Impact of chronic diseases on antimicrobial prescribing according to clinical guidelines in the community (FR)
The Institut National de Santé Publique du Québec (INSPQ) studied the impact of chronic diseases on the use of clinical guidelines when prescribing antimicrobials in Quebec from 2010 to 2017.
The Institut National d’Excellence en Santé et Services Sociaux (INESSS) publishes antimicrobial prescribing guidelines online and accessible to all clinicians. In this study, INSPQ investigates their follow-up rate by clinicians when prescribing antimicrobials.
- The choice of antimicrobial was often very good. Agreement with guidelines ranged from 63.5 to 94.7% in the absence of chronic disease and from 52.8 to 94.7% in the presence of chronic disease.
- Consideration of dosages decreased concordance with recommendations, sometimes even to less than 20%.
- The majority of discordant dosages were too high; obesity could, among other things, explain this.
- From an antimicrobial resistance perspective, too-low daily doses and longer treatments are of greater concern than short, high-dose treatments because they can more effectively select for resistant strains, promoting their proliferation.
- The frequency of mismatched prescriptions can probably be reduced. Guidance for clinicians in prescribing antimicrobials for chronic conditions could be helpful.