Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries.
Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries.
复制标题
抗生素处方的变化及其对初级保健急性咳嗽患者恢复的影响：13个国家的前瞻性研究。
DOI：
10.1136/bmj.b2242
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发表时间：
2009-06-23
期刊：
影响因子：
--
通讯作者：
Goossens H
中科院分区：
文献类型：
--
作者：
Butler CC;Hood K;Verheij T;Little P;Melbye H;Nuttall J;Kelly MJ;Mölstad S;Godycki-Cwirko M;Almirall J;Torres A;Gillespie D;Rautakorpi U;Coenen S;Goossens H
目的描述在对比欧洲环境中急性咳嗽抗生素处方的变化及其对恢复的影响。设计横断面观察性研究，来自13个欧洲国家的14个初级保健研究网络的临床医生记录了症状的表现和管理。患者通过患者日记随访28天。设置初级保健。参与者新发或加重咳嗽或临床表现提示下呼吸道感染的成人。主要结果测量临床医生开抗生素处方和总症状严重程度评分。结果共招募了3402名患者（临床医生完成了99%（3368）参与者的病例报告表，80%（2714）返回了症状日记）。就诊时的平均症状严重程度评分范围为19（量表范围0 - 100）（西班牙和意大利网络）至38（瑞典网络）。网络的抗生素处方从20%到近90%不等（总体为53%），处方的抗生素类别差异很大。总体而言，阿莫西林是最常见的抗生素处方，但这一比例从挪威网络中处方抗生素的3%到英国网络中的83%不等。虽然氟喹诺酮类药物在三个网络中根本没有处方，但在米兰网络中有18%的处方。调整临床表现和人口统计学后，与总体平均值（处方比例：0.53）相比，抗生素处方仍存在相当大的差异，范围从挪威（比值比0.18，95%置信区间0.11 - 0.30）到斯洛伐克（11.2，6.20 - 20.27）。一旦考虑到临床表现，使用和未使用抗生素的患者的恢复率相似（系数-0.01，P<0.01）。结论：临床表现的变化不能解释欧洲急性咳嗽抗生素处方的显著变化。抗生素处方的变化与临床上重要的恢复差异无关。试用注册Clinicaltrials.gov NCT 00353951。
Objective To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery. Design Cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries. Setting Primary care. Participants Adults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection. Main outcome measures Prescribing of antibiotics by clinicians and total symptom severity scores over time. Results 3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to 83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18, 95% confidence interval 0.11 to 0.30) to Slovakia (11.2, 6.20 to 20.27) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics (coefficient −0.01, P<0.01) once clinical presentation was taken into account. Conclusions Variation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery. Trial registration Clinicaltrials.gov NCT00353951.
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影响因子：
2.6
作者：
Akkerman, Annemiek E.;Kuyvenhoven, Mariike M.;van Dijk, Liset
通讯作者：
van Dijk, Liset
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作者：
Welschen, I;Kuyvenhoven, MM;Verheij, TJM
通讯作者：
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