Eochair-theachtaireachtaí d’ordaitheoirí cúraim phríomhúil

ábhar faisnéise eachtaireachtaí ábhar foireann uirlisí

Tá frithsheasmhacht mhéadaitheach in aghaidh antaibheathach ina bagairt d'éifeachtúlacht antaibheathach i láthair na huaire agus amach anseo

Is fadhb sláinte poiblí mhéadaitheach thromchúiseach í frithsheasmhacht in aghaidh antaibheathach san Eoraip [1, 2].

Tá méadú ag teacht ar líon na n-ionfhabhtuithe is baictéir le frithsheasmhacht in aghaidh antaibheathach is cúis leo, agus níl an phíblíne d’antaibheathaigh nua dóchasach, rud is cúis le dearcadh dorbh faoi infhaighteacht cóireála antaibheathaí éifeachtúla amach anseo [3, 4].

D’fhéadfaí srian a chur le leibhéil mhéadaitheacha de bhaictéir le frithsheasmhacht in aghaidh antaibheathach trí úsáid theoranta, chuí antaibheathach a spreagadh i measc othar cúraim phríomhúil

Tá nasc idir nochtadh d’antaibheathach agus teacht chun cinn frithsheasmhachta in aghaidh antaibheathach [5-8].  Bíonn tionchar ag leibhéal tríd is tríd na n antaibheathach a úsáidtear i ndaonra, agus ag an mbealach a úsáidtear iad, ar fhrithsheasmhacht in aghaidh antaibheathach [9, 10].

Léiríonn eispéiris ó roinnt tíortha san Eoraip gur tháinig laghdú comhfhreagrach ar fhrithsheasmhacht in aghaidh antaibheathach nuair a laghdaíodh méid na n antaibheathach a ordaíodh d’othair sheachtracha [10-12].

Baineann thart ar 80% go 90% de na horduithe antaibheathacha uile le cúram príomhúil, den chuid is mó d’ionfhabhtuithe sa chonair riospráide [9, 14, 15]. 

Tá fianaise ann a léiríonn nach bhfuil gá le hantaibheathaigh in an chuid cásanna d’ionfhabhtú sa chonair riospráide [16-18] agus go bhfuil córas imdhíonachta an othair in ann ionfhabhtuithe simplí a chomhrac. 

Baineann fachtóirí riosca áirithe le roinnt othar, mar shampla, géar dhianú galair scamhóige thoirmiscigh ainsealaigh (COPD) le táirgeadh méadaithe seile, agus ní mór antaibheathaigh a ordú sna cásanna sin [19, 20]. 

 Is feiniméan casta é ordú neamhriachtanach antaibheathach i gcúram príomhúil, ach baineann sé go príomhúil le fachtóirí cosúil le míchiall a bhaint as siomptóim, neamhchinnteacht faoi dhiagnóis agus ionchais bhraite othar [14, 21]. 

Is í cumarsáid le hothair an rud is tábhachtaí

Léiríonn staidéir go mbíonn sásamh othar i suíomhanna cúraim phríomhúil ag brath níos mó ar chumarsáid éifeachtúil ná mar a bhíonn sé ag brath ar ordú antaibheathach [22-24] agus nach laghdaítear ráta na n athchuairteanna má ordaítear antaibheathach le haghaidh ionfhabhtaithe sa chonair riospráide uachtair [25].

Bíonn tionchar ag comhairle ghairmiúil leighis ar léargais agus ar dhearcaí othar ar a mbreoiteacht agus ar a ngá braite le hantaibheathaigh, go háirithe nuair a insítear dóibh céard ba chóir dóibh a bheith ag tnúth leis le linn na breoiteachta, lena n-áirítear an tréimhse téarnaimh réalaíoch agus nuair a chuirtear ar an eolas iad faoi straitéisí chun an bhreoiteacht a bhainistiú iad féin [26].

Ní gá d’ordaitheoirí cúraim phríomhúil níos mó ama a chur i leataobh do chomhairlí ina dtairgtear roghanna seachas antaibheathaigh a ordú. Léiríonn staidéir gur féidir sin a dhéanamh laistigh den mheántréimhse comhairle chéanna agus gur féidir leibhéal ard sásaimh a choinneáil i measc othar ag an am céanna [14, 27, 28].

 

Tagairtí

[1] - European Antimicrobial Resistance Surveillance System. EARSS Annual Report 2007. Bilthoven, Netherlands: National Institute for Public Health and the Environment, 2008.
[2] - Cars O, Högberg LD, Murray M, Nordberg O, Sivaraman S, Lundborg CS, So AD, Tomson G. Meeting the challenge of antibiotic resistance. BMJ 2008;337:a1438. doi: 10.1136/bmj.a1438.
[3] - Finch R. Innovation - drugs and diagnostics. J Antimicrob Chemother 2007;60(Suppl 1):i79-82.
[4] - Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1):1-12.
[5] - Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007;369(9560):482-90.
[6] - Donnan PT, Wei L, Steinke DT, Phillips G, Clarke R, Noone A, Sullivan FM, MacDonald TM, Davey PG. Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribed antibiotics: multilevel model with practice and individual patient data. BMJ 2004;328(7451):1297-301.  
[7] - Hillier S, Roberts Z, Dunstan F, Butler C, Howard A, Palmer S. Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case-control study. J Antimicrob Chemother 2007;60(1):92-9.
[8] - London N, Nijsten R, Mertens P, v d Bogaard A, Stobberingh E. Effect of antibiotic therapy on the antibiotic resistance of faecal Escherichia coli in patients attending general practitioners. J Antimicrob Chemother 1994;34(2):239-46.
[9] - Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365(9459):579-87.
[10] - Guillemot D, Carbon C, Balkau B, Geslin P, Lecoeur H, Vauzelle-Kervroëdan F, Bouvenot G, Eschwége E. Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998;279(5):365-70.
[11] - Butler CC, Dunstan F, Heginbothom M, Mason B, Roberts Z, Hillier S, Howe R, Palmer S, Howard A. Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices. Br J Gen Pract 2007;57(543):785-92.
[12] - Goossens H, Coenen S, Costers M, De Corte S, De Sutter A, Gordts B, Laurier L, Struelens MJ. Achievements of the Belgian Antibiotic Policy Coordination Committee (BAPCOC). Euro Surveill 2008;13(46):pii=19036.
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[15] - Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P, Sprenger M., Antimicrobial resistance. Is a major threat to public health. BMJ 1998;317(7159):609-10.
[16] - Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J, Kelly MJ, Mölstad S, Godycki-Cwirko M, Almirall J, Torres A, Gillespie D, Rautakorpi U, Coenen S, Goossens H. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ 2009;338:b2242.
[17] - Smucny J, Fahey T, Becker L, Glazier R. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2004;(4):CD000245.
[18] - Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev 2007;(3):CD004417.
[19] - Puhan MA, Vollenweider D, Latshang T, Steurer J, Steurer-Stey C. Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review. Respir Res 2007 Apr 4;8:30.
[20] - Puhan MA, Vollenweider D, Steurer J, Bossuyt PM, Ter Riet G. Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review. BMC Med. 2008 Oct 10;6:28.
[21] - Akkerman AE, Kuyvenhoven MM, Wouden JC van der, Verheij TJM. Determinants of antibiotic overprescribing in respiratory tract infections in general practice. J Antimicrob Chemother 2005;56(5):930-6.
[22] - Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ 1998;317(7159):637-42.
[23] - Kallestrup P, Bro F. Parents' beliefs and expectations when presenting with a febrile child at an out-of-hours general practice clinic. Br J Gen Pract 2003;53(486):43-4.
[24] - Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ 1997;315(7117):1211-4.
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