Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention
Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention
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DOI：
10.7326/m15-1840
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发表时间：
2016-03-15
影响因子：
39.2
通讯作者：
Qaseem, Amir
中科院分区：
文献类型：
--
作者：
Harris, Aaron M.;Hicks, Lauri A.;Qaseem, Amir
背景：急性呼吸道感染（阿尔蒂）是成人抗生素处方的最常见原因。阿尔蒂患者经常不适当地使用抗生素。本文介绍了健康成人（那些没有慢性肺部疾病或免疫功能低下的条件）提出与阿尔蒂. Methods的抗生素使用的最佳实践：一个叙述性文献综述的证据，适当的抗生素使用阿尔蒂在成人进行。来自专业协会的最新临床指南得到了荟萃分析、系统评价和随机临床试验的补充。为了识别循证文献，使用以下医学主题词检索了截至2015年9月的科克伦图书馆、PubMed、MEDLINE和EMBASE："急性支气管炎"、"呼吸道感染"、"咽炎"、"鼻窦炎"和"普通感冒"。"高价值护理建议1：临床医生不应对支气管炎患者进行检测或开始抗生素治疗，除非怀疑有肺炎。高价值护理建议2：临床医生应该对有提示A组链球菌性咽炎症状的患者进行检测（例如，持续发烧，颈前淋巴结炎，和扁桃体咽部渗出物或其他适当的症状组合）。只有在确诊为链球菌性咽炎的情况下，临床医生才应使用抗生素治疗患者。临床医生应保留抗生素治疗急性鼻窦炎的患者持续症状超过10天，发病严重的症状或体征的高热（> 39摄氏度）和脓性鼻涕或面部疼痛持续至少连续3天，或在典型的病毒性疾病持续5天后症状恶化，最初症状改善（双重恶心）。高价值护理建议4：临床医生不应为普通感冒患者开抗生素。
Background: Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.Methods: A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold."High-Value Care Advice 1: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.High-Value Care Advice 2: Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.High-Value Care Advice 3: Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 degrees C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).High-Value Care Advice 4: Clinicians should not prescribe antibiotics for patients with the common cold.