Le médecin généraliste face à une morsure de tique : enquête de pratique auprès des médecins généralistes de Nouvelle Aquitaine

Abstract : Introduction : Lyme disease is the most common vector-borne disease in temperate areas of the Northern Hemisphere. In France, according to the 2006 consensus conference, postexposure prophylactic antibiotics is not systematically recommended but, in some cases, it can be discussed. Objective : To evaluate the prescription of prophylactic antibiotics by general practitioners in asymptomatic patients after a recent tick bite, to evaluate the motive behind these prescriptions, the therapeutic plans used and how frequent a Lyme disease serology is ordered. Material and method : Declarative practice survey based on questionnaires sent to general practitioners in Nouvelle Aquitaine from the 25th of January to the 31st of August. The survey analysed socio-demographic characteristics, the number of consultations for tick bites during the last 12 months, the prescription of prophylactic antibiotics and the demande for Lyme disease serology. Results : 402 GPs participated to our study, 59,2% prescribed prophylactic antibiotics according to clinical circumstances. The main prescribing criteria was a duration of tick attachment greater than 48 hours (81.1%), immune-compromised patient (53,4%) and bloodsoaked tick (50,8%). Amoxicillin is used by 58,2% of the GPS in our study, doxycycline by 38,7% of them. Lyme disease serology is prescribed by 14,4% of the GPs. GPs in the former Limousin region prescribed significantly fewer antibiotics (49.5%) (p=0.0004) than those in Aquitaine (70.2%) or Poitou-Charentes (66.7%). GPs younger than 45 years of age prescribed significantly more antibiotics (73.6%) than those older than 45 years of age (56.4%) (p=0.0003). Conclusion : Despite it’s rarely indication, prophylactic antibiotic use is important. The HAS 2018 recommendations have clarified how to manage post tick exposure, indicating the absence of the indication to prescribe post exposure prophylactic antibiotics. It could be interesting to evaluate the impact of these recommendations on our practices. disease serology is prescribed by 14,4% of the GPs. GPs in the former Limousin region prescribed significantly fewer antibiotics (49.5%) (p=0.0004) than those in Aquitaine (70.2%) or Poitou-Charentes (66.7%). GPs younger than 45 years of age prescribed significantly more antibiotics (73.6%) than those older than 45 years of age (56.4%) (p=0.0003). Conclusion : Despite it’s rarely indication, prophylactic antibiotic use is important. The HAS 2018 recommendations have clarified how to manage post tick exposure, indicating the absence of the indication to prescribe post exposure prophylactic antibiotics. It could be interesting to evaluate the impact of these recommendations on our practices. 2018 recommendations have clarified how to manage post tick exposure, indicating the absence of the indication to prescribe post exposure prophylactic antibiotics. It could be interesting to evaluate the impact of these recommendations on our practices.
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Master Thesis
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Submitted on : Friday, April 12, 2019 - 6:43:24 PM
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Pierre Guillou. Le médecin généraliste face à une morsure de tique : enquête de pratique auprès des médecins généralistes de Nouvelle Aquitaine. Médecine humaine et pathologie. 2019. ⟨dumas-02098649⟩

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