Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis
Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis
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DOI：
10.1001/jama.279.11.875
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发表时间：
1998-03-18
影响因子：
120.7
通讯作者：
Sande, MA
中科院分区：
文献类型：
--
作者：
Nyquist, AC;Gonzales, R;Sande, MA
背景-抗药性细菌的传播与抗生素的使用有关。儿童每年接受相当大比例的抗生素处方，并且是旨在减少不必要抗生素使用的努力的重要目标群体。目的-评估18岁以下被诊断为感冒、上呼吸道感染(URI)的儿童的抗生素处方做法，设计--对参加1992年全国门诊医疗保健调查的执业医生进行的具有代表性的全国性调查，回应率为73%。设置-以办公室为基础的医生实践。参与者。-医生为18岁以下的患者填写患者记录表。主要结果衡量标准。-主要诊断和抗生素处方。结果-总共记录了531次儿科办公室就诊，其中主要诊断为感冒、URI或支气管炎，44%的普通感冒患者、46%的URI患者和75%的支气管炎患者开了抗生素。推算到美国，650万张处方(占所有儿童处方的12%)是为被诊断为患有URI或鼻咽炎(普通感冒)的儿童开的，470万张(占所有儿童处方的9%)是为被诊断为支气管炎的儿童开的。在控制了混杂因素后，5至11岁的儿童使用抗生素的频率高于年龄较小的儿童(优势比[OR]，1.94；95%可信区间[CI]，1.13-3.33)，儿科医生的比例低于非儿科医生(OR，0.57；95%CI，0.35-0.92)，0至4岁儿童收到的抗生素处方占所有抗生素处方的53%，中耳炎是最常见的抗生素处方(占所有处方的30%)。结论-为被诊断为感冒、URI和支气管炎的儿童开抗生素处方，这些情况通常不会受益于抗生素，占美国儿童每年抗生素处方总数的相当大比例。
Context.-The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use.Objective.-To evaluate antibiotic-prescribing practices for children younger than 18 years who had received a diagnosis of cold, upper respiratory tract infection (URI), or bronchitis in the United States.Design.-Representative national survey of practicing physicians participating in the National Ambulatory Medical Care Survey conducted in 1992 with a response rate of 73%.Setting.-Office-based physician practices.Participants.-Physicians completing patient record forms for patients younger than 18 years.Main Outcome Measures.-Principal diagnoses and antibiotic prescriptions.Results.-A total of 531 pediatric office visits were recorded that included a principal diagnosis of cold, URI, or bronchitis, Antibiotics were prescribed to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis. Extrapolating to the United States, 6.5 million prescriptions (12% of all prescriptions for children) were written for children diagnosed as having a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions for children) were written for children diagnosed as having bronchitis. After controlling for confounding factors, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92), Children aged 0 to 4 years received 53% of all antibiotic prescriptions, and otitis media was the most frequent diagnosis for which antibiotics were prescribed (30% of all prescriptions).Conclusions.-Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.