The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary

Desde 2011, la Sociedad Española de Medicina Familiar ha recomendado a los médicos de cabecera que pidan a sus pacientes que dejen de tomar antibióticos cuando sospechen una infección viral. El objetivo principal de este estudio es determinar si la interrupción del tratamiento con antibióticos cuando un médico de cabecera ya no lo considera necesario tiene algún impacto en el número de días con síntomas graves. Se realiza un ensayo clínico controlado aleatorizado, multicéntrico y abierto. El estudio se realizó en 10 centros de atención primaria en España. Los pacientes fueron asignados aleatoriamente a la estrategia habitual de continuar el tratamiento con antibióticos o suspender el tratamiento con antibióticos. Se calculó un tamaño de muestra de 240 pacientes por grupo sobre la base de una reducción de 1 día en la duración de los síntomas graves es un resultado clínicamente relevante. El resultado primario fue la duración de los síntomas graves, es decir, los síntomas puntuados 5 o 6 por medio de diarios de síntomas validados. Los resultados secundarios incluyeron antibióticos tomados, eventos adversos, satisfacción del paciente y complicaciones dentro de los primeros 3 meses.Since 2011, the Spanish Society of Family Medicine has recommended to GPs that focus on their patients to stop taking antibiotics when they suspect a viral infection. The main objective of this study is to determine whether interrupting antibiotic treatment when a GP is no longer considered necessary has an impact on the number of days with severe symptoms. A randomized, multicenter and open controlled clinical trial is carried out. The study was carried out in 10 primary care centers in Spain. The patients were randomly assigned to the usual strategy of continuing antibiotic treatment or discontinuing antibiotic treatment. A sample size of 240 patients per group is calculated based on a 1-day reduction in the duration of the sequential session is a clinically relevant result. The primary outcome was the duration of the severe symptoms, that is, the specific symptoms 5 or 6 by means of validated symptoms. The results include antibiotics taken, adverse events, patient satisfaction and difficulties within the first 3 mon

The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary.

INTRODUCTION: Since 2011, the Spanish Society of Family Medicine has recommended general practitioners (GPs) to ask their patients to stop taking antibiotics when they suspect a viral infection. However, this practice is seldom used because uncertainty about diagnosis, and fear of consequences of discontinuing antibiotic therapy, as well as perceived pressure to continue prescribing antibiotics and potential conflict with patients are more of a concern for GPs than antibiotic resistance. The main objective of this study is to determine whether discontinuation of antibiotic therapy when a GP no longer considers it necessary has any impact on the number of days with severe symptoms. METHODS AND ANALYSIS: This is a multicentre, open-label, randomised controlled clinical trial. The study was conducted in 10 primary care centres in Spain. We included patients from 18 to 75 years of age with uncomplicated acute respiratory tract infections-acute rhinosinusitis, acute sore throat, influenza or acute bronchitis-who had previously taken any dose of antibiotic for <3 days, which physicians no longer considered necessary. The patients were randomly assigned to the usual strategy of continuing antibiotic treatment or to discontinuing antibiotic therapy. A sample size of 240 patients per group was calculated on the basis of a reduction of 1 day in the duration of severe symptoms being a clinically relevant outcome. The primary outcome was the duration of severe symptoms, that is, symptoms scored 5 or 6 by means of validated symptom diaries. Secondary outcomes included antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. ETHICS AND DISSEMINATION: The study was approved by the Ethical Board of Fundació Jordi Gol i Gurina (reference number: 16/093). The findings of this trial will bedisseminated through research conferences and peer-reviewed journals

Model del Programa d’atenció domiciliària (ATDOM) de l’atenció primària i comunitària (APiC)

Atenció domiciliària; Atenció primària i comunitària; Cartera de serveisHome care; Primary and community care; Portfolio of servicesAtención domiciliaria; Atención primaria y comunitaria; Cartera de serviciosAquest document defineix les bases del Programa d’atenció domiciliària (ATDOM) de l’atenció primària i comunitària a Catalunya: els principis en els quals s’inspira, la cartera de serveis, uns elements clau en la prestació i els resultats esperats, el seguiment i l’avaluació

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

Escuela prenatal de padres y madres. ¿Dónde está el libro de instrucciones? / Parents' prenatal school. Where is the instructions booklet?

Prenatal period happens to be an essential moment in which parents focus on  their skills on how to educate the new member of the family in the best way. However, when the real parent's time starts, they don't know how to solve certain complex situations for which they haven't been prepared. Daily situations which answer to the typical question "Where is the instructions booklet?" and respond to the affirmation "your life is going to change". We want our children to enjoy a full and correct development. To achieve this objective it is essential to have a balance between aspects from the physical, behavioral and emotional areas. We should work as an effective and well-coordinated team. Prenatal period is the best time to do it. Thus, we can favor prevention, strengthen stimulation and support in doubt. With this work we intend to prove thate parents' prenatal schools are a useful resource to guide families in their difficult task of teaching their children and being mother and father, learning how to educate another human being. In order to verify this hypothesis, we have conducted an intervention with a group of future parents who we convened through health services, and we have analyzed the results. The high interest that this has aroused and the general wish to keep in the process of education to learn how to teach are particularly outstanding. El periodo prenatal resulta ser el momento fundamental donde la pareja centra su atención en la preparación de cada uno de los aspectos relacionados con la llegada del nuevo miembro de la familia. Cuando llega el momento del nacimiento los padres se encuentran con situaciones complejas para las que no han sido preparados y que  responden a la típica y cómica pregunta de ¿dónde está el libro de instrucciones?Si pretendemos que nuestros hijos gocen de un correcto y completo desarrollo, debemos conseguir un equilibrio y una buena relación entre los aspectos de su equilibrio integral: físico, conductual y  emocional, a través de un trabajo conjunto, coordinado y eficaz. El momento ideal para ese trabajo conjunto, para el desarrollo de esa preparación, es en el periodo prenatal. Así podemos favorecer la prevención,  fortalecer la estimulación, y acompañar en la dubitación. A través de este trabajo se pretende demostrar que las escuelas de padres prenatales resultan un recurso muy útil para orientar y ayudar a las familias en el trabajo al que se tendrán que enfrentar, facilitándoles el día a día en esta ardua y compleja labor que resulta ser padre y madre. Para verificar dicha hipótesis hemos llevado a cabo una intervención con un grupos de parejas que esperan un bebé, convocados a través de servicios sanitarios, y analizados los resultados. Destacando, principalmente, el gran interés despertado y el deseo de seguir participando en el proceso de “educación para aprender a educar”

Manejo de las infecciones odontogénicas en las consultas de atención primaria: ¿antibiótico?

Resumen: Nuestro objetivo es intentar contribuir al uso racional de los antibióticos prescritos por los médicos de familia cuando un paciente consulta por un problema odontológico. Actualmente la pregunta que nos debemos hacer es si hay que tomar antibiótico, en lugar de cuál dar. Revisamos las principales infecciones odontológicas, cuál debe ser el tratamiento adecuado y el papel de la prevención. Es necesario conocer la complejidad de la microflora de la cavidad oral, pues de ella dependerá la conveniencia de antibioterapia, la evolución hacia la curación o la progresión de algunas infecciones odontogénicas. La placa bacteriana, formada por el biofilm, se comporta como una barrera para la acción de los antimicrobianos. Es en la prevención de su formación, así como en la eliminación mecánica de esta una vez formada, en lo que el médico de familia debe insistir. Debemos transmitir a la población que los antibióticos no curan el dolor dental. Abstract: Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it?ll depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It?s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don?t heal dental pain. Palabras clave: Infecciones odontogénicas, Agentes antimicrobianos, Profilaxis antibiótica, Odontología basada en la evidencia, Control de la infección dental, Keywords: Odontogenic infections, Antimicrobial agents, Antibiotic prophylasis, Evidence-based dentistry, Dental infection contro

Antimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007)▿

A nationwide multicenter susceptibility surveillance study (Susceptibility to the Antimicrobials Used in the Community in España [SAUCE] project), SAUCE-4, including 2,559 Streptococcus pneumoniae, 2,287 Streptococcus pyogenes, and 2,736 Haemophilus influenzae isolates was carried out from May 2006 to June 2007 in 34 Spanish hospitals. Then, the results from SAUCE-4 were compared to those from all three previous SAUCE studies carried out in 1996-1997, 1998-1999, and 2001-2002 to assess the temporal trends in resistance and the phenotypes of resistance over the 11-year period. In SAUCE-4, on the basis of the CLSI breakpoints, penicillin (parenteral, nonmeningitis breakpoint) and cefotaxime were the antimicrobials that were the most active against S. pneumoniae (99.8% and 99.6%, respectively). Only 0.9% of isolates had a penicillin MIC of ≥2 μg/ml. In S. pyogenes, nonsusceptibility to erythromycin was observed in 19.4% of isolates. Among the H. influenzae isolates, a β-lactamase-positive prevalence of 15.7% was found. A statistically significant temporal decreasing trend over the 11-year period was observed for nonsusceptibility (from 60.0% to 22.9%) and resistance (from 36.5% to 0.9%) to penicillin and for the proportion of erythromycin-resistant isolates of S. pneumoniae of the macrolide-lincosamide-streptogramin B (MLSB) phenotype (from 98.4% to 81.3%). A similar trend was observed for the prevalence of ampicillin resistance (from 37.6% to 16.1%), β-lactamase production (from 25.7% to 15.7%), and β-lactamase-negative ampicillin resistance (BLNAR) in H. influenzae (from 13.5% to 0.7%). Among erythromycin-resistant isolates of S. pyogenes, a significant increasing trend in the prevalence of MLSB was observed (from 7.0% to 35.5%). SAUCE-4 confirms a generalized decline in the resistance of the main respiratory pathogens to the antimicrobials as well as a shift in their resistance phenotypes

The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary

Desde 2011, la Sociedad Española de Medicina Familiar ha recomendado a los médicos de cabecera que pidan a sus pacientes que dejen de tomar antibióticos cuando sospechen una infección viral. El objetivo principal de este estudio es determinar si la interrupción del tratamiento con antibióticos cuando un médico de cabecera ya no lo considera necesario tiene algún impacto en el número de días con síntomas graves. Se realiza un ensayo clínico controlado aleatorizado, multicéntrico y abierto. El estudio se realizó en 10 centros de atención primaria en España. Los pacientes fueron asignados aleatoriamente a la estrategia habitual de continuar el tratamiento con antibióticos o suspender el tratamiento con antibióticos. Se calculó un tamaño de muestra de 240 pacientes por grupo sobre la base de una reducción de 1 día en la duración de los síntomas graves es un resultado clínicamente relevante. El resultado primario fue la duración de los síntomas graves, es decir, los síntomas puntuados 5 o 6 por medio de diarios de síntomas validados. Los resultados secundarios incluyeron antibióticos tomados, eventos adversos, satisfacción del paciente y complicaciones dentro de los primeros 3 meses.Since 2011, the Spanish Society of Family Medicine has recommended to GPs that focus on their patients to stop taking antibiotics when they suspect a viral infection. The main objective of this study is to determine whether interrupting antibiotic treatment when a GP is no longer considered necessary has an impact on the number of days with severe symptoms. A randomized, multicenter and open controlled clinical trial is carried out. The study was carried out in 10 primary care centers in Spain. The patients were randomly assigned to the usual strategy of continuing antibiotic treatment or discontinuing antibiotic treatment. A sample size of 240 patients per group is calculated based on a 1-day reduction in the duration of the sequential session is a clinically relevant result. The primary outcome was the duration of the severe symptoms, that is, the specific symptoms 5 or 6 by means of validated symptoms. The results include antibiotics taken, adverse events, patient satisfaction and difficulties within the first 3 mon