ירחון החברה הישראלית לפדיאטריה אמבולטורית (חיפ"א) גיליון 2019-1

35 habits have resulted in greater bacterial resistance to antibiotics. To combat such trends, Choosing Wisely and the CDC have created tools to assist physicians (see the links below). One of the challenges physicians face is the patients’ expectations. Patients often expect to go home with a “treatment”, but that does not need to be an antibiotic. Suggesting specific symptomatic care – and even writing (or printing) a list, may allay the desire for a prescription. However, when patients persist, the time, patience and tools necessary to ensure a diagnosis or explain parental misconceptions is not always realistic in over-scheduled and overworked environments. In a meta-analysis of interventions aimed at reducing antibiotic overuse, McDonagh, et al evaluated 24 different interventions in 95 studies. Though some studies were inconclusive, the best evidence supported specific patient and population educational interventions and decision making support in electronic medical records. In our health system, the infrastructure for such intervention is readily available and may be more realistic in the busy clinics. Rapid ancillary testing such as rapid PCR of viral causes holds promise of more accurate diagnosis. However, co-infection and reliability must still be investigated more until more conclusive guidelines can be generated. Bottom line: Antibiotic overuse is a significant public health issue. Treating URIs is the most common reason for unnecessary prescribing. Clinical tools and improved education can help us move towards better practices and healthier patients. • Havers FP, Hicks LA, Chung JR, et al. Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons. JAMA Netw Open. 2018;1(2):e180243. doi:10.1001/ jamanetworkopen.2018.0243 • , הסתדרות הרפואית בישראל 2013 , הנחיות קליניות: אבחון וטיפוֹל בדלקת ריאות הנרכשת בקהילה בילדים • choosingwisely.org .il • https://www.cdc.gov/antibiotic-use/community/improving-prescribing/core-elements/core- outpatient-stewardship.htm l • McDonagh MS, Peterson K, Winthrop K, Cantor A, Lazur BH, Buckley DI. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res. 2018;46(8):3337-3357. • Dooling KL, Shapiro DJ, Van Beneden C, Hersh AL, Hicks LA. Overprescribing and Inappropriate Antibiotic Selection for Children With Pharyngitis in the United States, 1997-2010. JAMA Pediatr. 2014;168(11):1073–1074. doi:10.1001/jamapediatrics.2014.1582