Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections
Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections
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DOI：
10.1001/archpedi.156.11.1114
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发表时间：
2002-11-01
影响因子：
--
通讯作者：
Kelleher, KJ
中科院分区：
文献类型：
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作者：
Nash, DR;Harman, J;Kelleher, KJ
目的：确定近年来在治疗儿童支气管炎、病毒性上呼吸道感染、鼻窦炎、中耳炎和咽炎时适当使用抗生素的比率是否发生了变化，并确定与使用不适当抗生素治疗相关的因素。设计：国家门诊医疗调查被用来检查提供初级保健的医生的抗菌药物处方习惯，孩子数据分析从1995年至1998年。设置：以儿科为基础的医生实践。参与者：儿科医生，家庭医生和全科医生，填写调查表，为18岁以下的患者。主要结果测量：抗生素的适当使用上呼吸道感染。结果：多变量分析用于检查与使用不适当的抗生素治疗上呼吸道感染或支气管炎与1995年的患者相比，1998年诊断为上呼吸道感染的患者接受抗生素治疗的可能性低0.69倍（95%置信区间，0.59-0.81）。多变量分析也用于评估与使用抗生素治疗鼻窦炎或中耳炎的次优治疗特征相关的因素。1998年诊断为鼻窦炎或中耳炎的儿童使用疗效不佳的抗生素的可能性是1995年的0.3倍（95%可信区间[CI]，0.16-0.48）。结论：医生正在慢慢改善抗生素处方模式，但使用不适当的抗生素仍然很常见。几乎一半的上呼吸道感染患者接受抗生素治疗。
Objectives: To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy.Design: The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998.Setting: Office-based physician practices.Participants: Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years.Main Outcome Measure: The appropriate use of antibiotics for upper respiratory tract infections.Results: Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995.Conclusions: Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.