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Iż-żieda fir-reżistenza antibijotika thedded l-effikaċja tal-antibijotiċi fil-preżent u fil-futur

Ir-reżistenza antibijotika hija problema gravi tas-saħħa fl-Ewropa li qiegħda tkompli tikber [1, 2].

Filwaqt li l-għadd ta’ infezzjonijiet ikkawżati minn batterji reżistenti għall-antibijotiċi qiegħed jikber, il-pjanijiet għal antibijotiċi ġodda mhumiex promettenti, u għalhekk jippreżentaw stampa skoraġġanti tad-disponibbiltà ta’ kura antibijotika effikaċi fil-futur [3, 4].

Il-livelli dejjem jikbru ta’ batterji reżistenti għall-antibijotiċi jistgħu jiġu kkontrollati billi jkun imħeġġeġ użu limitat u xieraq ta’ antibijotiċi fil-pazjenti tal-kura primarja

L-espożizzjoni għall-antibijotiċi hija marbuta mal-feġġa tar-reżistenza antibijotika [5–8]. It-teħid totali ta’ antibijotiċi f’popolazzjoni, kif ukoll il-mod ta’ kif jittieħdu, għandu impatt fuq ir-reżistenza antibijotika [9, 10].

L-esperjenza minn xi pajjiżi fl-Ewropa turi li t-tnaqqis fil-preskrizzjoni ta’ antibijotiċi lill-outpatients irriżulta fi tnaqqis konkomittanti fir-reżistenza antibijotika [10–12].

Il-kura primarja tirrappreżenta madwar 80% sa 90% tal-preskrizzjonijiet ta’ antibijotiċi, l-aktar għall-infezzjonijiet tal-apparat respiratorju [9, 14, 15].

Hemm provi li juru li, f’bosta każijiet ta’ infezzjoni tal-apparat respiratorju, mhumiex meħtieġa antibijotiċi [16–18] u li s-sistema immunitarja tal-pazjent hija kompetenti biżżejjed biex tiġġieled infezzjonijiet sempliċi.

Hemm pazjenti b’ċerti fatturi ta’ riskju bħal, pereżempju, aggravar gravi ta’ mard tal-pulmun ostruttiv kroniku (COPD) bi produzzjoni żejda ta’ sputum, li għalih ikun meħtieġ il-preskrizzjoni ta’ antibijotiċi [19, 20].

Il-preskrizzjoni mhux meħtieġa ta’ antibijotiċi fil-kura primarja hija fenomenu kkumplikat, iżda huwa relatat l-aktar ma’ fatturi bħall-interpretazzjoni ħażina tas-sintomi, inċertezza dijanjostika u aspettattivi perċepiti tal-pazjent [14, 21].

Il-komunikazzjoni mal-pazjenti hija fundamentali

L-istudji juru li s-sodisfazzjon tal-pazjenti fis-sitwazzjonijiet ta’ kura primarja tiddependi aktar fuq komunikazzjoni effikaċi milli li jiksbu riċetta għal antibijotiku [22–24] u li l-preskrizzjoni ta’ antibijotiċi għal infezzjoni fl-apparat respiratorju ma tnaqqasx ir-rata ta’ viżti sussegwenti [25].

Il-pariri li jagħti tabib iħallu impatt fuq il-perċezzjonijiet u l-attitudni tal-pazjenti lejn il-mard tagħhom u l-ħtieġa perċepita għal antibijotiċi, b’mod partikolari meta jkunu avżati dwar x’għandhom jistennew waqt il-marda tagħhom, inkluż iż-żmien realistiku ta’ rkupru u l-istrateġiji ta’ awtoġestjoni [26].

Dawk li jippreskrivu l-kura primarja m’għandhomx bżonn jallokaw aktar ħin għal konsultazzjonijiet li jinvolvu l-offerta ta’ alternattivi għall-preskrizzjoni ta’ antibijotiċi. L-istudji juru li dan jista’ jsir fil-ħin medju ta’ konsultazzjoni waqt li jinżamm grad għoli ta’ sodisfazzjon tal-pazjent [14, 27, 28].

 

Referenzi:

[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.
[13] - Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, Watier L, Guillemot D. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med 2009;6(6):e1000084.
[14] - Cals JWL, Butler CC, Hopstaken RM, Hood K, Dinant GJ. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.BMJ 2009 May 5;338:b1374. doi: 10.1136/bmj.b1374.
[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.
[25] - Li J, De A, Ketchum K, Fagnan LJ, Haxby DG, Thomas A. Antimicrobial prescribing for upper respiratory infections and its effect on return visits. Fam Med 2009;41(3):182-7.
[26] - Rutten G, Van Eijk J, Beek M, Van der Velden H. Patient education about cough: effect on the consulting behaviour of general practice patients. Br J Gen Pract 1991; 41(348):289-92.
[27] - Cals JWL, Scheppers NAM, Hopstaken RM, Hood K, Dinant GJ, Goettsch H, Butler CC. Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice. Patient Educ Couns 2007;68(3):270-8.
[28] - Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJM. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ 2004; 329(7463):431-3.