The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care
Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Digital revista |
| Language: | English |
| Published: |
South African Medical Association
2016
|
| Online Access: | http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000600014 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| id |
oai:scielo:S0256-95742016000600014 |
|---|---|
| record_format |
ojs |
| spelling |
oai:scielo:S0256-957420160006000142016-07-01The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary careBrink,A Jvan Wyk,JMoodley,V MCorcoran,CEkermans,PNutt,LBoyles,TPerovic,OFeldman,CRichards,G AMendelson,MAntibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.South African Medical AssociationSAMJ: South African Medical Journal v.106 n.6 20162016-06-01journal articletext/htmlhttp://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000600014en |
| institution |
SCIELO |
| collection |
OJS |
| country |
Sudáfrica |
| countrycode |
ZA |
| component |
Revista |
| access |
En linea |
| databasecode |
rev-scielo-za |
| tag |
revista |
| region |
África del Sur |
| libraryname |
SciELO |
| language |
English |
| format |
Digital |
| author |
Brink,A J van Wyk,J Moodley,V M Corcoran,C Ekermans,P Nutt,L Boyles,T Perovic,O Feldman,C Richards,G A Mendelson,M |
| spellingShingle |
Brink,A J van Wyk,J Moodley,V M Corcoran,C Ekermans,P Nutt,L Boyles,T Perovic,O Feldman,C Richards,G A Mendelson,M The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| author_facet |
Brink,A J van Wyk,J Moodley,V M Corcoran,C Ekermans,P Nutt,L Boyles,T Perovic,O Feldman,C Richards,G A Mendelson,M |
| author_sort |
Brink,A J |
| title |
The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| title_short |
The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| title_full |
The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| title_fullStr |
The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| title_full_unstemmed |
The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| title_sort |
role of appropriate diagnostic testing in acute respiratory tract infections: an antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care |
| description |
Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication. |
| publisher |
South African Medical Association |
| publishDate |
2016 |
| url |
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000600014 |
| work_keys_str_mv |
AT brinkaj theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT vanwykj theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT moodleyvm theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT corcoranc theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT ekermansp theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT nuttl theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT boylest theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT perovico theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT feldmanc theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT richardsga theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT mendelsonm theroleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT brinkaj roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT vanwykj roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT moodleyvm roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT corcoranc roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT ekermansp roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT nuttl roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT boylest roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT perovico roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT feldmanc roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT richardsga roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare AT mendelsonm roleofappropriatediagnostictestinginacuterespiratorytractinfectionsanantibioticstewardshipstrategytominimisediagnosticuncertaintyinprimarycare |
| _version_ |
1756005794869936128 |