Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the UK: Implications for developing management guidelines
Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the UK: Implications for developing management guidelines
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DOI：
10.1016/s0954-6111(97)90258-4
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发表时间：
1997-08-01
影响因子：
4.3
通讯作者：
Holmes, W
中科院分区：
文献类型：
--
作者：
Macfarlane, J;Lewis, SA;Holmes, W
呼吸道症状是全科医生 (GP) 咨询的最常见原因，医院的专家经常被要求提供管理指南，特别是在抗生素处方方面。本作者评估了 115 名全科医生在治疗 1089 名患有急性下呼吸道疾病（包括咳嗽）的成年人时与抗生素使用相关的因素。他们给四分之三的患者开了抗生素，但认为其中不到三分之一的患者明确需要使用抗生素，五分之一的患者需要使用 Mot。单变量分析显示，对于存在基础疾病、痰变色、呼吸短促、喘息、发烧、胸部检查体征和“其他因素”的老年患者，老年全科医生更频繁地开出抗生素。多变量逻辑回归证实了所有这些结果的独立影响，除了潜在疾病、呼吸短促和喘息的存在之外。 “其他因素”包括患者的“压力”和社会因素，以及全科医生的工作压力或之前与患者接触的经验。这些因素对处方有重要影响，特别是如果全科医生认为不需要使用抗生素。阿莫西林是首选（占总数的 58%），除非患者最近因同一疾病接受过抗生素治疗。广谱抗生素更常用于患有慢性肺部疾病、痰液变色、检查时出现胸部体征以及全科医生认为需要使用抗生素的患者。然而，这些抗生素也被用于 14% 的既往健康患者。全科医生使用各种各样的术语来描述疾病，缺乏一致性或结构。关于抗生素的使用和选择的决定以及全科医生做出决定的信心是患者、医生和疾病之间复杂的相互作用，不仅受到临床特征的影响，还受到当前问题的社会和心理因素的影响。当医院专家被要求就制定初级保健相关指南提供建议时，需要重视这些问题。
Respiratory symptoms are the most common cause of general practitioner (GP) consultation, and hospital-based specialists are often called on to provide management guidelines, particularly in the area of antibiotic prescribing. The present authors have assessed factors associated with antibiotic use by 115 GPs when managing 1089 adults with an acute lower respiratory tract illness, including cough. They prescribed antibiotics to three-quarters of patients, but felt antibiotics to be definitely indicated in less than one-third of these cases and Mot needed in one-fifth. Univariate analysis revealed that antibiotics were prescribed more frequently by older GPs for older patients in the presence of underlying disease, discoloured sputum, shortness of breath, wheeze, fever, signs on chest examination, and 'other factors'. Multivariate logistic regression confirmed an independent effect for all these findings except for the presence of underlying disease, shortness of breath and wheeze. 'Other factors' included patient 'pressure' and social factors, and GP work pressure or prior experience with the patient. These factors were an important influence on prescribing, especially if the GP felt an antibiotic was not indicated.Amoxycillin was the first choice (58% of total) except where the patient had recently received antibiotics for the same illness. Broader spectrum antibiotics were used more commonly in patients with chronic lung disease, discoloured sputum, chest signs on examination and where the GP felt antibiotics were indicated. However, these antibiotics were also prescribed to 14% of previously well patients. General practitioners used a wide variety of terms to describe the illness with little consistency or structure.The decision concerning the use and choice of antibiotics and the confidence with which the GP makes that decision is a complex interaction between patient, doctor and disease, being affected not only by clinical features but also by the social and psychological elements of the presenting problem. Such issues need to be appreciated by hospital specialists when called on to advise on developing relevant guidelines for primary care.