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UNIVERSITE DE STRASBOURG
FACULTE DE MEDECINE DE STRASBOURG
ANNEE 2019 N° 150
THESE
PRESENTEE POUR LE DIPLOME DE
DOCTEUR EN MEDECINE
Diplôme d’Etat
DES de Médecine Générale
Par
SCHLEININGER RAHME Hélène
Née le 27/12/1987 à Colmar
EVALUATION DES PRATIQUES DE PRESCRIPTIONS ANTIBIOTIQUES
DANS LES INFECTIONS RESPIRATOIRES HAUTES DE L’ENFANT
TELLES QUE LES ANGINES, LES OTITES ET LES
RHINOPHARYNGITES DANS UN CABINET DE MEDECINE GENERALE
ET DE PEDIATRIE, AINSI QUE DANS UN SERVICE D’URGENCES DANS
LA REGION DE STRASBOURG
Président de jury : Professeur Christian Debry
Directeur de Thèse : Docteur Anne Laure Bernardin
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Remerciements
A Monsieur le Professeur Christian Debry, qui m!a fait l!honneur de pr"sider cette th#se. !!!!!!!!!!!!
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!!!!!!!!!!!!!!!A Anne Laure Bernardin, ma directrice de th#se, merci pour ta patience, ta disponibilit" et ta gentillesse. Je ne garde que de bons souvenirs $ tes c%t"s durant ce travail et mon semestre de p"diatrie. Tu as toujours "t" de bons conseils, tu as su m!aiguiller, me conseiller et surtout me canaliser.
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A Professeur Daniel Christmann, qui a eu la gentillesse de s!int"resser $ mon travail, veuillez trouver l!expression de ma sinc#re reconnaissance.
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A Professeur Pierre Kuhn Je vous suis reconnaissante d!avoir accept" d!&tre membre de mon jury. Veuillez trouver en ces mots l!expression de ma sinc#re gratitude!"
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Au Professeur Michel Velten, je vous remercie d!avoir accept" d!&tre membre du jury de cette th#se. Merci pour vos bons conseils et votre disponibilit". Veuillez trouver ici le t"moignage de toute ma reconnaissance.
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A mon mari Michel, mon mari, mon tout. Je t!aime plus que tout, merci d!&tre $ mes c%t"s depuis presque dix ans. Tu es la personne la plus bienveillante, et la plus gentille que je connaisse. Merci pour ton soutien et ta bonne humeur au quotidien. Tu es un homme et un papa extraordinaire, Elias et moi avons beaucoup de chance de t!avoir.
A notre fils Elias, l!amour de ma vie, ma plus jolie rencontre. Devenir maman est pour moi la plus belle chose au monde. Tu es un petit gar'on plein d!"nergie et de sensibilit", qui rend nos journ"es sportives mais tellement plus agr"ables. Merci d!&tre toi, de ne pas faire semblant et de faire de moi une femme accomplie et une maman heureuse.
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A mes parents, merci de me soutenir au quotidien. Nous sommes une famille recompos"e, mais tellement soud"e. Merci $ Momo et maman pour l!"ducation, les valeurs et l!humilit" que vous nous avez inculqu"es. Je suis tr#s fi#re de ce que nous sommes et de ce que nous vivons ensemble au quotidien. Vous &tes tellement importants pour moi, je vous aime plus que tout. Marie… beaucoup de choses $ te dire en si peu de lignes… Ma s(ur, ma moiti", mon bin%me, tellement de complicit" entre nous. Tu es une jeune femme de caract#re, qui n!a pas sa langue dans sa poche, mais ce que j!appr"cie par-dessus tout chez toi, c!est ta sensibilit", ta puret" et surtout… Ta maladresse malgr" toi ! tu es ma Pierre Richard $ moi. Merci d!&tre l$ pour moi, mais surtout pour Elias. Bastien, la force tranquille, quand rien ne va tout va. J!aime ton calme, ta s"r"nit" et ta bonne humeur. Tu es un fr#re et un parrain du tonnerre.
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Logan, petit fr#re au grand caract#re, il est vrai qu!on a v"cu des choses pas "videntes, mais on a toujours r"ussi $ s!en sortir. Bien loin le temps du petit gar'on blondinet que j!habillais en fille, tu vas bient%t te marier, un jour devenir papa, je sais que tu es heureux et je te souhaite le meilleur. Je t!aime
A Francis, St"phane et mamie je vous aime.
A mes cousines, Murielle, Carole, C"line et Marine, je garde en m"moire que de bons moments $ vos c%t"s, je suis s)re qu!il y en aura encore tant d!autres.
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A Mireille, Elie, Chris, Patrick et Nathalie, ma famille de c(ur, merci de m!avoir accueillie et de m!avoir fait confiance. Vous avez une place importante dans mon c(ur, et je suis reconnaissante de tout ce que vous faites pour nous. La famille avant tout et c!est ce que j!appr"cie chez vous. Merci pour votre amour au quotidien, je suis fi#re et heureuse d!avoir une si grande et belle famille.
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A mes copines, bien plus, mes amies, Magali, Elod, Aurore, Claire, Sandra, Gwen, Emilie, Flora, Catherine, Marion, merci de supporter mon caract#re bien tremp", je sais que ce n!est pas "vident $ g"rer tous les jours. Celles qui me connaissent savent que pour moi l!amiti" est tr#s importante… Vous avez toutes une place singuli#re et particuli#re dans ma vie et celle de ma famille. A Audrey, alias m"m", mon amie, ma t"moin, merci pour tout. Merci pour ta * crazy attitude +, ta bonne humeur quelque-soit les circonstances et ton "ternelle gentillesse. Tiens-toi pr&te pour ton EVJF, tu ne vas pas t!en remettre. Tu es une maman formidable pour votre petite Chlo" et tu seras une magnifique mari"e. Merci $ ma Elo, ma s(ur de c(ur, tellement importante pour moi ! Je pourrais t!"crire tous les mots du monde mais aucun ne pourrait r"sumer ce que je ressens pour toi. Plus de 15 ans d!amiti" et encore tant de belles ann"es $ venir.
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A mes cointernes de choc Julie, et Myl#ne alias Jeanne Moreau, pas de bol il a fallu me supporter et m!"couter r,ler pendant 6 mois, mais quelle bonne ambiance entre nous. Nos s"quences mascottes au chocolat me manquent. Merci pour tous ces bons moments pass"s ensemble. Merci aux littlefish de m!avoir d"tendue en Corse quelques semaines avant ma th#se. Second round en D"cembre $ Abu Dhabi. Fais-moi confiance Nico, le Toplexil 'a marche bien. A ma team Gyn"co, Hind, Eve, B"n", Sidi et Thomas, sans oublier b"b" Adam, que de bons moments, des fous rires ensemble ! Des instants courts mais tellement intenses. Il faut vraiment qu!on arrive $ se voir avant que nos enfants arrivent $ leur majorit". D!ailleurs Eve et Thomas c!est quand vous voulez pour go)ter aux joies des nuits blanches.
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A ma copine C"cilia, qui a "t" un r"el coup de foudre amical. Quasiment le m&me parcours, on se conna-t, on ne triche pas, on est nous-m&me, et surtout on s!aime. Courage pour ta th#se $ venir, ce n!est vraiment pas un exercice facile, mais je sais que tu rel#veras le d"fi haut la main. A Eric, premier m"decin que j!ai remplac", merci pour ta confiance et ton aide depuis ces quatre ann"es. A mes deux secr"taires pr"f"r"es Sabrina et Ma.t", merci pour tous ces bons moments de rigolade, de partage, et de soutien. Merci pour votre super travail et surtout, merci pour cette bonne ambiance dans laquelle j!aime tant venir travailler.
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ANNEXE 1
Selon le site de santé publique France
! *#&!
ANNEXE 2
Selon le rapport de l’ANSM de 2018 ]Y^
! *#'!
ANNEXE 3
Selon le rapport de l’ANSM de 2018 ]Y^
ANNEXE 4
Selon le rapport de l’ANSM de 2018 ]Y^
! *#(!
ANNEXE 5
Selon le rapport de l’ANSM de 2018 ]Y^
! *#)!
ANNEXE 6
Liste des antibiotiques critiques publiés en 2013 par l’ANSM ]-^
! *$+!
ANNEXE 7
ECN PILLY 2018
! *$*!
ANNEXE 8
Selon l’HAS de novembre 2016
! *$"!
ANNEXE 9
Selon l’HAS de Novembre 2016
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ANNEXE 10
QUESTIONNAIRE THESE HELENE SCHLEININGER-RAHME
Motif d’admission :
-angine
-otite
-rhinopharyngite
Diagnostic final :
-angine
-otite
-rhinopharyngite
Caractéristiques de l’enfant :
-Age
-antécédents
-Poids
-Taille
Durée de la fièvre :
-inferieure à 48h
-supérieure à 48h
Intensité de la fièvre :
-température (chiffre max de la valeur au domicile ou au cabinet)
Tolérance de la fièvre et de la pathologie :
-réactif : oui non
-tonus : bon moyen mauvais
-état général : bon moyen mauvais
-signes de sepsis : oui non
-appétit : bon mauvais
-sommeil : bon mauvais
Contage :
- oui non
Nombre de consultations précédentes pour le même épisode :
L’enfant est-il déjà sous antibiotiques ?
-oui non
Si oui lequel (ou lesquels), et depuis combien de temps ?
Y’a t’il eu des examens complémentaires réalisés pour cet épisode ? :
-oui non
Si oui :
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Le médecin qui prend en charge l’enfant a t’il ressenti une pression parentale pour la
mise en place d’une antibiothérapie ?
-oui non
Si oui, sous quelle forme ?
Caractéristiques du médecin :
-Age :
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-Pour les urgences : Un avis sénior a t’il été demandé ? Oui non
Antibiotique prescrit à la sortie :
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Jan 2017.
2. ANSM. Bien Utiliser les Antibiotiques.Nov 2018.
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4. Santé Mdl. Des politiques publiques pour préserver l'efficacité des antibiotiques. Jun
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5. Antibiothérapie par voie générale en pratique courante dans les infections respiratoire
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! *'+!
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61. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, et al.
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62. Lambert MF, Masters GA, Brent SL. Can mass media campaigns change antimicrobial
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63. Ryves R, Eyles C, Moore M, McDermott L, Little P, Leydon GM. Understanding the
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duration of penicillin prescriptions on outcomes for acute sore throat in adults: the
DESCARTE prospective cohort study in UK general practice. Br J Gen Pract.
2017;67(662):e623-e33.
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