Revue médicale suisse
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Antibiotic overuse in primary care setting is a major contributor to the development of resistant bacteria. Antibiotic consumption is low in Switzerland compared to neighbour countries, but improvement is possible and has to be pursued. Antibiotic stewardship helps physician to better recognize patients who need antibiotic (guidelines implementation, electronic decision support and laboratory testing) and educate patients about the uselessness of antibiotics in a given situation (delayed prescription and shared decision making). Clinical studies demonstrated the efficacy of these interventions in reducing antibiotic consumption, mainly in acute respiratory infections, without affecting patients' clinical outcome.
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Cutaneous drug eruptions are delayed type hypersensitivity reactions that can be potentially life threatening. Severe cutaneous adverse reactions encompass the acute generalized exanthematous pustulosis (AGEP), the drug reaction with eosinophilia and systemic symptoms (DRESS), the Stevens-Johnson syndrome (SJS) and the toxic epidermal necrolysis (TEN, synonym: Lyell syndrome). ⋯ Therefore early diagnosis and the interruption of the culprit drug are crucial. In this review, we discuss the physiopathology, the most common eliciting drugs, the diagnostic criteria and the proposed treatments of DRESS.