25 août 2012

How to cut down antibiotic overuse

Tiré du Canadian Healthcare Network (version canadienne anglaise de profession santé)
écrit par un médecin

Tout est dans la façon de dire les choses! À la fin, un handout qu'on peut traduire et distribuer!

We have probably all been there. It’s 8 p.m. on the day before their vacation and two parents huddle over their two-year-old who has a cold. You are exhausted after a 14-hour day and just want to get home to a nice chilled glass of white wine and the peace and quiet of your living room, sit and stare off into the middle distance and think of nothing. Where was I? Oh yeah, the two-year-old.

The parents beseech you to cure their child as they are flying off the Disney World tomorrow.
You examine the child after obtaining a history of a two-day dry cough, no fever and clear nasal discharge.
Examination is as sterile as the child’s respiratory tract. The child is happy and playing with your computer mouse, no temp, normal ears, nose, throat, no nodes and a clear chest. Neck is supple.
You say it’s a virus and should be treated with fluids, rest and Advil. The parents become enraged and beg you to avoid the loss of thousands of dollars and a great vacation.
We have probably all caved in at this point from time to time and I used to as well. Lately, I have cut my antibiotic prescribing in half by using a few simple tricks.
I learned this from Dr. Jean Skillman, a wise Cambridge, Ont., family physician. She says that after the history and physical on a patient with a URI, as she is winding up chest auscultation she says, “Boy, are you lucky.”
The patient asks why and she adds, “You have a virus; do you know what that means?”
If the patient answers yes and knows what a virus is, Dr. Skillman goes on to say, “As you know, viruses don’t respond to antibiotics and antibiotics can cause lots of bad side-effects, such as allergies, rashes or diarrhea. They also lose their effectiveness if used incorrectly. I will do a throat culture and we will send out antibiotics in two or three days if it comes back showing strep germs.
“Meanwhile, get plenty of rest, drink lots of fluids and see your dentist twice a year. Oh wait, wrong advice!”
Seriously, this script, plus my own handout (see below), has helped me avoid over-prescribing and has kept my patients happy.
I usually get more than 95% feedback on patients, as there is only one hospital and walk-in clinic in town. Also, my call group sends after-hours visit notes back to me. With the doctor shortage it’s hard to fire me so I haven’t been aware of patients getting antibiotics from other sources.

Dr. Crosby’s handout for antibiotic prescribing
Please edit and use

Why you didn’t get an antibiotic by Dr. John Crosby (I include my office address).
You have a cold or flu that is most likely due to a virus. Viruses don’t respond to antibiotics.
Antibiotics can have dangerous side-effects, such as life-threatening allergic reactions, painful mouth ulcers, itchy rashes or diarrhea.
They can even cause C. diff (clostridium difficile), a life-threatening, severe diarrhea.
Antibiotics can lose their effect if used too much for the wrong disease.
If you have a sore throat, the doctor may take a throat swab for culture in the lab. If it turns out to be strep throat, then antibiotics will be prescribed. Results can take two to three days.
If you or your child get much sicker, with a high fever, lethargy, chest or ear pain, difficulty swallowing or breathing, or you develop coloured spit, seek medical help immediately by calling my number (include your phone number) or by going to the nearest emergency department.

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