title: Management of suspected infectious diarrhoea by English GPs: are they right?
abstract: BACKGROUND
  The criteria used when GPs submit stool specimens for microbiological investigation are unknown.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Questionnaire survey of 974 GPs in 172 surgeries in England.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile post-antibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this.
authors.affiliation: Public Health England, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester.
authors.forename: Cliodna Am
authors.initials: CA
authors.lastname: McNulty
authors.forename: Gemma
authors.initials: G
authors.lastname: Lasseter
authors.forename: Neville Q
authors.initials: NQ
authors.lastname: Verlander
authors.forename: Harry
authors.initials: H
authors.lastname: Yoxall
authors.forename: Philippa
authors.initials: P
authors.lastname: Moore
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.forename: Mark
authors.initials: M
authors.lastname: Evans
mesh_terms: D003967:Diarrhea / Q000628:therapy*; D004739:England; D005243:Feces / Q000382:microbiology; D058006:General Practice / Q000379:methods / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000592:standards; D007239:Infections / Q000175:diagnosis / Q000628:therapy*; D008487:Medical History Taking; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012017:Referral and Consultation; D013048:Specimen Handling / Q000379:methods / Q000592:standards
keywords: E. coli O157; antibiotics; diarrhoea; general practice; guidance; investigation