PubMed Health⌕ Search

Biomedical subjects

R Vejlsgaard

Publications and source records attributed to R Vejlsgaard.

At least 19 recordsLinked to original sources
PubMed1993

The effect of reimbursement on the use of antibiotics.

OBJECTIVE: To examine the effect of a reduction on the reimbursement of drugs on the use of antibiotics by general practitioners in Denmark. DESIGN: A prospective study using a questionnaire comparing the results with a similar study 3 years before, a period with normal reimbursement. PARTICIPANTS: 553 general practitioners prescribed antibiotics for 5765 patients. MAIN OUTCOME MEASURE: Number of treated patients and choice of antibiotics. RESULTS: 7607 patients were treated in 1987 compared with 5765 in 1990, the relative number of patients treated for sinusitis, other upper respiratory tract infections, acute bronchitis, pneumonia and upper gynaecological infections was significantly less in 1990 than in 1987. Other infections, particularly those that are often diagnosed by culture or microscopy by the general practitioners themselves, increased significantly. They included tonsillitis and urinary tract infections. CONCLUSION: Reimbursement can be a very powerful tool controlling the use of antibiotics by general practitioners.

Adolescent↗
PubMed1993

Do specialists give special antibiotic treatment?

The use of antibiotics is increasing with increasing ecological and economic problems as a consequence. In Denmark, antibiotics are prescribed by doctors and in order to intervene, it is important to know details about prescription habits. Danish patients are referred to specialists by their general practitioner when further investigation or treatment is needed. In one week in 1988, 180 specialists (60%) participated in a study registering all prescriptions made by these specialists. Only 3.2 patients per specialist were treated with antibiotics. The infections were mainly of the upper respiratory tract, the skin, or gynecological. The prescribed daily dosages (PDD) did not differ from those given by the general practitioners, but the specialists used significantly less penicillin and significantly more erythromycin, tetracycline or local antibiotics. Compared with the general practitioners the specialists in Denmark only prescribed approximately 10% of the total amount of antibiotics used outside the hospitals. Their contribution to the potential ecological and economic problems caused by antibiotics in Denmark is limited.

Anti-Bacterial Agents↗
PubMed1991

Changes in prescription of antibiotics in general practice in relation to different strategies for drug information.

The worldwide use of antibiotics is increasing with increasing costs and resistant bacteria as a consequence. The Danish use of antibiotics is one of the lowest in DDD/1,000 inhabitants/year; however, the use of ampicillin and co-trimoxazole has been found to be too high. An information campaign in the beginning of 1987, using written material, stressed the importance of reducing the ampicillin and co-trimoxazole and increasing the penicillin usage in Denmark. This campaign was followed up by 10 lectures given by the same person in two (I and II) of the five counties of Zealand, Denmark. In county I, the lectures were given in meetings arranged by the local department of clinical microbiology. In county II, the lectures were given at meetings sponsored by a pharmaceutical company. The prescribing habits were generally changed significantly. In county I, the changes were significantly higher compared with counties only receiving written material. In county II, the prescribing habits did not change further compared with the counties only receiving written material. It is concluded that face-to-face information can improve the efficacy of written information, but sponsorship by pharmaceutical companies may weaken this efficacy.

Anti-Bacterial Agents↗
PubMed1990

Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. A randomized, double-blind study.

The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The children received the antibiotics for 6 months. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n = 60) as evaluated by actuarial percentage recurrence-free analysis (p = 0.0025). However, no differences was found in patients without urinary tract abnormalities. Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76% trimethoprim resistant bacteria during prophylaxis, compared with 8% before (p less than 0.0001) and 17% after (p less than 0.0001) prophylaxis. The percentage of recurrences due to E. coli (70-80%) was unaffected by trimethoprim prophylaxis, but the proportion due to trimethoprim resistant E. coli was significantly higher during prophylaxis (65%) than before (6%, p less than 0.0001) and after (11%, p less than 0.001). The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). Following prophylaxis there was no difference in the actuarial percentage recurrence-free curves of the two regimens. Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21%) (p = 0.05). The majority of side effects in the nitrofurantoin group derived from gastrointestinal symptoms. In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities.

Adolescent↗
PubMed1990

[Purulent meningitis in Denmark].

The epidemiology of meningococcal disease in Denmark has changed in recent years, with a rise in the number of cases in the 14-18 year age group. During the last decade 80 per cent of the meningococci belonged to Group B and 20 per cent to Group C. The treatment has followed the lines of the recommendations issued by the Rigshospitalet but some hospital departments have now chosen other preparations, as appears from the study presented in the article.

Adolescent↗
PubMed1989

[Screening for bacteriuria in the laboratory: autotrak, test strips and microscopic examination compared with culture].

A prospective investigation was undertaken to compare quantitative culture of 739 samples of urine in a microbiological laboratory with the screening methods: phase contrast microscopy examination, test strip examinations for nitrite and leukocyte esterase (Multistix-2, Ames) and "Autotrak" (automatic quantitating of the bacterial content in fluids: BBT instruments). The three screening methods were, by and large, of equal value as regards true positive diagnostic frequency (0.48-0.55) and true negative diagnostic frequency (0.92). The methods were also equally rapid but microscopy examination was by far the cheapest (0.15 Danish crowns per test as compared with 1.75 for test strips and 3.10 for "Autotrak"). In addition, microscopic examination has the further advantage, although this of lesser value where cocci are concerned, of being capable of differentiating the morphology of the bacteria and their motility. It is noted that test strips have a false negative rate of approximately 13%.

Bacteriological Techniques↗
PubMed1989

Antibiotic treatment of children with secretory otitis media. A randomized, double-blind, placebo-controlled study.

A double-blind, randomized, placebo-controlled clinical trial was conducted to evaluate one month of amoxicillin-clavulanate potassium treatment of children with secretory otitis media. In total, 264 children, aged 1 to 10 years, were randomly assigned to either antibiotic or placebo treatment; 43 patients were excluded during treatment, equally distributed in both groups, leaving 221 patients completing the trial. The inclusion criterion was a type C2 and type B tympanometry result of at least three months' duration. Tympanometry was performed every month for 12 additional months. At the end of the treatment period, the disease was reversed in 61% in the antibiotic-treated group compared with 30% in the placebo-treated group (P less than .0001), and the improvement was persistently significant in favor of antibiotic for eight months. The effect was present in all age groups and independent of laterality of disease. The middle-ear status at the end of treatment was the determining factor for the outcome of tympanometry the year following treatment. From the end of treatment, there was no difference between tympanometry in a patient having been treated with the antibiotic and a patient having been treated with placebo. Antibiotic treatment shifts the individual patient from poor to better tympanometric conditions, so antibiotics can be recommended in the treatment of secretory otitis media before inserting ventilating tubes.

Acoustic Impedance Tests↗
PubMed1989

An information campaign--an important measure in controlling the use of antibiotics.

Denmark is one of the countries using the smallest quantity of antibiotics in proportion to its population. Nevertheless, the use of ampicillin and co-trimoxazole has been found to be undesirably high. An information campaign was carried out to reduce the ampicillin and co-trimoxazole usage and to increase the penicillin usage as a consequence. To evaluate the efficacy of the campaign 602 general practitioners participated in the study, and the antibiotic treatment of 7607 patients, treated in week 13 in 1987, was recorded. These prescriptions were compared with the prescriptions recorded in two previous but identical investigations in 1979 and in 1983. The prescribing habits had changed significantly after the information campaign, resulting in national savings of two million Danish kroner/million inhabitants/year. Information could be an important measure in controlling the worldwide use of antibiotics.

Ampicillin↗
PubMed1989

Use of antibiotics in general practice in Denmark in 1987.

The worldwide usage of antibiotics is increasing making detailed information on prescribing patterns and intervention methods necessary. This investigation focused on the general practitioner's (GP's) usage of antibiotics in Denmark. Information on 7,607 patients treated by 602 GP's during 1 week in March 1987 were collected. The most commonly treated infectious diseases were upper respiratory tract infections (40%) and lower respiratory tract infections (17%). Penicillin was by far the most frequently prescribed antibiotic (44%), followed by antibiotics used locally (17%) and ampicillins (14%). Compared with previous investigations, this result indicated a relative increase in prescription of penicillin during recent years. The mean number of daily dosages was 2-3 and the duration of treatment 6-7 days, with ampicillin generally given 1 day longer than penicillin. The differences between prescribed daily dosages (PDD) found and defined daily dosages (DDD) ranged from + 40% to - 50%, making estimations of numbers of treated patients from total usage of antibiotics in DDD/1,000 inhabitants/day impossible.

Adolescent↗
PubMed1989

[Urinary tract infections, etiology, diagnosis and treatment with effective antibiotics].

Among young, sexually active women, the prevalence of urinary tract infections (UTI) is five per cent, which is 30-50 times higher than among men. The incidence increases with age, and the female: male ratio declines. UTI account for 40 per cent of nosocomial infections. Single dose treatment is to be highly recommended in acute, uncomplicated cases of UTI in adult women, the advantages being satisfactory effect, fewer side effects, reduced development of resistance, and substantial reduction in antibiotic consumption.

Adult↗
PubMed1987

The long-term prognosis of bacteriuria in pregnancy. A 16 to 17 year follow-up study.

An investigation made in 1966-67 of 2,122 pregnant women revealed 182 (8.6%) with significant asymptomatic bacteriuria, of whom 127 could be located in 1983. In 182 non-bacteriuric controls from the same investigation 105 could be located. Eight bacteriuric and 1 non-bacteriuric patient had died, all from causes of death unrelated to urinary tract infections. Data were collected by questionnaires, together with a urine specimen from approximately 73% of the survivors. No differences could be found between the initial bacteriuric and non-bacteriuric group concerning the number and complications of later pregnancies, urinary tract infections requiring hospitalization, or recognized arterial hypertension. In 1983, more of the initially bacteriuric women had experienced urinary tract infections not demanding hospitalization and more were bacteriuric (greater than or equal to 10(5) col/ml), compared with the controls: 36.5% and 28.8%, respectively. These high rates probably indicate some contamination due to self-sampling. B. anitratum was a new bacteria emerging, compared with the original study.

Bacteriuria↗
PubMed1987

Detection of neutrophilocytes and NO2-producing bacteria in urine by dipstick BM-test-9.

A prospective study compared the detection of leucocytes and bacteria in urine with the dipstick test (presence of esterases in granulocytes and nitrite) to chamber counting of urine, microscopic examination of the urinary sediment, and urine culture. Examined were 174 urine specimens. The dipstick esterase test and the sediment count were almost equally sensitive in detecting leucocyturia. Using chamber count and a cut-off point of 10 or more leucocytes per cubic millimeter as denoting significant leucocyturia, the esterase test gave a predictive value for negative test (PV neg) of 75% and a predictive value for positive test (PV pos) of 96%. PV neg of the dipstick nitrite test was 78% and PV pos 100% in detecting bacteriuria (10(5) bacteria per milliliter). Combining the esterase test with the nitrite test did not increase PV neg. Our result was that the dipstick test seems to be a simple screening procedure for leucocyturia and bacteriuria. The test is suggested to replace the time-consuming microscopic examinations of urine for leucocytes. When the nitrite test is positive, routine urine culture may be omitted.

Adolescent↗