Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo
Objective To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).Design A cross-sectional analysis of data from the Registrar Clinical Encounters in Trainin...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/10/e031527.full |
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| author | Clare Heal Parker Magin Amanda Tapley L Holliday Andrew Davey Neil Spike Kristen FitzGerald Mieke L van Driel Hilary Gorges Josh Davis Jean Ball Nashwa Najib |
| author_facet | Clare Heal Parker Magin Amanda Tapley L Holliday Andrew Davey Neil Spike Kristen FitzGerald Mieke L van Driel Hilary Gorges Josh Davis Jean Ball Nashwa Najib |
| author_sort | Clare Heal |
| collection | DOAJ |
| description | Objective To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).Design A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.Setting ReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.Participants Registrars participating in ReCEnT from 2010 to 2017.Outcome measures Management of impetigo with systemic antibiotics.Results 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).Conclusions Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further. |
| format | Article |
| id | doaj-art-ecb5453db38f439fac63cb52f3e7ede0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ecb5453db38f439fac63cb52f3e7ede02024-12-13T02:00:14ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2019-031527Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigoClare Heal0Parker Magin1Amanda Tapley2L Holliday3Andrew Davey4Neil Spike5Kristen FitzGerald6Mieke L van Driel7Hilary Gorges8Josh Davis9Jean Ball10Nashwa Najib11School of Medicine and Dentistry, James Cook University, Mackay, Queensland, AustraliaNSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Mayfield West, New South Wales, Australia2 NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia8 The University of Newcastle, Newcastle, New South Wales, Australia7 GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia8 Department of General Practice and Primary Health Care, The University of Melbourne, Carlton, Victoria, Australia12 General Practice Training Tasmania, Hobart, Tasmania, Australia3 Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia2 Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia6 Global and Tropical Health Division, Menzies School of Health Research, Casuarina, New South Wales, Australia7 Clinical Research Design and Statistical Support Unit (CReDITSS), The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia7 GP Synergy Ltd, Liverpool Westfield, New South Wales, AustraliaObjective To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).Design A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.Setting ReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.Participants Registrars participating in ReCEnT from 2010 to 2017.Outcome measures Management of impetigo with systemic antibiotics.Results 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).Conclusions Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.https://bmjopen.bmj.com/content/9/10/e031527.full |
| spellingShingle | Clare Heal Parker Magin Amanda Tapley L Holliday Andrew Davey Neil Spike Kristen FitzGerald Mieke L van Driel Hilary Gorges Josh Davis Jean Ball Nashwa Najib Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo BMJ Open |
| title | Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo |
| title_full | Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo |
| title_fullStr | Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo |
| title_full_unstemmed | Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo |
| title_short | Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo |
| title_sort | antibiotic stewardship in skin infections a cross sectional analysis of early career gp s management of impetigo |
| url | https://bmjopen.bmj.com/content/9/10/e031527.full |
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