membranous tonsillitis were males (65%) and 35% were females. Most of the cases were seen in 6-12 years of age and belonged to the lower socioeconomic group, and also to the lower Assam belt. Most of the cases were seen in the months of November to January. This prospective study gives a view of the different etiologies of acute membranous tonsillitis, its presentation and how its management affects the outcome of the patients and also affects the mortality and morbidity. This study also shows that diphtheria is still prevalent in the current Indian scenario and thus, proper implementation of the vaccination programs and prompt reporting of the cases should be done to prevent outbreaks.
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Jiang X, Lin A, Li S, Shi Y, Zhou F, Felix Gomez GG, Gregory RL, Zhang C, Chen S, Huang R. Effects of artificial honey and epigallocatechin-3-gallate on streptococcus pyogenes. BMC Microbiol 2022; 22:207. [PMID: 36028794 PMCID: PMC9419396 DOI: 10.1186/s12866-022-02611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2022] Open
Abstract
Background Streptococcus pyogenes is an important global human pathogen that causes pharyngitis, and antibacterial therapy has become an important part of the overall therapy for pharyngitis. As natural derivatives, honey and green tea are often recommended for patients with pharyngitis in traditional Chinese medicine without experimental theoretical basis on wether the combined effect of honey and green tea on pharyngitis is better than they alone. The aims of this study were to explore the effects of artificial honey (AH) and epigallocatechin-3-gallate (EGCG) on S. pyogenes and elucidate the possible mechanisms, which were investigated using MIC (the minimum inhibitory concentration), FIC (fractional inhibitory concentration) index, growth pattern, biofilm formation and RT-qPCR. Results The MIC of AH on S. pyogenes was 12.5% (v/v) and the MIC of EGCG was 1250 μg/ml. The FIC index of AH and EGCG was 0.5. The planktonic cell growth, growth pattern and biofilm formation assays showed that AH and EGCG mixture had stronger inhibitory effect on S. pyogenes than they alone. RT-qPCR confirmed that the expression of hasA and luxS gene were inhibited by AH and EGCG mixture. Conclusions AH and EGCG mixture can inhibit the planktonic cell growth, biofilm formation and some virulence genes expression of S. pyogenes, better than they alone. The combination of honey and green tea have the potential to treat pharyngitis as natural derivatives, avoiding drug resistance and double infection.
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Affiliation(s)
- Xiaoge Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - An Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Shijia Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Yangyang Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Endodontic Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fangjie Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Endodontic Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | | | - Richard L Gregory
- Department of Oral Biology, School of Dentistry, Indiana University, Indianapolis, USA
| | - Chaoliang Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Song Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Ruijie Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Oral Biology, School of Dentistry, Indiana University, Indianapolis, USA.
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Cabreros I, Agniel D, Martino SC, Damberg CL, Elliott MN. Predicting Race And Ethnicity To Ensure Equitable Algorithms For Health Care Decision Making. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:1153-1159. [PMID: 35914194 DOI: 10.1377/hlthaff.2022.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Algorithms are currently used to assist in a wide array of health care decisions. Despite the general utility of these health care algorithms, there is growing recognition that they may lead to unintended racially discriminatory practices, raising concerns about the potential for algorithmic bias. An intuitive precaution against such bias is to remove race and ethnicity information as an input to health care algorithms, mimicking the idea of "race-blind" decisions. However, we argue that this approach is misguided. Knowledge, not ignorance, of race and ethnicity is necessary to combat algorithmic bias. When race and ethnicity are observed, many methodological approaches can be used to enforce equitable algorithmic performance. When race and ethnicity information is unavailable, which is often the case, imputing them can expand opportunities to not only identify and assess algorithmic bias but also combat it in both clinical and nonclinical settings. A valid imputation method, such as Bayesian Improved Surname Geocoding, can be applied to standard data collected by public and private payers and provider entities. We describe two applications in which imputation of race and ethnicity can help mitigate potential algorithmic biases: equitable disease screening algorithms using machine learning and equitable pay-for-performance incentives.
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Affiliation(s)
| | - Denis Agniel
- Denis Agniel, RAND Corporation, Santa Monica, California
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Ahmad A, Nor J, Abdullah AA, Tuan Kamauzaman TH, Yazid MB. Patient Factors in Inappropriate Antibiotic Prescribing for Upper Respiratory Tract Infection in the Emergency Department. Malays J Med Sci 2021; 28:72-83. [PMID: 33958962 PMCID: PMC8075589 DOI: 10.21315/mjms2021.28.2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/07/2020] [Indexed: 10/29/2022] Open
Abstract
Background Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs. Methods This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018-2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate. Results A total of 261 cases were included - 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; P = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; P = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; P = 0.003) were significantly associated with inappropriate antibiotic prescription. Conclusion Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.
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Affiliation(s)
- Azmi Ahmad
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Junainah Nor
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ariff Arithra Abdullah
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Mohd Boniami Yazid
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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ASLANER H, MISTIK S, ERTÜRK ZARARSIZ G, KILIÇ H, ÇETİN BENLİ N. Evaluation of the Use of the Mistik Score and Modified Centor Score in Sore Throat. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.839462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rusic D, Bukić J, Seselja Perisin A, Leskur D, Modun D, Petric A, Vilovic M, Bozic J. Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review. Antibiotics (Basel) 2021; 10:antibiotics10010063. [PMID: 33440609 PMCID: PMC7827930 DOI: 10.3390/antibiotics10010063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022] Open
Abstract
Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
- The Split-Dalmatia County Pharmacy, Dugopoljska 3, 21 204 Dugopolje, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
- Correspondence:
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Hansen GT. Point-of-Care Testing in Microbiology: A Mechanism for Improving Patient Outcomes. Clin Chem 2020; 66:124-137. [PMID: 31811002 DOI: 10.1373/clinchem.2019.304782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasingly, demands for improved health and quality of life conflict with the realities of delivering healthcare in an environment of higher expenditures, adherence to test utilization, and patient-centered experience. Patient-centered care is commonly identified as a goal of healthcare delivery, and yet healthcare systems struggle with delivery of care to patients, often failing to identify the seriously ill and capitalize on the predictive qualities of diagnostic testing. Point-of-care (POC) testing provides access to rapid diagnosis and predictive value key to realizing patient outcomes. An evaluation of cost-effective models and the clinical impact of POC testing for clinical microbiology is needed. CONTENT Accurate and rapid diagnostics have the potential to affect healthcare decisions to a degree well out of proportion to their cost. Contemporary healthcare models increasingly view POC testing as a mechanism for efficient deployment of healthcare. POC testing can deliver rapid diagnosis in environments where testing results can be used to direct management during patient visits and in areas where centralized laboratory testing may limit access to care. Nucleic acid assays, designed for POC testing, can match, or exceed, the sensitivity of conventional laboratory-based testing, eliminating the need for confirmation testing. Here, the goals of POC testing for microbiology, applications, and technologies, as well as outcomes and value propositions, are discussed. SUMMARY The combination of rapid reporting, an increasing array of organisms capable of causing disease, actionable resulting, and improved patient outcomes is key in the evolution of POC testing in clinical microbiology.
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Affiliation(s)
- Glen T Hansen
- Microbiology and Molecular Diagnostics, Hennepin County Medical Center, Department of Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN.,Department of Pathology & Laboratory Medicine University of Minnesota, School of Medicine.,Department of Medicine, Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN
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12
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Reinholdt KB, Rusan M, Hansen PR, Klug TE. Management of sore throat in Danish general practices. BMC FAMILY PRACTICE 2019; 20:75. [PMID: 31153357 PMCID: PMC6545212 DOI: 10.1186/s12875-019-0970-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline. METHODS A cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients. RESULTS In total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%). CONCLUSION Danish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.
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Affiliation(s)
- Kasper Basse Reinholdt
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Maria Rusan
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Otorhinolaryngology, Region Hospital Holstebro, Holstebro, Denmark
| | | | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
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Bactericidal and Anti-Biofilm Activity of Ethanol Extracts Derived from Selected Medicinal Plants against Streptococcus pyogenes. Molecules 2019; 24:molecules24061165. [PMID: 30909644 PMCID: PMC6471238 DOI: 10.3390/molecules24061165] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 01/28/2023] Open
Abstract
Background: There is a growing interest in medicinal plants which have been traditionally used for the treatment of human infections. This study assessed 14 ethanol extracts (EEs) on bacterial growth and biofilm formation of Streptococcus pyogenes. Methods: Constituent major phytochemicals in the extracts were identified using ultra performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS). Micro-broth dilution and time-kill assays were used to determine antibacterial activities. Anti-biofilm activities were studied using MTT assay, and morphology of biofilms was observed by scanning electron microscopy (SEM). Transmission electron microscopy (TEM) was employed to visualize the ultra-cross section structure of bacteria treated with efficacious extracts. Results: Licorice root, purple coneflower flower, purple coneflower stem, sage leaves and slippery elm inner bark EEs were the most effective, with minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of 62.5 μg/mL and 125 μg/mL, respectively. The minimum biofilm inhibitory concentration (MBIC) of extracts ranged from 31.5–250 μg/mL. Morphological changes were observed in treated biofilms compared to the untreated. The four most effective extracts exhibited the ability to induce degradation of bacterial cell wall and disintegration of the plasma membrane. Conclusion: We suggest that EEs of sage leaf and purple coneflower flower are promising candidates to be further investigated for developing alternative natural therapies for the management of streptococcal pharyngitis.
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Soleymani F, Rashidian A, Hosseini M, Dinarvand R, Kebriaeezade A, Abdollahi M. Effectiveness of audit and feedback in addressing over prescribing of antibiotics and injectable medicines in a middle-income country: an RCT. ACTA ACUST UNITED AC 2019; 27:101-109. [PMID: 30788839 DOI: 10.1007/s40199-019-00248-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
Overprescribing of antibiotics and injectable medicines is common in ambulatory care in many low- and middleincome countries. We evaluated the effects of three different interventions in improving physician prescribing. We conducted a four-armed randomized controlled trial with one-month and three- months follow-up. General physicians, pediatricians, and infectious disease specialists were included in this study if they had an outpatient office in Tehran, Iran. The study involved two behaviorally guided interventions: "new-design audit and feedback (NA&F)"; "printed educational material (PEM)" and an existing intervention of "routinely conducted audit and feedback (RA&F)". The theoretical framework underpinning the intervention was the theory of planned behavior. Main outcome measures were the percentage change in the proportion of prescriptions containing injectable dexamethasone; oral amoxicillin and cefixime. NA&F reduced the proportion of prescriptions particularly those containing dexamethasone injectable and cefixime (1.64, 0.99 absolute percentage change, p = 0.006, p = 0.01 respectively). PEM reduced the proportion of prescriptions containing cefixime (0.93 absolute percentage change p = 0.04). Other primary outcomes had no significant differences. A secondary outcome measure showed overall prescribing of injectables also reduced (absolute risk reduction: 3%). Overally, the study provides strong evidence that using theoretical insights in the development of the intervention improved prescribing behavior that lasted at least three months after the intervention. The design, format, and presentation of messages in feedback forms significantly influence the impact of audit and feedback on physician prescribing. While the interventions were effective, the impacts on inappropriate prescribing were modest and limited. In settings with rampant problems of overprescribing, intensive interventions are required to substantially improve prescribing patterns. Graphical abstract Graphical abstract.
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Affiliation(s)
- Fatemeh Soleymani
- No.2-440, Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Tehran University of Medical Sciences, Tehran, Iran.
- Pharmaceutical Management & Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Rashidian
- No.2-440, Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Tehran University of Medical Sciences, Tehran, Iran
- Pharmaceutical Management & Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economic, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rassoul Dinarvand
- Pharmaceutical Management & Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmaceutics, Faculty of Pharmacy and Nanotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezade
- No.2-440, Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Tehran University of Medical Sciences, Tehran, Iran
- Pharmaceutical Management & Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Vasudevan J, Mannu A, Ganavi G. McIsaac Modification of Centor Score in Diagnosis of Streptococcal Pharyngitis and Antibiotic Sensitivity Pattern of Beta-hemolytic Streptococci in Chennai, India. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1467-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ. Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits. Malays J Med Sci 2018; 25:6-21. [PMID: 30914875 PMCID: PMC6422577 DOI: 10.21315/mjms2018.25.6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 07/30/2018] [Indexed: 12/02/2022] Open
Abstract
This review highlights the clinical scoring tools used for the management of acute pharyngotonsillitis in primary care clinics. It will include the prevalence of group A pharyngotonsillitis among children and adults worldwide and the selective tests employed for diagnosing group A streptococcal pharyngotonsillitis. Pharyngotonsillitis is one of the common reasons for visits to primary care clinics worldwide, and physicians tend to prescribe antibiotics according to the clinical symptoms, which leads to overprescribing antibiotics. This in turn may lead to serious health impacts and severe reactions and may promote antibiotic resistance. These significantly add on to the health care costs. The available information from health organisations and previous studies has indicated the need to manage the diagnosis of pharyngotonsillitis to improve prescribing habits in primary care clinics.
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Affiliation(s)
- Abdulrahman Muthanna
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Hani Syahida Salim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Rukman Awang Hamat
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Nurainul Hana Shamsuddin
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Siti Zulaikha Zakariah
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
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Low M, Almog R, Balicer RD, Liberman N, Raz R, Peretz A, Nitzan O. Infectious disease burden and antibiotic prescribing in primary care in Israel. Ann Clin Microbiol Antimicrob 2018; 17:26. [PMID: 29885657 PMCID: PMC5994243 DOI: 10.1186/s12941-018-0278-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotics are frequently prescribed at many of the visits to primary care clinics, often for conditions for which they provide no benefit, including viral respiratory tract infections. OBJECTIVES The aim was to evaluate primary care visits due to infectious diseases, and to estimate antibiotic prescribing and antibiotic dispensing by pharmacies. METHODS Diagnosis of infectious disease, antibiotic prescribing and dispensing data at the individual patient level were extracted for 2015 from Clalit Health Services' electronic medical records and linked to determine the condition for which the antimicrobial was prescribed. RESULTS There were 6.6 million visits due to infections, representing 22% of all primary care visits. The most common events were upper respiratory tract infections (38%) and pharyngitis (10%). Highest prescription rates were for urinary tract infections (80%), otitis media (64%), pharyngitis (71%), sinusitis (63%), and lower respiratory tract infections (76%). The highest rates of undispensed prescriptions were for acute gastroenteritis, urinary tract infections, and pharyngitis (24, 23, and 16%, respectively). CONCLUSIONS Infectious diseases constitute a heavy burden on primary care, with overprescribing of antibiotics. Intervention to reduce unwarranted antibiotic use is needed. In pediatric care, interventions should focus on better controlling antibiotic consumption and encouraging adherence to guidelines for upper respiratory tract infections, pharyngitis, and otitis media. In adults interventions should aim to monitor antibiotic prescribing for upper respiratory tract infections and improve adherence to guidelines for urinary tract infections.
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Affiliation(s)
- Marcelo Low
- Clalit Research Institute & Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel. .,School of Public Health, University of Haifa, Haifa, Israel.
| | - Ronit Almog
- School of Public Health, University of Haifa, Haifa, Israel.,Rambam Medical Center, Haifa, Israel
| | - Ran D Balicer
- Clalit Research Institute & Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nicky Liberman
- Clalit Health Services, Community Medicine Division, Tel-Aviv, Israel
| | - Raul Raz
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Avi Peretz
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center Poriya, Tiberias, Israel.,The Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel
| | - Orna Nitzan
- The Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel.,Infectious Disease Unit, Poriya Medical Center, Tiberias, Israel
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Mazińska B, Hryniewicz W. Polish Physicians’ Attitudes Towards Antibiotic Prescription and Antimicrobial Resistance. Pol J Microbiol 2017; 66:309-319. [PMID: 29319521 DOI: 10.5604/01.3001.0010.4856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance has been one of the biggest global current issues in medicine and public health. Overuse and imprudent use of antimicrobial agents are recognized as one of the leading causes of antibiotic resistance. The aim of this study was to analyze the attitudes of Polish physicians practicing at the community level towards antibiotics and antimicrobial resistance. The majority of physicians taking part in the survey believed that Polish people overuse antibiotics (98%). Most physicians (91%) considered that antimicrobial resistance is a major problem at present. The majority of physicians indicated the reasons for prescribing the antibiotic are related to health factors, such as optimal recovery (best effectiveness, least side effects) (80%), latest therapeutic guidelines (70%) and microbiological/epidemiological factors (63%). Knowledge of the National Recommendations for the management of Community-Acquired Respiratory Tract Infections 2010 (NR-CA-RTI) developed within National Programme for Protection of Antibiotics was declared by 84% of respondents. Among those who are aware of the NR-CA-RTI, the majority follow them in their daily practice (91%). Among physicians, 62% are not familiar with the Centor/McIsaac scores used to differentiate bacterial and viral infections in patients presenting with a sore throat. Among physicians familiar with the scores, 90% use them in their daily practice. Rapid microbiological detection methods for Group A beta-hemolytic streptococcal pharyngitis are used only by 20% of respondents. Almost all of physicians declared readiness to use these tests. Main sources of information on antibiotics prescribing originate from Polish medical journals, scientific conferences organized by medical societies, pharmaceutical companies.
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Affiliation(s)
- Beata Mazińska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
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Yousefi N, Rashidian A, Soleymani F, Kebriaeezade A. Relationship Between the Provision of Injection Services in Ambulatory Physician Offices and Prescribing Injectable Medicines. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2017; 16:399-403. [PMID: 28496493 PMCID: PMC5423265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Overuse of injections is a common problem in many low-income and middle income countries. While cultural factors and attitudes of both physicians and patients are important factors, physicians› financial intensives may play an important role in overprescribing of injections. This study was designed to assess the effects of providing injection- services in physicians› ambulatory offices on prescribing injectable medicines. This cross-sectional study was conducted in Tehran in 2012 -2013and included a random sample of general physicians, pediatricians and infectious disease specialists. We collected data on the provision of injection services in or in proximity of physician offices, and obtained data from physicians› prescriptions in the previous three-month period. We analyzed the data using ANOVA, Student›s t-test and linear regression methods. We obtained complete data from 465 of 600 sampled physicians. Overall 41.9% of prescriptions contained injectable medicines. 75% of physicians offered injection services in their offices. Male physicians and general physicians were more likely to offer the services, and more likely to prescribe injectables. We observed a clear linear relationship between the injection service working hours and the proportion of prescriptions containing injectables (p-value<0.001). Providing injection service in the office was directly linked with the proportion of prescriptions containing injectables. While provision of injection services may provide a direct financial benefit to physicians, it is unlikely to be able to substantially reduce injectable medicines› prescription without addressing the issue.
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Affiliation(s)
- Naeimeh Yousefi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Rashidian
- Department of Health Management and Economic, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,Knowledge Utilization Research Center, Tehran University of Medical Sciences, ,Tehran, Iran. Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail:
| | - Fatemeh Soleymani
- Iran food and drug organization. MOH&ME Iran, Tehran and National Committee on Rational Drug Use, Food and Drug Organization, Ministry of Health and Medical Education.
| | - Abbas Kebriaeezade
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran. ,Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran. ,Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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Saengcharoen W, Jaisawang P, Udomcharoensab P, Buathong K, Lerkiatbundit S. Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria. Int J Clin Pharm 2016; 38:1318-25. [PMID: 27573720 DOI: 10.1007/s11096-016-0373-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
Abstract
Background Inappropriate use of antibiotic treatment for pharyngitis by community pharmacists is prevalent in developing countries. Little is known about how the pharmacists identify patients with bacterial pharyngitis. Objective To ascertain the appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria and to identify factors related to antibiotic dispensing. Setting 1040 Thai community pharmacists. Method A cross-sectional survey of community pharmacists was conducted in November 2012 to March 2013. The self-administered questionnaires were mailed to 57 % of community pharmacists in the south of Thailand (n = 1040). The survey included questions on diagnosis of streptococcal pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs regarding antibiotic dispensing. Main outcome measure The appropriateness of diagnosis of streptococcal pharyngitis according to the original and modified Centor criteria and determinants of antibiotic dispensing including demographic characteristics of pharmacists, knowledge on pharyngitis, and attitudes and control beliefs on antibiotic dispensing. Results Approximately 68 % completed the questionnaires (n = 703). Compared to the pharmacists who reported not dispensing antibiotics in the hypothetical case with common cold, those reported dispensing antibiotics were more likely to consider the following conditions-presence of cough, mild sore throat and patients with age >60 years as cues for diagnosis of streptococcal pharyngitis (p < 0.05). The use of fewer scores of the clinical prediction rules for diagnosis was observed in antibiotic dispensers, compared to who did not do so (p < 0.005). Antibiotic dispensing was positively associated with period of dispensing experience (>5 years) [odds ratio (OR) 1.52; 95 % confidence interval (CI) 1.03-2.23], belief that antibiotics could shorten duration of pharyngitis (OR 1.48; 95 % CI 1.11-1.99), belief that antibiotics could prevent the complications (OR 1.44; 95 % CI 1.09-1.91) and belief that dispensing antibiotics could satisfy the patients (OR 1.31; 95 % CI 1.01-1.71). Nonetheless, antibiotic dispensing was negatively associated with knowledge about pharyngitis (OR 0.83; 95 % CI 0.75-0.93). Conclusion Pharmacists who are knowledgeable on the Centor criteria are more likely to appropriately diagnose streptococcal pharyngitis and less likely to dispense antibiotics in such case.
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Affiliation(s)
- Woranuch Saengcharoen
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Pornchanok Jaisawang
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Palita Udomcharoensab
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Kittika Buathong
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Sanguan Lerkiatbundit
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Chakraborti C. Systemic Negligence: Why It Is Morally Important for Developing World Bioethics. Dev World Bioeth 2014; 15:208-13. [DOI: 10.1111/dewb.12063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Osman KM, Hassan WMM, Mohamed RAH. The consequences of a sudden demographic change on the seroprevalence pattern, virulence genes, identification and characterisation of integron-mediated antibiotic resistance in the Salmonella enterica isolated from clinically diarrhoeic humans in Egypt. Eur J Clin Microbiol Infect Dis 2014; 33:1323-37. [DOI: 10.1007/s10096-014-2072-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/27/2014] [Indexed: 12/20/2022]
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