Antibiotics for coughing in general practice: Exploring, describing and optimising prescribing.

摘要

Background. It has been shown that community antibiotic sales mirror patterns of antibiotic resistance in Western Europe. Others have observed that changes in antibiotic use may be followed by changes in antibiotic resistance. Consequently, the best way of preserving the effectiveness of antibiotics is to use them more appropriately, i.e. in cases where patients will actually benefit. The alternative of continuing to develop new antibiotics will only solve the problem of antibiotic resistance if the principles of judicious use of antibiotics are implemented at the same time. The growth in resistance is progressing faster than the development of new antibiotics.; Aims. This dissertation aims to contribute to the development of effective strategies for a more appropriate use of antibiotics in the context of increasing bacterial resistance. Since coughing is one of the most common complaints in general practice, and most antibiotics are prescribed by general practitioners and for this condition, the appropriate use of antibiotics to treat coughing is a key area of action in order to tackle the resistance problem. Consequently, by describing, exploring and optimising the prescription of antibiotics for coughing we can safeguard a major development in the field of medicine, i.e. the use of antibiotics in the treatment of life-threatening infections.; Conclusion. This dissertation clearly shows that the prescription of antibiotics for the most frequent (RTI) complaint in general practice, i.e. coughing, requires optimisation. This can be achieved by means of a guideline for good clinical practice, provided the guideline fits in with current common practice and is implemented by means of academic detailing. In doing so, we can achieve the goals of the Belgian public awareness campaign: “Antibiotics: Use them less often, but better”. GPs not only prescribed less, but also better because of our intervention. Furthermore, this did not happen at the expense of patient recovery.; Furthermore, there is significant interaction between doctor and patient in the decision to prescribe antibiotics. So, in order to develop effective strategies aimed at a more appropriate use of antibiotics, we need to focus on both the doctor and the patient and, in particular, on doctor-patient communication. More specifically, the discussion of patient expectations about antibiotic prescription and the (in)appropriateness of it, supported by relevant and evidence-based recommendations is the key to success for the GP. Likewise, interventions should focus on both the prescribers and the consumers. Therefore we advise a combination of interventions such as a national public awareness campaign and an intervention like ours, which directly addressed GPs.; Finally, interventions to change behaviour—in this case the prescription behaviour—cannot claim to have a lasting effect. They need to be repeated to preserve the effectiveness of antibiotics in future health care.