Uso prudente de antibióticos y propuestas de mejora desde la atención primaria
Prudent use of antibiotics and suggestions for improvement in the primary health care system
Carles Llor
Centro de Salud Jaume I, Universidad Rovira i Virgili, Tarragona, España
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Los datos procedentes de la historia clínica y de la exploración física no ayudan, en la mayoría de las ocasiones, a discernir si la etiología de la infección es bacteriana o no y, en caso de duda, el médico de familia acostumbra a prescribir antibióticos a pesar del efecto marginal de estos medicamentos en la mayoría de las infecciones respiratorias. Además, los médicos de AP sobrestimamos la proporción de pacientes con infecciones que esperan recibir un antibiótico y, a menudo, esta percepción resulta ser errónea basándose en la literatura científica. Además, las expectativas de los pacientes suelen basarse en falsas asunciones o experiencias de consultas previas. Distintas estrategias han resultado ser útiles para hacer un uso más prudente de antibióticos en AP. La prescripción diferida de antibióticos se recomienda principalmente en infecciones no graves de supuesta etiología viral en los pacientes que manifiestan su preferencia por recibir antibióticos. La mejora de las habilidades comunicativas también ha mostrado ser útil para reducir la prescripción antibiótica así como la utilización de pruebas de diagnóstico rápido en la consulta, principalmente técnicas antigénicas rápidas para el diagnóstico de la faringitis estreptocócica y la determinación de la proteína C reactiva. Los resultados del estudio Happy Audit, realizado recientemente en nuestro país, así lo confirman.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A third of all primary care (PC) visits are due to infectious diseases and more than half of these are due to respiratory tract infections. In most cases, data from the clinical history and physical examinations do not help discern whether the aetiology of the infection is bacterial or not and, when in doubt, the family doctor tends to prescribe antibiotics despite the marginal effect that these drugs have on most respiratory infections. Moreover, PC physicians overestimate the proportion of patients with infections who expect to receive antibiotics and according to the scientific literature this perception is often wrong. In addition, patient expectations are often based on false assumptions or experiences from previous visits. Various strategies have proven useful in promoting more prudent use of antibiotics in PC. Delayed prescription of antibiotics is recommended mainly in non-serious infections of suspected viral aetiology in patients who express a preference for antibiotics. Improving communication skills has also proven useful in reducing prescriptions of antibiotics as has the use of rapid diagnostic tests in the doctor's office, mainly rapid antigen techniques for diagnosis of strep throat and determination of C-reactive protein. 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| 2022 Octubre | 15 | 15 | 30 |
| 2022 Septiembre | 15 | 13 | 28 |
| 2022 Agosto | 12 | 8 | 20 |
| 2022 Julio | 11 | 14 | 25 |
| 2022 Junio | 17 | 14 | 31 |
| 2022 Mayo | 13 | 13 | 26 |
| 2022 Abril | 15 | 17 | 32 |
| 2022 Marzo | 18 | 20 | 38 |
| 2022 Febrero | 8 | 15 | 23 |
| 2022 Enero | 7 | 20 | 27 |
| 2021 Diciembre | 17 | 17 | 34 |
| 2021 Noviembre | 30 | 21 | 51 |
| 2021 Octubre | 23 | 26 | 49 |
| 2021 Septiembre | 9 | 17 | 26 |
| 2021 Agosto | 4 | 13 | 17 |
| 2021 Julio | 8 | 19 | 27 |
| 2021 Junio | 6 | 15 | 21 |
| 2021 Mayo | 11 | 11 | 22 |
| 2021 Abril | 13 | 37 | 50 |
| 2021 Marzo | 11 | 14 | 25 |
| 2021 Febrero | 31 | 17 | 48 |
| 2021 Enero | 17 | 18 | 35 |
| 2020 Diciembre | 14 | 19 | 33 |
| 2020 Noviembre | 11 | 9 | 20 |
| 2020 Octubre | 13 | 9 | 22 |
| 2020 Septiembre | 16 | 14 | 30 |
| 2020 Agosto | 16 | 19 | 35 |
| 2020 Julio | 11 | 10 | 21 |
| 2020 Junio | 4 | 8 | 12 |
| 2020 Mayo | 16 | 10 | 26 |
| 2020 Abril | 8 | 15 | 23 |
| 2020 Marzo | 23 | 25 | 48 |
| 2020 Febrero | 23 | 11 | 34 |
| 2020 Enero | 12 | 14 | 26 |
| 2019 Diciembre | 11 | 20 | 31 |
| 2019 Noviembre | 22 | 29 | 51 |
| 2019 Octubre | 21 | 18 | 39 |
| 2019 Septiembre | 26 | 9 | 35 |
| 2019 Agosto | 15 | 16 | 31 |
| 2019 Julio | 17 | 26 | 43 |
| 2019 Junio | 43 | 43 | 86 |
| 2019 Mayo | 68 | 70 | 138 |
| 2019 Abril | 43 | 59 | 102 |
| 2019 Marzo | 11 | 13 | 24 |
| 2019 Febrero | 16 | 14 | 30 |
| 2019 Enero | 9 | 8 | 17 |
| 2018 Diciembre | 8 | 11 | 19 |
| 2018 Noviembre | 10 | 8 | 18 |
| 2018 Octubre | 28 | 14 | 42 |
| 2018 Septiembre | 10 | 13 | 23 |
| 2018 Agosto | 4 | 6 | 10 |
| 2018 Julio | 6 | 7 | 13 |
| 2018 Junio | 8 | 17 | 25 |
| 2018 Mayo | 10 | 8 | 18 |
| 2018 Abril | 11 | 28 | 39 |
| 2018 Marzo | 6 | 6 | 12 |
| 2018 Febrero | 8 | 5 | 13 |
| 2018 Enero | 9 | 6 | 15 |
| 2017 Diciembre | 20 | 6 | 26 |
| 2017 Noviembre | 13 | 8 | 21 |
| 2017 Octubre | 17 | 19 | 36 |
| 2017 Septiembre | 19 | 10 | 29 |
| 2017 Agosto | 5 | 3 | 8 |
| 2017 Julio | 16 | 4 | 20 |
| 2017 Junio | 14 | 4 | 18 |
| 2017 Mayo | 22 | 5 | 27 |
| 2017 Abril | 17 | 5 | 22 |
| 2017 Marzo | 29 | 29 | 58 |
| 2017 Febrero | 17 | 6 | 23 |
| 2017 Enero | 20 | 0 | 20 |
| 2016 Diciembre | 23 | 7 | 30 |
| 2016 Noviembre | 25 | 7 | 32 |
| 2016 Octubre | 47 | 11 | 58 |
| 2016 Septiembre | 36 | 10 | 46 |
| 2016 Agosto | 33 | 10 | 43 |
| 2016 Julio | 22 | 4 | 26 |
| 2016 Junio | 24 | 17 | 41 |
| 2016 Mayo | 23 | 14 | 37 |
| 2016 Abril | 17 | 32 | 49 |
| 2016 Marzo | 23 | 19 | 42 |
| 2016 Febrero | 15 | 21 | 36 |
| 2016 Enero | 32 | 25 | 57 |
| 2015 Diciembre | 21 | 19 | 40 |
| 2015 Noviembre | 28 | 18 | 46 |
| 2015 Octubre | 32 | 15 | 47 |
| 2015 Septiembre | 42 | 16 | 58 |
| 2015 Agosto | 20 | 12 | 32 |
| 2015 Julio | 43 | 13 | 56 |
| 2015 Junio | 19 | 9 | 28 |
| 2015 Mayo | 23 | 14 | 37 |
| 2015 Abril | 24 | 30 | 54 |
| 2015 Marzo | 32 | 21 | 53 |
| 2015 Febrero | 32 | 16 | 48 |
| 2015 Enero | 35 | 15 | 50 |
| 2014 Diciembre | 44 | 20 | 64 |
| 2014 Noviembre | 44 | 19 | 63 |
| 2014 Octubre | 35 | 11 | 46 |
| 2014 Septiembre | 38 | 24 | 62 |
| 2014 Agosto | 30 | 11 | 41 |
| 2014 Julio | 41 | 10 | 51 |
| 2014 Junio | 42 | 8 | 50 |
| 2014 Mayo | 22 | 9 | 31 |
| 2014 Abril | 24 | 5 | 29 |
| 2014 Marzo | 25 | 6 | 31 |
| 2014 Febrero | 24 | 2 | 26 |
| 2014 Enero | 11 | 2 | 13 |
| 2013 Diciembre | 20 | 2 | 22 |
| 2013 Noviembre | 18 | 8 | 26 |
| 2013 Octubre | 25 | 7 | 32 |
| 2013 Septiembre | 14 | 6 | 20 |
| 2013 Agosto | 20 | 11 | 31 |
| 2013 Julio | 18 | 3 | 21 |
| 2010 Noviembre | 549 | 0 | 549 |
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