Quaternary prevention is the set of measures taken to avoid, reduce, or alleviate the harm caused by healthcare activities [
Although the concept is accepted without any opposition among professionals, in our daily practice we find ourselves immersed in clinical actions that call into question (unintentionally, of course) quaternary prevention [
This is the case, for example, of the recommendation given for patients with superinfected bronchiectasis by
Pulmonary function and quality of life remain unchanged whether they take placebo or antibiotic;
The rates of colonization by germs resistant to Azithromycin skyrocket;
Cases of diarrhea, abdominal pain, and other gastrointestinal discomfort increase;
Hepatotoxicity may appear; Cases of decreased hearing have been described;
Moreover, as a group effect, not only of azithromycin, the authors recall that prolonged use of macrolides can be related to a higher rate of cardiovascular events (prolongation of the QT interval, hypokalemia, hypomagnesemia, significant bradycardia, bradyarrhythmias, or decompensated heart failure).
If we reflect on the characteristics of the patients who usually present superinfection of bronchiectasis by
With this comment, we do not intend to question any of these summaries; do not understand it this way. We congratulate and applaud the quality of the review by the authors of the main clinical guidelines in this field, the recommendation documents and the summaries. We know how complicated it is to review a topic of these characteristics. However, if we respect and do not forget what the term “quaternary prevention” entails [
We therefore consider it important to keep quaternary prevention very much in mind in our daily work. It is obvious that at the professional level we must demand of ourselves continuing education and provide the best possible care for our patients. However, we must also be self-critical and individualized when it comes to prescribing treatments or exposing patients to clinical tests or complementary examinations. Quaternary prevention must always prevail in the practice of our profession and we physicians must respect what this concept implies. We must remain alert so as not to indiscriminately accept everything that the clinical guidelines and recommendations indicate, choosing which patients and at what times it may benefit them or, on the contrary, put them at risk. Only in this way will we be able to work keeping on the horizon the idea of achieving the maximum benefit for our patients [
The authors have no conflict of interest to declare. The authors declared that this study has received no financial support.