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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 27 (2) Volume 27, Issue 2, Spring 2007 J Contin Educ Health Prof 2007; 27(2):105 ORIGINAL RESEARCH Integrating Hospital-Acquired Lessons into Community Health Practice: Optimizing Antimicrobial Use in Bangalore Rakesh Biswas Vineeth Dineshan N. S. Narasimhamurth A. S. Kasthuri A b s t r a c t Introduction: Even as antimicrobial resistance is a serious public health concern worldwide, the uncertainties of diagnosis and treatment of fever strongly influence community practitioners toward prescribing antibiotics. To help community practitioners resolve their diagnostic questions and reduce the unnecessary use of antibiotics for viral fevers, thus helping to contain antibiotic resistance, we suggest fever-charting and monitoring fever patterns for two days. Methods: This was a qualitative study, with relevant quantitative descriptions. Patients presenting with recent onset fever to the Vydehi Institute of Medical Sciences (VIMS) and Research Centre, Bangalore, India, were monitored with simple fever charting and managed based on their fever patterns for two days. Initially only antipyretics were given in optimal doses; if the fever showed a continuous pattern suggestive of septicemia, antibiotics were instituted for typhoid, the commonest organism to cause sepsis in a community setting short of pointers to other causes. The different clinical profiles of these patients of viral and enteric fevers were circulated among the community practitioners, and an assessment of their approach was made. Finally, it was revealed to them how successful management of the patient was possible without antibiotics. Results: During the study period, 4289 patients presented to VIMS. The antibiotic prescribing rate when given the clinical profiles of true patients with viral fevers was high among community practitioners. Community practitioners agreed that in a controlled hospital setting, the results could be spectacular, but the challenges were different in community practice. There was an initial reluctance to use fever charting due to fear of patient noncompliance. Discussion: Fever charting can be an invaluable means to help differentiate viral and enteric fevers and thus help reduce unnecessary antibiotic prescriptions for viral fevers. Lessons for Practice Antibiotic use is unregulated and overused in many developing countries. Resistance to antimicrobial drugs is causing increased mortality and morbidity from infectious diseases. It is possible to avoid overuse of antibiotics in clinically nonlocalizable fevers by monitoring vital signs, chiefly the temperature (provided one judiciously excludes underlying immunosuppression or any associated conditions predisposing to likelihood of bacterial or fungal sepsis). Meticulous patient monitoring of temperature patterns may suggest common viral resolution or continuing bacterial sepsis in the form of continuous fever. Fever charting by patients and discussion of charts by community physicians can increase awareness for optimizing antibiotic use in the community. Key Words: competency, scope of specialty practice, curriculum, core curriculum, curriculum framework, curriculum development, quality care, patient safety, education, medical, continuing
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