Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians
Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians
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DOI：
10.1001/jama.278.11.901
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发表时间：
1997-09-17
影响因子：
120.7
通讯作者：
Sande, MA
中科院分区：
文献类型：
--
作者：
Gonzales, R;Steiner, JF;Sande, MA
康泰克斯抗生素的使用与耐药性微生物的增加有关。先前的一项研究表明，感冒、上呼吸道感染和支气管炎占门诊医生所有抗生素处方的近三分之一。对于这些情况，抗生素的使用频率以及使用者和使用者尚不清楚。测量抗生素处方率，并确定美国诊断为感冒，上呼吸道感染和支气管炎的成年人使用抗生素的预测因素。参加1992年全国门诊医疗保健调查的执业医师的抽样调查。基于医学的实践。主题。-医生（n=1529）填写成人门诊患者记录表（n=28787）。主要结果测量。感冒、上呼吸道感染和支气管炎的抗生素处方。因感冒、上呼吸道感染和支气管炎就诊导致约1200万份抗生素处方，占1992年成人所有抗生素处方的21%。共有51%的诊断为感冒的患者，52%的诊断为上呼吸道感染的患者和66%的诊断为支气管炎的患者接受了抗生素治疗。女性（比值比[OR]，1.65; 95%置信区间[CI]，1.05-2.62）和农村执业地点（OR，2.25; 95% CI，1.33-3.80）与较高的抗生素处方率相关，而黑人（OR，0.44; 95% CI，0.21-0.93）与较低的抗生素处方率相关。在双变量分析中，患者年龄、西班牙裔、地理区域、医生专业和支付来源与抗生素处方率无关。多变量logistic回归分析表明，只有农村地区（调整后OR为2.58，95%CI为1.39-4.76）与更频繁的感冒、上呼吸道感染和支气管炎抗生素处方独立相关。尽管抗生素对感冒、上呼吸道感染或支气管炎没有什么好处，但在美国，这些病症占了诊所医生开给成年人的抗生素处方的相当大的比例。抗生素的过度使用在地理区域、医疗专业和支付来源中普遍存在。因此，改变这些条件的处方行为的有效策略将需要广泛的基础。
Contex.-Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of all antibiotic prescribing by ambulatory care physicians. How frequently antibiotics are prescribed for these conditions and for and by whom is not known.Objectives.-To measure antibiotic prescription rates and to identify predictors of antibiotic use for adults diagnosed as having colds, upper respiratory tract infections, and bronchitis in the United States.Design.-Sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1992.Setting.-Office-based physician practices.Subjects.-Physicians (n=1529) completing patient record forms for adult office visits (n=28787).Main Outcome Measures.-Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis.Results.-Office visits for colds, upper respiratory tract infections, and bronchitis resulted in approximately 12 million antibiotic prescriptions, accounting for 21% of all antibiotic prescriptions to adults in 1992. A total of 51% of patients diagnosed as having colds, 52% of patients diagnosed as having upper respiratory tract infections, and 66% of patients diagnosed as having bronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibiotic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower antibiotic prescription rates. Patient age, Hispanic ethnicity, geographic region, physician specialty, and payment sources were not associated with antibiotic prescription rates in the bivariate analysis. Multivariate logistic regression analysis identified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to be independently associated with more frequent antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis.Conclusion.-Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States.; Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based.