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Master Thesis

Bon usage des fluoroquinolones par les médecins généralistes des groupes qualité de Guadeloupe

Abstract : Introduction: In 2015 some estimations evaluated that 30% to 50% of antibiotic prescriptions in France were not conformed to the latest guidelines for good practice of antibiotic use. The resistance to antibiotics is a worldwide threat to public health, with a negative impact in patient outcomes. Our aim was to identify the determining factors in the prescription of fluoroquinolones (FQ) by the general practitioners (GP) in Guadeloupe (indications, choice of the molecule, dosage, duration and adaptation) and make an inventory of this prescription before and after corrective intervention. Methods: We realized a qualitative survey of the determinants of the prescription of FQ by the general practitioners of the quality groups in Guadeloupe in 2016. We then conducted a descriptive case-control study before and after corrective intervention, focused on the average number of prescribed boxes of FQ by these practitioners,during the first semester of 2016 and 2017. Results: Of the 94 physicians to include, 51 participated in the study. Of the 30 analyzable records, 90% (n = 27) of FQ prescriptions were for urinary tract disease with major use of Ofloxacin. Only 4 cards out of the 30 were fully compliant with FQ's policy of good practice, with 18 questionable indications and 15 nonconformities for the duration of prescription. For the descriptive study before and after corrective intervention, the FQ prescription of 86 doctors of the Guadeloupe quality groups could be compared to that of a control group with 199 GPs from Guadeloupe. Thus,we observed that between 2016 and 2017, the quality groups decreased their FQ prescription with an average of 19 to 17boxes per GP per semester whereas an upward trend could be observed in the control group increasing from 27 to 28. The corrective intervention was associated with an improvement in the prescription of fluoroquinolones by the physicians of the quality groups (p = 0.03). Conclusion: Our study showed that GPs of the quality groups used FQ mainly to treat diseases related to the urinary system, which is an approved indication of use in first intention only in case of acute nephritis. Dosages were respected but the duration was too long in half of the cases (n=15). On the basis of this observation, a corrective intervention was carried out and significantly improved the prescription of FQ by the physicians of the quality groups compared to that of the control group, but repeated intervention would probably have a greater impact.
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Maxime Ducasse. Bon usage des fluoroquinolones par les médecins généralistes des groupes qualité de Guadeloupe. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02886585⟩

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