Case Study
Volume 5 Issue 2
C Colella*, T Tricarico, V Gasparre and M Zamparella
July 29, 2024
Abstract
Aim: To define and evaluate the role of Apulian General Practitioners in regarding the prescribing appropriateness of antibiotics and the importance of counseling for patients, to identify and manage the problem of ABR, particularly in the context of upper respiratory tract infections.
Materials and methods: the survey was conducted through the administration of a questionnaire consisting of 10 items addressed to the GPs of the Apulian territory, in the period from January to April 2024, by email, instant messaging and social media.
Results: 180 General Practitioners were interviewed, (58% women 42% men) of which 45% GPs with >1500 patients, 32% urgent care doctors, 16% GPs with 1200-1500 patients, 3% GPs with 1000- 1200 patients and 5% GPs with 800-1000 patients.
65% of GPs (n:117) prescribe an average of 5 antibiotics per week, 22% of GPs (n:39) prescribe 6-10 antibiotics and 13% (n:24) more than 10 antibiotics. Patients ask for antibiotics for the following reasons: pharyngitis (68%), urinary tract infections (69%), cough (40%), acute bronchitis (44%), otitis (23%), sinusitis (18%), cold (16%), other flu symptoms (15%). General Practitioners report that every day on average at least one patient requires a prescription for an antibiotic for a pharyngitis. In 33% of cases it is a woman (33%), very insistent (52%), arguing the need to resume her work activity as soon as possible (34%), for self-diagnosis (32%) for comparison with family members with similar symptoms who would have been prescribed an antibiotic (32%), for having started home therapies, residues of previous therapies.
GPs report a patients’ poor awareness about side effects, compared to the deep-rooted belief that the antibiotic guarantees a quicker and better resolution of symptoms.The proposals to stem the phenomenon from the GPs interviewed suggest patient education to limit improper requests (79%), counseling not to use antibiotics in viral infections (77%), information on individual adverse events linked to abuse (56%), empowerment regarding the impact on the global health of the planet and the growing difficulty in treating infections caused by resistant germs (52%), synergistic action with pharmacists (48%), greater diffusion and training for the application of treatment guidelines in primary care (19%) and more frequent updating on the issue of AMR (15%).
Regarding the use of diagnostic tests such as the rapid test for beta hemolytic streptococcus, although little used in general practice, the majority of participants (80%) consider it strategic to avoid inappropriate antibiotic therapies and guide the patient towards its use of symptomatic. 83% of GPs recommend the use of anti- inflammatory-analgesics for the management of "sore throats" and confirm the need to combat the abuse of antibiotic therapy requests.
Conclusions: Antibiotic resistance is a multifactorial public health issue that requires urgent prevention and control actions at global and cross-sectoral. General Practitioners in Apuglia have a fundamental role on the correct use of antibiotics. It is necessary to promote health education and patient counseling, citizen empowerment about good hygiene practices (use of DPI, hand washing, etc.), attention to environmental contamination (e.g. waste disposal); to encourage adherence to vaccination and the appropriate use of antibiotic or symptomatic therapies for themselves and for the community; to reduce the tendency to self- prescribe antibiotics and the adverse events related to it, such as the percentage of treatment failures and healthcare costs; to apply the guidelines in pharmaceutical prescriptions; to join collaborative, research and innovation initiatives to combat ABR.
A possible helpful tool may be the use of rapid diagnostic tests to reduce the inappropriate prescription of antibiotics. We need to move from a simple idea of appropriateness in prescription to an overall cultural appropriateness of a healthcare nature.
In fact, General Practitioners can act effectively only with other stakeholders, to trigger virtuous processes, respecting the skills and responsibilities of each individual, in order to always be able to operate for the best clinical outcome, in the absence of ethical conflicts. At the same time, we hope for more training opportunities for healthcare workers, pharmacists and veterinarians, in integrated multi-sectoral events, according to the principles of One Health.
Keywords: antibiotic resistance; General Practitioners; sore throat
References