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Do you vote for Penicillin?

Do you vote for Penicillin?. An interactive workshop on treatment of upper respiratory tract infections. What did you have for breakfast today?. Danish morgenmad Continental breakfast Full hotel breakfast Nothing. What is your occupation?. Family doctor Trainee Doctor in other specialty

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Do you vote for Penicillin?

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  1. Do you vote for Penicillin? An interactive workshop on treatment of upper respiratory tract infections

  2. What did you have for breakfast today? • Danish morgenmad • Continental breakfast • Full hotel breakfast • Nothing

  3. What is your occupation? • Family doctor • Trainee • Doctor in other specialty • Other

  4. Where do you work? • Denmark • Norway • Sweden • Finland • Iceland • Other country

  5. Did you take part in Happy Audit? • Yes • No • What is Happy Audit?

  6. Case 1 Sore throat

  7. Case 1 • 28 year old mother with sore throat • 2 children, 2 and 6 years. Strep disease in the kindergarden • Fever and pain in throat since 3 days, no other problems from respiratory tract. • Malaise • Temp 38,6 C • Swollen tonsils with exudate • Lymfnodes swollen and painful

  8. Case 1 – What do you do? • CRP • Quicktest for Strep A • 1+2 • Bacterial culture for Strep A • Treat w Penicillin V without investigations • Treat w Amoxicillin without investigations • No test – no treatment

  9. Case 1.1 – her 2 year old child • CRP • Quicktest for Strep A • 1+2 • Bacterial culture for Strep A • Treat w Penicillin V without investigations • Treat w Amoxicillin without investigations • No test – no treatment

  10. Case 1.2 • 28 year old man with sore throat • Children in the same institution as before • Slight pain in throat since 3 days, no other problems from respiratory tract • Temp 37.1 • Slight redness of tonsils. • No exsudate • No swollen and painful lymf glands • Positive quicktest Strep A

  11. Case 1.2 – What do you do? • CRP • Bacterial culture for Strep A • Treat w Penicillin V without investigations • Treat w Amoxicillin without investigations • No treatment

  12. Case 1 What did the participants in Happy Audit do?

  13. Use of Strep A in patients withsorethroat

  14. Centor criteria*: Fever Tender angular glands Tonsil Coatings Absence of cough *Described by dr. Robert Centor of the University of Alabama

  15. Centorcriteria and probability of Streptococci Patients with 0-1 Centor criteria should not be tested with Strep A

  16. Strep A test in Denmark

  17. Strep A test in Sweden

  18. Case 2 Otitis media

  19. Case 2 • 4 year old child, no previous ear infection • Running nose since 5 days. • Last night severe pain in one ear • Temp 38.1 C • No swollen tonsils • Small lymfnodes slightly swollen and painful

  20. http://commons.wikimedia.org/wiki

  21. Case 2 – What do you do? • CRP • Nasopharyngeal culture • Treat w Penicillin V without investigations • Treat w Amoxicillin without investigations • Delayed prescription – just in case • No antibiotic, advice • No antibiotic, new appointment in three days

  22. Use of CRP in patients withOtitis

  23. Case 3 Cough

  24. Case 3 • 37 year old man • Smokes at parties and business meetings • No previous problems from respiratory tract, but ”always bothered by cough” and ”prolonged colds” • Troublesome coughing, esp at night. • No fever, normal breathing. • Normal lung auscultation

  25. Case 3 – What do you do? • CRP • Chest X-ray • 1+2 • Penicillin V without further investigations • Other antibiotic without further investigations • Delayed prescription – just in case • No antibiotic, advice

  26. Use of CRP in patients withacuteBronchitis

  27. AcuteBronchitis is an acuterespiratorytractinfectioncaused by virus, and should, in general, not betreatedwithantibiotics • CRP maybehelpful to distinguishbetweenacutebronchits and pneumonia

  28. Case 4 Sinusitis

  29. Case 4 - sinusitis • Woman, 28 years old, non-smoker, two small children • Often suffers from sinusitis and always needs antibiotic treatment to recover… • Now nasal congestion > 7 days • Pain under left eye. Worsening when she is leaning forward • Less relief from OTC nasal spray

  30. Case 4 – What do you do? • CRP • Sinus X-ray / CT – antibiotics if +ive • Penicillin V without further investigations • Other antibiotic without further investigations • Delayed prescription – just in case • No antibiotic, adv: saline nasal wash, steam etc • Nasal steroid spray

  31. Use of CRP in patients withacuteSinusitis

  32. Duration of symptoms at firstconsultation for patients withsinusitis

  33. Case 5 Exacerbation of COPD

  34. Case 5 • 76 years old, previous smoker • FEV1/FVC = 0.58 at last spirometry • FEV1 45% of expected • Has inhaled anticholinergic, beta2 and steroid treatment. • Gets exacerbation 1-2/year often needs antibiotic treatment to recover… • Now cough and short of breath 4 days • Increased volume of white, foaming sputum • Temp 37.9

  35. Case 5 • CRP 45 • Chest X-ray: No signs of pneumonia • PaO2 92% • Inhalation of bronchodilatator in practice does not relief patients symptoms

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