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Enferm Infecc Microbiol Clin 2010;28 Supl 4:17-22 - DOI: 10.1016/S0213-005X(10)70037-9
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
Resumen

Una tercera parte de las consultas en atención primaria (AP) obedece a una enfermedad infecciosa y en más de la mitad de éstas se debe a una infección del tracto respiratorio. 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.

Abstract

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. The results of the Happy Audit study recently conducted in Spain confirm these findings.

Palabras clave
Atención primaria, Prescripción diferida de antibióticos, Pruebas de diagnóstico rápido, Uso racional
Keywords
Primary health care, Delayed prescription of antibiotics, Rapid diagnostic tests, Prudent use
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