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Management of suspected infectious diarrhoea by English GPs: Are they right?

Lookup NU author(s): Professor Sarah O'Brien



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Background: The criteria used when GPs submit stool specimens for microbiological investigation are unknown. Aim: To determine what criteria GPs use to send stool specimens, and if they are consistent with national guidance, and whether GPs would prescribe an antibiotic before they receive a result. Design and setting: Questionnaire survey of 974 GPs in 172 surgeries in England. Method: GPs were sent a questionnaire (23 questions) based on national guidance. Results: Questionnaires were returned by 90% (154/172) of surgeries and 49% (477/968) of GPs. GPs reported sending stool specimens in about 50% of cases of suspected infectious diarrhoea, most commonly because of individual symptoms, rather than public health implications. Fewer considered sampling with antibiotic-associated diarrhoea post hospitalisation, or children with acute, painful, bloody diarrhoea; only 14% mentioned outbreaks as a reason. Nearly one-half of GPs reported they would consider antibiotics in suspected cases of Escherichia coli O157, which is contraindicated. Only 23% of GPs would send the recommended three specimens for ova, cysts, and parasites (OCP) examination. Although 89% of GPs gave some verbal advice on how to collect stool specimens, only 2% of GPs gave patients any written instructions. Conclusion: GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile postantibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this.

Publication metadata

Author(s): McNulty CAM, Lasseter G, Verlander NQ, Yoxall H, Moore P, O'Brien SJ, Evans M

Publication type: Article

Publication status: Published

Journal: British Journal of General Practice

Year: 2014

Volume: 64

Issue: 618

Pages: e24-e30

Print publication date: 01/01/2014

Online publication date: 30/12/2013

Acceptance date: 21/10/2013

Date deposited: 22/08/2019

ISSN (print): 0960-1643

ISSN (electronic): 1478-5242

Publisher: Royal College of General Practitioners


DOI: 10.3399/bjgp14X676429

PubMed id: 24567579


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Funder referenceFunder name
Public Health England