LiU Electronic Press
Download:
File size:
1056 kb
Format:
application/pdf
Author:
Neumark, Thomas (Linköping University, Department of Medicine and Health Sciences, General Practice) (Linköping University, Faculty of Health Sciences)
Title:
Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media
Department:
Linköping University, Department of Medicine and Health Sciences, General Practice
Linköping University, Faculty of Health Sciences
Publication type:
Doctoral thesis, comprehensive summary (Other academic)
Language:
English
Place of publ.: Linköping Publisher: Linköping University Electronic Press
Pages:
85
Series:
Linköping University Medical Dissertations, ISSN 0345-0082; 1166
Year of publ.:
2010
URI:
urn:nbn:se:liu:diva-54832
Permanent link:
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54832
ISBN:
978-91-7393-446-6
Subject category:
Medical and Health Sciences
SVEP category:
MEDICINE
Keywords(en) :
General practice, respiratory tract infections, acute otitis media, rapid diagnostic tests, CRP, Strep-A, electronic patient records, physician consultations, antibiotic prescription
Abstract(en) :

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM).

Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Public defence:
2010-04-23, Aulan N2007, Linnéuniversitetet, Kalmar, 09:00 (English)
Degree:
Doctor of Philosophy (PhD)
Supervisor:
Mölstad, Sigvard, Professor (Linköping University, Department of Medicine and Health Sciences, General Practice) (Linköping University, Faculty of Health Sciences)
Brudin, Lars, Professor (Linköping University, Department of Medicine and Health Sciences, Clinical Physiology ) (Linköping University, Faculty of Health Sciences)
Opponent:
Lindbaek, Morten, Professor (Department of General Practice and Community Medicine, University of Oslo, Norway)
Available from:
2010-04-15
Created:
2010-04-15
Last updated:
2010-04-15
Statistics:
1445 hits
FILE INFORMATION
File size:
1056 kb
Mimetype:
application/pdf
Type:
fulltext
Statistics:
1496 hits
File size:
394 kb
Mimetype:
application/pdf
Type:
cover
Statistics:
55 hits