Antimicrobial use for pediatric upper respiratory infections: Reported practice, actual practice, and parent beliefs
Antimicrobial use for pediatric upper respiratory infections: Reported practice, actual practice, and parent beliefs
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DOI：
10.1542/peds.104.6.1251
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发表时间：
1999-12-01
期刊：
影响因子：
8
通讯作者：
Schwartz, B
中科院分区：
文献类型：
--
作者：
Watson, RL;Dowell, SF;Schwartz, B
背景资料。为了应对耐药肺炎球菌的戏剧性出现，提倡更明智地使用抗生素。医生的信念，他们的处方实践，以及患者的态度之前已经在单独的研究中进行了评估。这项由三部分组成的研究包括全州范围内的邮寄调查、办公室图表审查和家长电话采访。我们比较了佐治亚州366名执业儿科医生和家庭医生对最近发表的关于诊断和治疗上呼吸道感染(URI)的建议的调查反应。我们进一步评估了从亚特兰大大都市区119名接受调查的儿科医生中随机挑选的25名儿科医生。对于每个人，随机选择日期看到的前30名年龄在12到72个月之间的患者的图表都被审查了前一年的相遇情况。每次实习的家长都接受了电话采访。在调查中，医生们一致认为过度使用抗生素是导致抗生素耐药性产生的主要因素(97%)，他们在决定为儿童URI提供抗生素治疗时应考虑选择性耐药性压力(83%)。然而，许多报道的做法并不符合最近公布的明智使用抗生素的原则。例如，69%的医生认为化脓性鼻炎是鼻窦炎的诊断结果；86%的医生认为无论咳嗽持续时间如何，都会给支气管炎开抗生素；42%的医生会给普通感冒开抗生素。家庭医生报告的做法更多地与发表的原则不符：他们明显比儿科医生更有可能省略气动耳镜检查(46%比25%)；省略诊断鼻窦炎的延长症状的要求(中位数4vs10天)；以及省略咽炎的实验室检测(27%vs14%)。在图表回顾中分析的7531次接触中，43%的人开出了抗生素处方，其中11%的检查、18%的电话和72%的URI就诊。在25名医生中，抗生素的总体使用率差异很大(每个儿童每年1-10个疗程)。一些诊断的特异率有更大的差异，特别是支气管炎和鼻窦炎。那些抗生素处方率最高的人回访办公室的次数高达30%。为化脓性鼻炎开抗生素的医生更有可能去看那些认为他们的孩子应该接受感冒症状评估的父母。医生认识到抗生素耐药性的问题，但他们报告的做法与最近发表的针对大多数儿科URI的建议不一致。儿科医生的实际处方做法往往与他们的亲密同事有很大不同。患者的信念与他们自己的医生的做法相关。
Background. In response to the dramatic emergence of resistant pneumococci, more judicious use of antibiotics has been advocated. Physician beliefs, their prescribing practices, and the attitudes of patients have been evaluated previously in separate studies.Methods. This 3-part study included a statewide mailed survey, office chart reviews, and parent telephone interviews. We compared survey responses of 366 licensed pediatricians and family physicians in Georgia to recently published recommendations on diagnosis and treatment of upper respiratory infections (URIs). We further evaluated 25 randomly selected pediatricians from 119 surveyed in the Atlanta metropolitan area. For each, charts from the first 30 patients between the ages of 12 and 72 months seen on a randomly selected date were reviewed for encounters during the preceding year. A sample of parents from each practice were interviewed by telephone.Results. In the survey, physicians agreed that overuse of antibiotics is a major factor contributing to the development of antibiotic resistance (97%), and that they should consider selective pressure for resistance in their decisions on providing antibiotic treatment for URIs in children in their practices (83%). However, many reported practices do not conform to the recently published principles for judicious antibiotic use. For example, 69% of physicians considered purulent rhinitis a diagnostic finding for sinusitis; 86% prescribed antibiotics for bronchitis regardless of the duration of cough; and 42% prescribed antibiotics for the common cold. Reported practices by family physicians were more often at odds with the published principles: they were significantly more likely than pediatricians to omit pneumatic otoscopy (46% vs 25%); to omit the requirement for prolonged symptoms to diagnose sinusitis (median 4 vs 10 days); and to omit laboratory testing for pharyngitis (27% vs 14%). Of the 7531 encounters analyzed in the chart review, 43% resulted in an antibiotic prescription, including 11% of checkups, 18% of telephone calls, and 72% of visits for URIs. There was wide variability in the overall antibiotic use rates among the 25 physicians (1-10 courses per child per year). There was an even wider variability in some diagnosis-specific rates; bronchitis and sinusitis in particular. Those with the highest antibiotic prescribing rates had up to 30% more return office visits. Physicians who prescribed antibiotics for purulent rhinitis were more likely to see parents who believed that their children should be evaluated for cold symptoms.Conclusions. Physicians recognize the problem of antibiotic resistance but their reported practices are not in line with recently published recommendations for most pediatric URIs. The actual prescribing practices of pediatricians are often considerably different from their close colleagues. Patient beliefs are correlated with their own physician's practices.