Antibiotic prescribing for upper respiratory tract infection: The importance of diagnostic uncertainty
Antibiotic prescribing for upper respiratory tract infection: The importance of diagnostic uncertainty
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DOI：
10.1016/j.jpeds.2004.09.020
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发表时间：
2005-02-01
影响因子：
5.1
通讯作者：
Wang, FEL
中科院分区：
文献类型：
--
作者：
Arnold, SR;To, T;Wang, FEL
目的小儿病毒性上呼吸道感染（viral upper respiratory tract infections，URI）抗生素滥用是一个严重的问题.我们确定了抗生素处方的临床特征，可能会增加关注可能的细菌感染（年龄，外观，发烧）在儿童URI.Study design我们创建了16个场景的儿童URI和分发他们通过邮件调查540儿科医生和家庭医生在安大略，加拿大。患者的临床特征，父母的压力，和医生的特点与抗生素处方的关联是通过使用logistic回归analysis.Results，共有257名医生作出回应（48%）。外观不良（OR，6.50; 95% CI，5.06 - 3.84）、发热超过38.5 ℃（OR，1.48; 95% CI，1.21 - 1.82）和年龄大于2岁（OR，2.27; 95% CI，1.85 - 2.78）与处方相关，而父母压力与处方无关。与抗生素使用相关的医生特征是家庭医生（OR，1.54; 95% CI，1.22 - 1.96），每周就诊的患者数量增加（OR，1.05; 95% CI，每增加20例患者，1.01至1.08），以及医生年龄的增加（OR，1.17; 95%CI，1.11至1.24，5年增量）。结论临床因素，这可能会导致医生担心可能的细菌感染的儿童，与抗生素的使用儿科URI。
Objectives Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI.Study design We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada. The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis.Results A total of 257 physicians responded (48%). Poor appearance (OR, 6.50; 95% CI, 5.06 to 3.84), fever above 38.5degreesC (OR, 1.48; 95% Cl, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95% Cl, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not. Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95% Cl, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95% Cl, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95% CI, 1.11 to 1.24, 5-year increments).Conclusions Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.