Article type
Year
Abstract
Objectives: To study the use of antibiotics (ABX) in out-patients, and concordance/discordance between evidence based clinical practice guidelines and real world. Acute otitis media (AOM) in children is the most common cause for prescription of ABX and was therefore selected for a special study.
Methods: In 5 Swedish counties (population 1,29 million), all GPs, ENT doctors, infectious disease doctors, and pediatricians were invited to take part in the study. During one week in November 2000, participating physicians completed a questionnaire for every outpatient (children and adults) who presented with an infection-related complaint.
Results: We collected 5.4 forms/1000 inhabitants, covering 41% of ABX dispensed during the study week. The same amount of ABX was sold as during the other weeks in November. ABX were prescribed to 59% of all infected patients; 44% of these prescriptions were for pcV. Of all ABX (to outpatients 0-100 years), 25% were prescribed to young children (0-7.99 years). ABX were prescribed to 95% of AOM cases.
Discussion: PcV for 5 days has been the recommended treatment of AOM in Sweden during the 1990's. A randomized clinical trial and observational studies in the Netherlands have shown that mild and moderate AOM cases >6 months old do not need ABX. One of us (I.Ax.) has therefore during the 1990's proposed the adoption of the Dutch guidelines in 2 papers in the national Swedish medical journal (Läkartidningen) and in other journals. An average issue of Läkartidningen has 120,000 readers (1.5% of the Swedish population), incl. ~80% of the 28,000 MDs <65 years old. New national guidelines for AOM, based on systematic reviews of the literature, were finally published in May 2000 by the National Board of Health, the Medical Research Council, and the counties. According to these guidelines, ABX are not necessary in most AOM cases in 2-16 years old patients. Restrictions in the use of ABX are recommended. It is obvious that the physicians disagree; they still treat 95% of AOM cases with ABX.
Conclusions: We plan a new study week in November 2002, probably limited to GP's since they prescribe the vast majority of ABX to outpatients. We need to discuss the disagreement regarding AOM with GPs. A possible solution may be deferred prescriptions: the parents get a prescription of ABX, but are asked to use the prescription only if the child does not improve during the next few days (BMJ 1999;318:715-6).
Methods: In 5 Swedish counties (population 1,29 million), all GPs, ENT doctors, infectious disease doctors, and pediatricians were invited to take part in the study. During one week in November 2000, participating physicians completed a questionnaire for every outpatient (children and adults) who presented with an infection-related complaint.
Results: We collected 5.4 forms/1000 inhabitants, covering 41% of ABX dispensed during the study week. The same amount of ABX was sold as during the other weeks in November. ABX were prescribed to 59% of all infected patients; 44% of these prescriptions were for pcV. Of all ABX (to outpatients 0-100 years), 25% were prescribed to young children (0-7.99 years). ABX were prescribed to 95% of AOM cases.
Discussion: PcV for 5 days has been the recommended treatment of AOM in Sweden during the 1990's. A randomized clinical trial and observational studies in the Netherlands have shown that mild and moderate AOM cases >6 months old do not need ABX. One of us (I.Ax.) has therefore during the 1990's proposed the adoption of the Dutch guidelines in 2 papers in the national Swedish medical journal (Läkartidningen) and in other journals. An average issue of Läkartidningen has 120,000 readers (1.5% of the Swedish population), incl. ~80% of the 28,000 MDs <65 years old. New national guidelines for AOM, based on systematic reviews of the literature, were finally published in May 2000 by the National Board of Health, the Medical Research Council, and the counties. According to these guidelines, ABX are not necessary in most AOM cases in 2-16 years old patients. Restrictions in the use of ABX are recommended. It is obvious that the physicians disagree; they still treat 95% of AOM cases with ABX.
Conclusions: We plan a new study week in November 2002, probably limited to GP's since they prescribe the vast majority of ABX to outpatients. We need to discuss the disagreement regarding AOM with GPs. A possible solution may be deferred prescriptions: the parents get a prescription of ABX, but are asked to use the prescription only if the child does not improve during the next few days (BMJ 1999;318:715-6).