Antibiotics shorten duration of acute cough? A cohort study. Teng CL, Efendie B, Lee VKM, Tey KK, Selvakumari S, Sarghunan P, Rafidah B, Bong YK, Shafiq.

Slides:

Advertisements

Similar presentations

Respiratory tract infections - antibiotic prescribing

Advertisements

Antibiotics - Sore throat

The Common Cold Created by VSU Student Health Center.

Influenza Prevention We anticipate that there will be two types of influenza illness and influenza vaccines this year Seasonal influenza – the usual flu.

Swine Influenza (pig flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine.

ECONOMIC ASSESSMENT OF IMPLEMENTATION TREATMENT GUIDELINES OF HYPERTENSION IN OUT-PATIENT PRACTICE Kulmagambetov IR Karaganda State Medical Academy, Kazakhstan.

CRITICAL READING Stephen Newell. December Reading a paper – R-E-A-D-ER  Relevant?  Educational? Does it add anything?  Applicable? Primary-care.

Welcome to Journal club Dr. Md. Abul Hossain Khan Honorary Trainee Department of microbiology, MMC A Comparative Study of Typhidot and Widal Test in Patients.

Influenza Prevention We anticipate that there will be two types of influenza illness and two different types of influenza vaccine this year Seasonal influenza.

G aps, challenges and opportunities Theo Verheij University Medical Center Utrecht Lower Respiratory Tract Infections in Primary Care.

Hypothesis-Generating Interviews. Goals Discuss the uses of hypothesis- generating interviews Present information on case-patient selection, questions.

Dr Helen Carter Specialist Registrar Public Health Health Protection Agency Regional Surveillance Unit West Midlands Influenza Surveillance Key Health.

Local Patient Participation Group ‘A centre of excellence delivering high quality care where patients and staff choose to be’ 21 st January 2015.

Public Health Update David Kirschke, MD Medical Director / Health Officer Northeast Tennessee Regional Health Office.

SORE THROAT & OTITIS MEDIA

Primary Care Research in Northern Ireland: where’s the evidence? Carmel M. Hughes School of Pharmacy Queen’s University Belfast.

Electronic Medical Record Use and the Quality of Care in Physician Offices National Conference on Health Statistics August 17, 2010 Chun-Ju (Janey) Hsiao,

RESPIRATORY TRACT INFECTIONS: ANTIBIOTIC PRESCRIBING

Streptococcus The Throat Pathogen.

Factors that Associated with Stress in Nursing Faculty in Thailand

The early use of Antibiotics in at Risk CHildren with InfluEnza Chief Investigator: Dr Kay Wang Senior Trial.

Implementation of local guideline by interactive workshop improves anticoagulation therapy and patient safety Puhakka J, Helsinki Health Centre, GP Suvanto.

Pandemic Influenza. Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Settings UK Pandemic Influenza Contingency Plan Operational.

Severity assessment for lower respiratory tract infections: potential use and validity of CRB-65 in primary care N. Francis, J. Cals, C. Butler, K. Hood,

The use of text messaging to improve asthma control a study of short message service (SMS) LATHY PRABHAKARAN 1, JANE C 1,CHUA K C 2, WONG W M 3, ABISHEGANANDED.

A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO,

IMPROVING DIABETES MANAGEMENT IN PRIMARY CARE

Electronic Health Records and Clinical Decision Support Systems Impact on National Ambulatory Care Quality Max J. Romano, BA; Randall S. Stafford, MD,

Collecting data in clinic.  Aim of BADBIR  Definition of Adverse Events  Adverse events in BADBIR  Adverse event recording in hospital case notes.

Progress of the Singapore TB Elimination Programme (STEP)

Danilo Saniatan R.N Charge Nurse RAC-Khurais Clinic.

Suttajit S a, Tantipidoke R a, Sitthi-amorn C a, Wagner A b, Ross-Degnan D b. a Chulalongkorn University, Bangkok; b Harvard Medical School, USA Problem.

1 Chiropractic visit observations among a group of patients who received chiropractic care for acute neck pain.

INTRODUCTION Upper respiratory tract infections, including acute pharyngitis, are common in general practice. Although the most common cause of pharyngitis.

Enterovirus D68 Illness in Hospitalized Children under 24 Months of Age Kayla B. Briggs 1, Rangaraj Selvarangan 2, Ferdaus Hassan 2, Mary Anne Jackson.

Stefan Ma1, Marc Lipsitch2 1Epidemiology & Disease Control Division

Definition of Family Medicine General practice / Family Medicine is an academic and scientific discipline, has its own educational content, research, evidence.

TB Management: A Medical Aid Perspective presented by Dr Noluthando Nematswerani.

Community Validation of Influenza-like Illness as a Predictor of Influenza Jonathan L. Temte, MD/PhD & Alexis Eastman, MS-2 University of Wisconsin School.

1 The Effect of Primary Health Care Orientation on Chronic Illness Care Management Julie Schmittdiel, Ph.D., Stephen M. Shortell, Ph.D., Thomas Rundall,

Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.

Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis Kharbanda AB, Dudley NC, Bajaj L, et al; Pediatric.

1 EFFICACY OF SHORT COURSE AMOXICILLIN FOR NON-SEVERE PNEUMONIA IN CHILDREN (Hazir T*, Latif E*, Qazi S** AND MASCOT Study Group) *Children’s Hospital,

Happy Audit II 2012 S. Chlabicz Department of Family Medicine and Community Nursing Medical University of Bialystok, Poland BARN meeting WARSAW 2013.

7 System Leadership study

Public Health Perspective on SARS Diagnostics Stephen M. Ostroff Deputy Director National Center for Infectious Diseases, CDC.

"Epidemiological Features of Rotavirus Infection among children below 5 years old in Jordan, Rationale for Vaccine Introduction,2015" Kareman Juma`ah Al-Zain.

Care Seeking and Treatment for Adults with Upper Respiratory Infections (URIs) in Congested Communities in Bangkok: Care Seeking and Treatment for Adults.

Using Antibiotics Wisely Team Lead Call #6 Diane Liu, MD Assistant Professor, Pediatrics Co-Director, UPIQ.

100 years of living science Chronic disease management in primary care: lessons to be learnt Dr Shamini Gnani November 2007, Mauritius.

©2007 K.L. Smith Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis October 20, 2007.

Diagnostic Accuracy of Acute Streptococcal Pharyngo-tonsillitis using the Centor Score Among Adults in the Malaysian Local Primary Care Setting to Improve.

„ Can we change doctor’s prescribing antibiotic habits? “

Fibromyalgia Impact Questionnaire McGill Pain Questionnaire

Larissa Grigoryan, MD, PhD Family and Community Medicine

The early use of Antibiotics in at Risk CHildren with InfluEnza

The ‘5C’ Walk-In Clinic:

18th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) Barcelona, Spain, April 2008 Oral presentation O249 – Sunday April.

Trap B and Hansen EH Euro Health Group, Denmark &

Primary Care Monitoring of Community Acquired Clostridia difficile

Subsequent Healthcare Utilization Associated With Early Physical Therapy for New Episodes of Low Back Pain in Older Adults Deven Karvelas, MD University.

LONG-TERM IMPACT OF AN MTP APPROACH

Dr. Glen E. Randall Dr. Michelle Howard McMaster University

Does an Increase in Opioid Dose lead to an Increase in Depression?

The Research Question PCMH Transformation

The Research Question In non-asthmatic adults presenting to primary care with acute lower respiratory tract infection and not requiring immediate antibiotics.

Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis by Tau-Hong Lee, Joshua.

Volume ():bjgpmar tau-hong_lee-fl-p

Pyramid of incidence of acute cough.

Percentage change since 1999, expressed as cumulative change from 1999, in rate of admissions of children for the acute infections normally managed in.

Presentation transcript:

Antibiotics shorten duration of acute cough? A cohort study. Teng CL, Efendie B, Lee VKM, Tey KK, Selvakumari S, Sarghunan P, Rafidah B, Bong YK, Shafiq Ali JS, Lee WH, Anuja K, Chen WS, Kennedy C. International Medical University, Malaysia WONCA Asia Pacific Region, Hong Kong, 4 – 7 June 2009 Oral Presentation, 7 June 2009

INTRODUCTION Systematic review on upper respiratory tract infections (URTI) did not support antibiotic use. In Malaysian primary care practices, antibiotic use is still commonly prescribed for URTI. –28.7% in public clinics (Med J Malaysia 2003) –68.4% in private clinics (Asia Pacific Family Medicine 2004)

INTRODUCTION Rationale of study: we hope to show to primary care doctors that the antibiotics they prescribe did not alter the course of the illness

METHODS: patients & settings 23 July to 25 September private clinics (16 doctors), 2 public clinics (14 doctors) Adult patients (  16 years) with acute URTI: cough or runny nose or sore throat with a duration of  7 days.

Data collection form for doctor Antibiotic data

Patient diary Return via self-addressed enveloped Text messaging and telephone calls

RESULTS & DISCUSSION 503 patients were enrolled Mean age 34 yrs (range 16-80, SD=12.5) 47 (9.3%) defaulted (unable to contact and/or diary not returned)

RESULTS & DISCUSSION Cough before presentation = 413 (82.1%) Cough before/after presentation = 424 (84.3%)

RESULTS: Cough duration in URTI 37% remained coughing at 7 th day 5.4% remained coughing at 14 th day

Cough duration Antibiotics = 7.2 days No antibiotics = 8.7 days p=0.004 Antibiotics shorten duration of cough?

Cough duration Private clinic (GP) = 6.9 days Public clinic (KK) = 10.3 days P<0.001 “Milder” URTI were seen in private clinics? (Private) (Public)

RESULTS & DISCUSSION Cough duration (Private) Antibiotics = 6.9 days No antibiotics = 6.7 days P>0.05 Cough duration (Public) Antibiotics =10.2 days No antibiotics = 10.3 days P>0.05 Differences in cough duration between those given antibiotic and not given antibiotic disappeared when clinic setting is taken into account

CONCLUSION This cohort study reaffirms the lack of effectiveness of antibiotic for cough in URTI. Caution need to be exercised when combining data on symptom presentation and prescribing in public and private primary care.

ACKNOWLEDGEMENT We wish to thank the following: –International Medical University for providing the funding. –Ministry of Health Malaysia for allowing this study in the public clinics –Doctors in private and public primary care clinics (and their patients) for their participation –Prof James Dickinson (University of Calgary) for his insightful comments

Teng CL, Efendie B, Lee VKM, et al. Antibiotics shorten duration of acute cough? A cohort study. WONCA Asia Pacific Regional Conference, Hong Kong, 4-7 June 2009 [Oral Presentation, 7 June 2009] Background. Systematic review on upper respiratory tract infections (URTI) did not support antibiotic use. However, in Malaysian primary care practices, antibiotic use is still commonly prescribed for URTI. Objectives. We conducted a cohort study to verify the ineffectiveness of antibiotic therapy in primary care practices in Malaysia. Methods. Adult patients (age 16 years) presenting with upper respiratory tract symptoms from public and private primary care clinics were followed up until symptoms resolved or up to 28 days. The participating doctors were advised to manage their patients in the usual way. The clinical details of patients were collected at recruitment and by patient diary (reminders given by text messaging and telephone call). Results/Key Message. 503 patients with URTI were enrolled (74.8% from private clinics). Patients presented earlier in private clinic compared to public clinics (mean cough duration before presentation: 2.42 days vs 3.11 days, p<0.001). Cough lasted shorter in private clinics (mean total cough duration: 6.9 days vs 10.3 days, p<0.001). Antibiotic prescribing rates were higher in private clinics (80.9% vs 29.1%). Cough duration was found to be shorter in patients given antibiotics (7.2 days vs 8.7 days, p=0.004), but this statistical difference disappeared when analysis was made separately by clinic setting. Conclusion. The earlier presentation of URTI in private clinic, acting together with the overwhelmingly high antibiotic prescribing rate, explains the apparent reduction of cough duration by antibiotic in this cohort study. This study finding reaffirms the lack of effectiveness of antibiotic for URTI symptoms. Throat culture taken =230, result available=229; Group A beta-haemolytic streptococcus isolated 4/229=1.7%].