Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain
Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain
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DOI：
10.1007/s00228-003-0706-z
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发表时间：
2004-03-01
影响因子：
2.9
通讯作者：
Munck, A
中科院分区：
文献类型：
--
作者：
Bjerrum, L;Boada, A;Munck, A
Objective.一个国家抗生素耐药性的流行反映了当地抗生素的消费情况。大多数抗生素是在一般实践中处方的，大多数处方可归因于呼吸道感染（RTI）的治疗。本研究的目的是比较抗生素耐药率高的国家（西班牙）和抗生素耐药率低的国家（丹麦）的全科医生（GP）对呼吸道感染的抗生素处方。哥本哈根和巴塞罗那的一组全科医生登记了2001年11月1日至2002年1月31日3周内与RTI患者的所有接触者（n=2833）。总体而言，西班牙全科医生治疗的患者比例高于丹麦全科医生。在调整了年龄和性别的不平等分布后，我们发现西班牙的全科医生对扁桃体和支气管/肺部感染病灶的患者开了更多的抗生素。窄谱青霉素是丹麦使用最多的抗生素，占所有处方的58%，其次是大环内酯类和广谱青霉素。在西班牙，处方分布在大量的化合物中，最常用的是广谱青霉素和阿莫西林+ β-内酰胺酶抑制剂的组合。在丹麦和西班牙，全科医生管理呼吸道感染的方式存在很大差异，这不能用全科医生中RTI的不同模式来解释。这些差异表明各国的建议不同、治疗传统不同或药品营销的影响不同。
Objective. The prevalence of antibiotic resistance in a country reflects the local consumption of antibiotics. The majority of antibiotics are prescribed in general practice and most prescriptions are attributable to treatment of respiratory tract infections (RTIs). The aim of this study was to compare general practitioners' (GPs') prescribing of antibiotics for respiratory tract infections in a country with a high prevalence of antibiotic resistance (Spain) with a country with a low prevalence of antibiotic resistance (Denmark).Methods. A group of GPs in Copenhagen and Barcelona registered all contacts (n=2833) with patients with RTIs during a 3-week period between 1 November 2001 and 31 January 2002.Results. Overall, Spanish GPs treated a higher proportion of patients than Danish GPs. After adjusting for unequal distribution of age and sex, we found that Spanish GPs prescribed significantly more antibiotics to patients with focus of infection in tonsils and bronchi/lungs. Narrow-spectrum penicillin was the most used antibiotic in Denmark, representing 58% of all prescriptions issued, followed by macrolide and broad-spectrum penicillin. In Spain, prescriptions were distributed among a great number of compounds, with broad-spectrum penicillins and combinations of amoxicillin plus betalactamase inhibitors most frequently used.Conclusion. The substantial difference in the way GPs manage respiratory tract infections in Denmark and Spain cannot be explained by different patterns of RTIs in general practice. The discrepancies indicate variations in national recommendations, different treatment traditions or different impact of pharmaceutical marketing.