Focus
Infezioni respiratorie, self help e prescrizione antibiotica
nella pratica ambulatoriale
PRIMARY CARE PAEDIATRICIAN’S ANTIBIOTIC PRESCRIPTION AND SELF-HELP USE IN RESPIRATORY INFECTIONS
L. Mauri, M. Narducci, A. Nova, F. Zanetto
Novembre 2010 - pagg. 565 -574
Abstract
Aims - Assessing the primary care paediatricians (PCPs) antibiotic prescriptions and the
self-help use during respiratory infections in children.
Methods - 58 PCPs have registered diagnosis, self-help and therapy of the respiratory infections
observed during 2007, one week a month.
Results - In a total of 49,525 children, 23,801 were visited by PCPs for respiratory infections.
In 14.7% cases (3,489) self-help was utilized. According to the self-help test results,
no antibiotic prescription has been done in 47.5% cases. Penicillins were prescribed
in 76.2% cases, macrolides in 13.4% and cephalosporins in 10.3%. Amoxicillin
was the most used active principle, indeed it was prescribed in 58% cases.
Conclusions - The progressive self-help spread could be a determining factor in diagnostic
accuracy improving and appropriateness in PCPs prescriptive practice.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Nova A, Narducci M, Zanetto F, et al. La prescrizione
antibiotica sistemica nella pratica del
pediatra di famiglia. Quaderni acp 2008;15:
106-11.
2. Maltezou HC, Tsagris V, Antoniadou A, et
al. Evaluation of a rapid antigen detection test
in the diagnosis of streptococcal pharyngitis
in children and its impact on antibiotic prescription.
J Antimicrob Chemother 2008;62:
1407-12.
3. Reggiani L. Self help e percorso diagnostico
di una febbre da causa sconosciuta. Medico e
Bambino 2007;26:370-4.
4. Sanders S, Barnett A, Correas-Velez I, et al.
Systematic review of the diagnostic accuracy
of C-reactive protein to detect bacterial infection
in nonhospitalized infants and children
with fever. J Pediatr 2008;153:570-4.
5. Maheswaeri N. How useful is C-reactive
protein in detecting occult bacterial infection
in young children with fever without apparent
focus? Arch Dis Child 2006;91:533-5.
6. Scottish Intercollegiate Guidelines Network.
Management of sore throat and indications
for tonsillectomy, 1999; http://www.
sign.ac.uk/guidelines/fulltext/34/index.
html.
7. American Academy of Pediatrics, Committee
on Infectious Diseases. Group A streptococcal
infections. In: The Red Book. Elk
Groove Village, IL: American Academy of Pediatrics
2000:526-36.
8. Finish Medical Society Duodecim. Sore
throat and tonsillitis. In: EBM Guidelines. Evidence-
Based Medicine. Helsinki, Finland:
Duodecim Medical Publications Ltd., 2004.
9. Cincinnati Children’s Hospital Medical Center.
Evidence based clinical practice guideline
for fever of uncertain source in children in 2 to
36 months of age. Cincinnati Children’s Hospital
Medical Center-Hospital Medical Center,
2000 (revised 2003; reviewed 2006). NGC:00-
3783.
10. Agenzia Sanitaria Regione Emilia Romagna.
Raccomandazioni faringotonsillite, 2007;
http://asr.regione.emilia-romagna.it/wcm/
asr/collana_dossier/doss.153.htm.
11. Agenzia Sanitaria Regione Emilia Romagna.
Raccomandazioni otite media acuta,
2007; http://asr.regione.emilia-romagna.it/
wcm/asr/collana_dossier/doss.154.htm.
12. NICE clinical guideline 69. Prescribing of
antibiotics for self-limiting respiratory tract infections
in adults and children in primary care.
July 2008.
13. Moro ML, Marchi M, Gagliotti C, et al.
Why do paediatricians prescribe antibiotics?
Results of an Italian regional project. BMC Pediatr
2009;9:69.
14. ICPC-2-R, International Classification of
Primary Care, revise 2nd edition (WONCA International
Classification Committee). Oxford:
Medical Publications, 2006.
15. Clavenna A, Bonati M, Rossi E, et al. Il profilo
prescrittivo della popolazione pediatrica
italiana nelle cure primarie. Ricerca&Pratica
2004;120:224-94.
16. Clavenna A, Berti A, Gualandi L, et al.
Drug utilisation profile in the Italian paediatric
population. Eur J Pediatr 2009;168:173-180.
17. Sorveglianza Pediatri Sentinella. Attitudini
Prescrittive in Pediatria (APE). Istituto Superiore
di Sanità, 2004.
18. Cazzato T, Pandolfini C, Campi R, Bonati
M, Gruppo di lavoro ACP Puglia-Basilicata. Attitudini
prescrittive nella Pediatria di Famiglia.
Giornale Italiano di Farmacia Clinica 2001;15:
21-5.
19. Saugo M, Pellizzari M, Giarno M, et al.
Prescrizione di antibiotici sistemici in età pediatrica
nell’ULSS n°4 “Alto Vicentino”: fattori
legati al bambino e al medico curante. Medico
e Bambino, pagine elettroniche 2004;7;
http://www.medicoebambino.com/index.php
?id=RI0407_10.html.
20. Clavenna A, Bonati M, Campi R, et al. La
prescrizione di farmaci per i bambini e gli anziani
nella ASL di Lecco. Ricerca&Pratica
2007;135:100-12.
21. Borgnolo G, Simon G, Francescutti C, et
al. Antibiotic prescription in Italian children:
a population-based study in Friuli Venezia Giulia,
north-east Italy. Acta Paediatr 2001;90:
1316-20.
22. Rossignoli A, Clavenna A, Bonati M. Antibiotic
prescription and prevalence rate in the
outpatient paediatric population: analysis of
surveys published during 2000-2005. Eur J
Clin Pharmacol. 2007;63:1099-106.
23. Clavenna A, Sequi M, Bortolotti A, et al.
Determinants of the drug utilization profile in
the paediatric population in Italy’s Lombardy
Region. Br J Clin Pharmacol 2009;67:565-71.
24. Pandolfini C, Campi R, Clavenna A, et al.
Italian paediatricians and off-label prescriptions:
loyal to regulatory or guideline standards?
Acta Paediatr 2005;94:1-5.
25. De Jong J, van den Berg PB, de Vries TW,
et al. Antibiotic drug use of children in the
Netherlands from 1999 till 2005. Eur J Clin
Pharmacol 2008;64:913-19.
26. Reggiani L. Self help e percorso diagnostico
delle faringotonsilliti. Medico e Bambino
2007;26:445-8.
Corrispondenza: maurilaur@tin.it