Infectious diseases in primary care; managing the interface between the person and the community
Infectious diseases in primary care; managing the interface between the person and the community
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DOI：
10.3109/13814788.2012.680061
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发表时间：
2012-06-01
影响因子：
3.4
通讯作者：
Coenen, Samuel
中科院分区：
文献类型：
--
作者：
Coenen, Samuel
呼吸道感染仍然是初级保健中最常见的新诊断之一。最常见的原因是急性咳嗽。全科医生必须在诊断不确定、患者偏好和抗菌素耐药性的情况下作出抗生素处方决定。抗菌素耐药性与初级保健中的抗生素处方之间存在因果关系。GRACE观察性研究（www.grace-lrti.org）表明，临床表现的差异并不能解释欧洲初级保健中患有急性咳嗽的成人抗生素处方的巨大差异，并且使用任何抗生素、特定抗生素类别或不使用抗生素治疗的恢复情况相似。一项GRACE随机对照试验（RCT）研究了抗生素治疗急性咳嗽的效果，该试验招募的患者数量超过了Cochrane综述中所有随机对照试验的总和，并将有能力确定阿莫西林将（不）受益的患者亚组。另一项多国GRACE随机对照试验正在等待进行，评估主要基于网络的成功干预措施对抗生素处方的影响，包括c反应蛋白即时检测、沟通技巧培训和交互式患者手册。考虑到潜在的长期成本效益，GRACE系列观察性和干预性研究正在加强证据基础，以减少诊断的不确定性，并以患者为中心的方式管理患者的期望，以实现更多的循证抗生素处方，这可能有助于遏制抗菌素耐药性。
Respiratory infections are still among the most common new diagnoses in primary care. The most frequent reason for encounter is acute cough. General practitioners have to make antibiotic prescribing decisions in a context of diagnostic uncertainty, patient preferences and antimicrobial resistance. There is a causal link between antimicrobial resistance and antibiotic prescribing in primary care. GRACE observational studies (www.grace-lrti.org), show that variation in clinical presentation does not explain the considerable variation in antibiotic prescribing in Europe for adults presenting in primary care with acute cough and that recovery is similar between those treated with any antibiotic, a particular antibiotic class, or no antibiotic. A GRACE randomized controlled trial (RCT) of the effect of antibiotics for acute cough has recruited more patients than all RCTs combined in the current Cochrane Review and will have the power to identify subgroups of patients who will (not) benefit from amoxicillin. Another multi-country GRACE RCT assessing the effect on antibiotic prescribing of largely web-based versions of successful interventions including a C-reactive protein point-of-care test, a communication skill training and an interactive patient booklet is awaited. Given potential long-term cost-effectiveness, the GRACE suite of observational and interventional studies are enhancing the evidence base for reducing diagnostic uncertainty and managing patient expectations in a patient-centred way to achieve greater evidence-based antibiotic prescribing that is likely to help containing antimicrobial resistance.