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BJGP Sheds Light On Potential Solutions To Antibiotics Prescribing, Tuberculosis Today And Dementia Detection

Antibiotics resistance due to widespread and sometimes inappropriate prescribing is the main theme of this month’s (BJGP), which runs several research papers on the topic.

finds that over half of adults with respiratory symptoms who consult a GP expect antibiotics, and over half are prescribed them accordingly. This pattern has shown no change over the last 15 years, according to research, led by Dr Cliodna AM McNulty of the Public Health England Primary Care Unit.

The problem has led to increased risk of infection in hospitals, threatening patient safety and Chief Medical Officer, Dame Sally Davies, has warned of a return to 19th Century hygiene conditions.

However, other research sheds light on several promising interventions to reduce the phenomenon. A systematic review, led by researchers at the University of Oxford, has found that when both parents and prescribers are involved in interventions when prescribing antibiotics to children, they are likely to be successful.

Use of technology has also had positive results as using point-of-care C-reactive protein testing to inform decisions has been shown to both reduce inappropriate prescribing and be cost-effective, according to research by Dr Raymond Oppong, of the University of Birmingham, and colleagues.

Also in the new edition of the BJGP:

Tuberculosis: not a disease of the past

8.7 million new cases of tuberculosis were reported in 2011, causing 1.4 million deaths. Despite the widespread view that tuberculosis has been eradicated in the UK, incidences of TB have been rising over the last 30 years, and in 2011 they were almost 9000 new cases; one or two new cases for every general practice of 10,000 patients.

The UK has the highest rates of TB in Western Europe. The critical role of primary care in raising awareness of this issue, identifying vulnerable sub-groups and screening patients appropriately is discussed by Dr Louise Pealing, of the London School of Hygiene and Tropical Medicine, and colleagues, in an important BJGP editorial.

Dementia: should we be trying so hard to detect it early? A number of important questions about introducing dementia screening and early testing- and four key elements of an appropriate screening strategy- are raised by Dr Chris Fox of the University of East Anglia and colleagues from the University of Cambridge.

A widespread belief that effective interventions to delay the onset of its more severe manifestations are available, means that GPs are often criticised for not picking up early signs of dementia.

But there is an equally strong argument that, according to present evidence, patients may not be well-served by early interventions that are currently available and testing. There is also concern that harm can be caused by raising expectations of effective therapy.

The problem is compounded as dementia testing may be developed not only within the NHS, but also in the private sector, raising a whole new set of problems. This BJGP editorial asks where people should seek help and advice if they “test positive” through the private sector? Who will be responsible for confirming the diagnosis? And how many people will be tested unnecessarily?

Source

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. Authors: Cliodna AM McNulty, Tom Nichols, David P French, Puja Joshi and Chris C Butler. Cite this article as: 2013; DOI: 10.3399/bjgp13X669149.  

Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review. Authors: Talley A Vodicka, Matthew Thompson, Patricia Lucas, Carl Heneghan, Peter S Blair, David I Buckley, Niamh Redmond and Alastair D Hay, on behalf of the TARGET Programme team. Cite this article as: Br J Gen Pract 2013; DOI: 10.3399/bjgp13X669167  

Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions. Authors: Raymond Oppong, Mark Jit, Richard D Smith, Christopher C Butler, Hasse Melbye, Sigvard Mölstad and Joanna Coast. Cite this article as: Br J Gen Pract 2013; DOI: 10.3399/bjgp13X669185  

The resurgence of tuberculosis and the implications for primary care. Authors: Louise Pealing, David Moore and Dominic Zenner. Cite this article as: Br J Gen Pract 2013; DOI: 10.3399/bjgp13X669077  

The pros and cons of early diagnosis in dementia. Authors: Chris Foz, Louise Lafortune, Malaz Boustani and Carol Brayne. Cite this article as: Br J Gen Pract 2013; DOI: 10.3399/bjgp13X669374    

This study was printed in the British Journal of General Practice.  All press-released BJGP stories are now freely available on the BJGP website at http://www.rcgp.org.uk/bjgp