Knee osteoarthritis is a common condition that causes debilitating pain. The painkillers and anti-inflammatory drugs commonly used orally can cause serious side effects. In order to limit these, clinical practice guidelines describe topical non-steroidal anti-inflammatory drugs as an attractive first-line option. Among the molecules available, diclofenac is the most commonly prescribed.The objective of our study is to evaluate the efficacy and safety of topical diclofenac in the treatment of knee osteoarthritis.We conducted a systematic review in the Cochrane, PubMed, and Embase databases, with a meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of topical diclofenac versus placebo in knee osteoarthritis. The risk of bias was assessed using the RoB2 tool. The outcomes of the selected RCTs were meta-analyzed using RevMan software, and their level of evidence was assessed using the Rebuild the Evidence Based (REB) method.Of the 2,463 articles identified, 13 RCTs were included, eight of which had a low risk of bias and from which data were extracted. The primary outcome measures (POMs) meta-analyzed were pain assessment and functional disability at 12 weeks of treatment according to the subscales of the Western Ontario and McMaster Universities Osteoarthritis Index. Diclofenac was statistically superior to placebo, with a standardized mean difference respectively of -1.49 [-2.14, -0.83] (95% CI), p<0.01 and -4.98 [-7.15, -2.80] (95% CI), p<0.01. For these two POMs, the REB method concluded that there was “strong evidence.” Secondarily, safety was analyzed, showing no significant difference in the overall occurrence of adverse effects. Subgroup analysis shows more frequent skin dryness in the diclofenac group and less frequent erythema.These results are consistent with those found in the literature. This work enabled the evidence to be graded according to the REB method.This systematic review and meta-analysis showed superiority at 12 weeks of treatment with topical diclofenac compared to placebo in relieving pain and functional impairment in knee osteoarthritis, with a high level of evidence and no serious adverse effects.

In 2015, France was the third largest consumer of analgesics in Europe and the largest consumer of paracetamol. In France, 43% of reasons for consulting a general practitioner are related to pain and 57% of patients consulting a general practitioner received a prescription for analgesics. Determine the prevalence of qualitative misuse of analgesic treatments in patients followed up in general practice at least once during the past year. The secondary objectives were to determine which drug classes were affected and the reasons for misuse.Nationwide, multicentre cross-sectional study of a population of adult patients who consulted their general practitioner at least once during the inclusion period. Recruitment was carried out in general medical offices throughout France between January 2022 and June 2022. Data was collected using a self-administered questionnaire.A total of 910 participants were recruited, 639 (70%) of whom were women, with an average age of 53 (± 18). Among them, 98 (11%) were identified as having misused at least one analgesic treatment. There was a correlation between analgesic misuse and lower educational achievement. The five most commonly used classes of drugs were, in descending order, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), codeine, tramadol and opium. Among the most commonly used classes of drugs, patients mainly misused antidepressants (48%), followed by tramadol (18%), opium (16%), morphine (13%) and codeine (11%). Finally, the main reasons given were ‘to feel better’ (55%), ‘to sleep’ (39%) and ‘to relax/counter stress’ (25%).The strength of this study lies in its original approach, as it focuses on primary care and was conducted directly in general practitioners' offices. In order to limit recall bias and facilitate the identification of medications containing analgesics, the analgesic treatments studied were listed under their various trade names. The representativeness of the sample is questionable, as only patients who were able to visit a general practitioner could be included. The 31 patients excluded from the study due to missing data are not comparable to the 910 patients in terms of age and professional status. The existence of social desirability and memory bias when completing the self-administered questionnaire cannot be excluded.It appears difficult to target a population at risk of misuse in primary care, encouraging the systematisation of prevention messages before introducing or dispensing pain relief treatment and taking the time to assess their personal use.

Antimicrobial resistance is a growing threat to global public health. It is central to the “One Health” concept, connecting human, animal, and environmental health. In XXX, action plans have been implemented to promote the appropriate use of antibiotics and curb the rise of bacterial resistance. At the same time, eco-prescribing is emerging as a new public health priority in response to the environmental crisis. XXX, the fourth highest antibiotic-prescribing country in XXX, is estimated to deliver nearly 50% unnecessary or inappropriate antibiotic prescriptions. General practitioners, who issue around 80% of all antibiotic prescriptions, stand at the center of this dual challenge.The principles of appropriate antibiotic use and eco-prescribing were compared. Both approaches share a common logic: prescribing less and prescribing better to protect public health and the environment. Appropriate antibiotic use is structured around five principles: correct indication, correct drug, correct dosage, correct duration, and reassessment. Eco-prescribing relies on three pillars: prescribing less, prescribing better, and reducing the environmental impact of prescriptions. The first two overlap with appropriate antibiotic use. Several simple strategies can reduce environmental impact: prioritizing the oral route, reducing packaging, and shortening treatment durations. Different scores assess the environmental impact of medications, including the PBT score (persistence, bioaccumulation, toxicity) and the CO₂ emission score. These indicators may diverge: for example, among fluoroquinolones, ofloxacin emits 28% less CO₂ than levofloxacin but has a higher PBT index.The environmental impact of antibiotics goes beyond existing scoring systems and must also account for their effects on the microbiota and on antimicrobial resistance. These limitations highlight the need to develop antibiotic-specific indicators that integrate both ecological and microbiological impacts.Beyond measurement tools, reducing unnecessary prescriptions remains the most effective lever. Eco-prescribing offers an additional lever and may enhance general practitioners’ awareness of appropriate antibiotic use by emphasizing its major environmental dimension.Prescribing less and prescribing better. Through their shared co-benefits, these two major public health challenges reinforce one another and provide strong motivation for healthcare professionals.

General practitioners (GPs) consider male urinary tract infections (mUTIs) to be diagnostically challenging.This study sought to identify factors associated with declared antibiotic prescribing intentions by French GPs for the management of mUTIs.A national observational practice survey was conducted using an online questionnaire comprising five randomly generated clinical vignettes presenting urinary symptoms in men. GPs indicated their prescribing intentions and diagnostic approach. The primary outcome was declared antibiotic prescribing intent (immediate, delayed, or none). Secondary outcomes included declared performance of digital rectal examination (DRE), urine dipstick testing, and requests for full blood count (FBC), prostate-specific antigen (PSA) testing, or urinary tract/prostate ultrasound. Descriptive analysis was performed and multivariable linear models were used to identify factors associated with antibiotic prescribing.Of 2,202 vignettes analysed (515 GPs), immediate antibiotic therapy was declared for 45.5%, delayed prescription for 36.3%, and no antibiotics for 18.1%. Intrinsic factors independently associated with immediate antibiotic prescribing were fever and burning on urination, followed by low-grade fever, urinary frequency, haematuria, and pelvic pain. The only extrinsic factor was a history of immunosuppression. Declared investigation rates were high: urine culture (96.6%), dipstick testing (61.4%), and PSA testing (21.2%). Fever positively influenced FBC requests, whilst burning on urination showed inverse association. Low-grade fever or burning on urination were associated with reduced ultrasound ordering. Antibiotic choice was predominantly (68%) a 14-day fluoroquinolone regimen, with levofloxacin most commonly prescribed.Declared investigation rates substantially overestimated actual practice reported in the literature, suggesting a gap between intentions and real-world behaviour. PSA testing, though lacking guideline support, was requested in selected cases. GPs consistently declared prescribing fluoroquinolones regardless of infection severity, aligning with French Infectious Diseases Society (SPILF) therapeutic guidelines but conflicting with French National Agency for Medicines and Health Products Safety (ANSM) warnings. A small minority declared prescribing fluoroquinolone-sparing agents such as nitrofurantoin or pivmecillinam, contrary to current recommendations.Fever and burning on urination are the main determinants of immediate antibiotic prescribing for mUTIs. Updated French guidelines are anticipated in 2026, based on Northern European countries' fluoroquinolone-sparing approaches, aiming to reduce broad-spectrum antibiotic consumption whilst maintaining therapeutic efficacy.

With the increasing incidence of Lyme borreliosis (LB) in France and its growing media coverage, general practitioners (GPs) are encountering this disease more frequently. They also face a complex infection that presents diagnostic and therapeutic challenges.This study aimed to analyze the antibiotic prescriptions issued by French GPs for LB and to compare them with existing recommendations.We conducted an observational, retrospective practice-based study using the THIN Cegedim database, covering the period from 2012 to 2022. The study was divided into three periods: 2012–2018 (T1), 2018–2019 (T2), and 2019–2022 (T3), in order to compare the evolution of prescriptions with the guidelines in force. Each prescription received a quality score (score 1: correct antibiotic chosen, but errors in dosage and duration; score 2: correct antibiotic, with either dosage or duration incorrect; score 3: correct antibiotic choice with correct dosage and duration).In total, 8,408 patients and 3,010 GPs from the 13 French regions were included. We identified 9,802 cases of erythema migrans (97.6%), 230 cases of Lyme arthritis (2.2%), and 11 cases of neuroborreliosis (0.1%). GPs prescribed the correct antibiotic in most cases (88.97% of prescriptions with an appropriate antibiotic). For erythema migrans, the quality of prescriptions rated as score 1 improved over time (T1: 14.8%; T2: 17.4%; T3: 37.7%; p=0.02), there was a slight increase in score 2 (T1: 35.9%; T2: 44.1%; T3: 38.2%; p=0.06), and a decrease in score 3 (T1: 38.2%; T2: 25.6%; T3: 13.4%; p=0.017). The study period was associated with poorer selection of treatment duration by GPs (p<0.001). The patient’s age and sex, as well as the region where the GPs practiced, were not associated with prescription quality.While GPs often prescribe the correct antibiotic, they face challenges regarding dosage and particularly treatment duration. This could be explained by the time required to implement a recommendation in routine care, as evidenced by the longer duration of period 1 of our study compared to periods 2 and 3.Targeted prescribing support tools for LB could help address these issues and improve adherence to recommendations.

Antibiotic prescription, its nature and its duration are a very common decision-making situation in primary care practice. Clinical practice guidelines (CPGs) are regularly emitted by various organisations on this topic.Our goal is to run a quality appraisal of the current French guidelines, for the most common primary care infectious pathologies.We collected all primary care CPGs that are currently prevailing in France through a systematic review of the french website Antibioclic®. For each of these guidelines, a quality assessment was run by 3 independent reviewers, by means of the Appraisal of Guidelines for REsearch & Evaluation II instrument. The main outcome was a 'reliability score', defined as the sum of the scores in domains 'rigour of development' and 'editorial independence'. To be considered 'reliable', the CPG had to reach a 60% threshold in these two domains. Secondary outcomes were as follows: global quality score of CPGs, number and ratio of CPGs for which a systematic review has been conducted during its conception.Over the 43 CPGs that have been assessed, none reached the 60%-threshold as to the reliability score. Only one CPG (2.33%) gets an over-60% quality assessment in the domain of rigour of development (D3), whereas three CPGs (6.98%) reach this threshold in the domain of editorial independence (D6). One CPG (2.33%) met the quality threshold of 60% as to overall assessment. Rigour of development and editorial independence are the domains that obtained the lowest average score, respectively, 11% and 21%. Overall assessment received an average score of 29%. A systematic review of the literature was mentioned for 10 CPGs (23.26%).Most clinical practice guidelines in infectious diseases for primary care do not meet minimum quality criteria. This raises questions both about the recommendations issued for antibiotic prescriptions and about the reliability of these guidelines.There is a lack of quality in the development process of the current French guidelines in primary care infectiology. This process should be reconsidered, with higher insistence as to its quality

Guidelines help practitioners make decisions in their daily practice. To be reliable, they must present the level of evidence for the recommendations (GRADE A, B, C, AE from the French National Authority for Health).To assess the level of evidence supporting antibiotic therapy recommendations inprimary care.After collecting the clinical practice guidelines (CPGs) listed on the Antibioclic®website (https://antibioclic.com), each recommendation regarding whether or not to prescribeantibiotics was evaluated based on whether it included a GRADE classification by the French National Authority for Health (HAS): A, B, C, or Expert Opinion (EO). The sources cited by the CPGs were reviewed. The recommendations and studies had to answer the question: ‘‘Should antibiotic therapy be prescribed in this situation?’’ The possible answers were ‘‘yes,’’ ‘‘no,’’ or‘‘conditional yes,’’ meaning delayed prescription. The primary outcome was the percentage of recommendations for which supporting studies were cited, in comparison to the stated GRADE.A total of 152 recommendations from 49 CPGs on antibiotic prescription were analyzed. In all, 71.7% did not mention a level of evidence, 3.3% were classified as GRADE A, and 9.2% as GRADE B. Upon reviewing the studies used to justify the recommendations, high-qualityevidence was identified for only 7.9% of the recommendations, while 80.9% had no referenced studies.More than three-quarters of antibiotic prescription recommendations in primary care do not have an indicated level of evidence (no GRADE). When a GRADE (A, B, C, AE) was mentioned, only 5/41 (12%) were level A. These results concern the most common situations in general practice and do not apply to hospitalised patients. Thus, most recommendations in favour of prescribing antibiotics in primary care are not based on a high level of evidence (only 14.5% had a GRADE of A or B).Most French recommendations regarding antibiotic prescription in primary caredo not provide the level of evidence supporting them