title: Developing best practice for fungal specimen submission--fungal audit of general practice.
abstract: The objective of this study was to investigate the management of suspected fungal nail infections by general practitioners (GPs) and determine whether guidance is sought when submitting specimens for investigation or treating cases. Questionnaires were sent to all GPs (n = 2420) served by five Health Protection Agency (HPA) collaborating laboratories in the South West of England. A total of 769 GPs responded - topical and oral antifungals were never used by 29% and 16% of GPs respectively. When antifungals were prescribed, topicals were normally given because of the severity of infection (32%); Amorolofine (53%) was the preferred choice. Oral antifungals were most often prescribed after receipt of a laboratory report (77%); Terbinafine was the preferred choice (86%). Seventy percent of GPs would only treat a suspected nail infection with oral antifungals after sending a sample for investigation, yet 27% never waited for a microscopy report before prescribing oral antifungal treatment. GPs routinely send specimens from suspected fungal nail infections for microbiological investigation, yet treatment is often prescribed before a result is received. With clinical signs of fungal infections often non-specific, GPs should rely on laboratory results before prescribing expensive and lengthy antifungal treatments. Laboratories could further reduce antifungal use by including guidance on microscopy and culture reports.
authors.affiliation: Microbiology Department, Health Protection Agency, Gloucestershire Royal Hospital, Gloucester, UK. gemmalomas@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Lasseter
authors.forename: C A M
authors.initials: CA
authors.lastname: McNulty
authors.forename: M
authors.initials: M
authors.lastname: Palmer
authors.forename: H
authors.initials: H
authors.lastname: Yoxall
authors.forename: C
authors.initials: C
authors.lastname: Kibbler
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017410:Practice Guidelines as Topic; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D000935:Antifungal Agents