Antiviral and antibiotic prescribing for influenza in primary care.
Antiviral and antibiotic prescribing for influenza in primary care.
复制标题
初级保健中针对流感的抗病毒和抗生素处方。
DOI：
10.1007/s11606-009-0933-9
复制
发表时间：
2009
影响因子：
5.7
通讯作者：
Blumentals,WilliamA
中科院分区：
文献类型：
--
作者：
Linder,JeffreyA;Nieva,HarryReyes;Blumentals,WilliamA
BACKGROUNDAnti-influenza antiviral medications reduce influenza-related morbidity, but may often be used inappropriately.OBJECTIVETo measure the rate of antiviral and antibiotic prescribing, the appropriateness of antiviral prescribing, and evaluate independent predictors of antiviral and antibiotic prescribing for influenza in primary care.DESIGN AND PATIENTSRetrospective analysis of 958 visits of clinician-diagnosed influenza in 21 primary care clinics in eastern Massachusetts from 1999 to 2007. We considered antiviral prescribing appropriate if patients had symptoms for 2 or fewer days, had fever, and any 2 of headache, sore throat, cough, or myalgias.MEASUREMEMTS AND MAIN RESULTSClinicians prescribed antivirals in 557 (58%) visits and antibiotics in 104 visits (11%). Of antiviral prescriptions, 38% were not appropriate, most commonly because of symptoms for more than 2 days (24% of antiviral prescriptions). In multivariate modeling, selected independent predictors of antiviral prescribing were symptom duration of 2 or fewer days (odds ratio [OR], 12.4; 95% confidence interval [CI], 8.3 to 18.6), year (OR, 1.4 for each successive influenza season; 95% CI, 1.3 to 1.7), patient age (OR, 1.3 per decade; 95% CI, 1.2 to 1.5), and, compared to having no influenza testing, having a negative influenza test (OR, 5.5; 95% CI, 3.4 to 9.1) or a positive influenza test (OR, 11.4; 95% CI, 6.7 to 19.3). Independent predictors of antibiotic prescribing included otoscopic abnormalities (OR, 3.3; 95% CI, 1.8 to 6.0), abnormal lung examination (OR, 4.0; 95% CI, 2.1 to 6.2), and having a chest x-ray performed (OR, 2.2; 95% CI, 1.3 to 3.8).CONCLUSIONSPrimary care clinicians are much more likely to prescribe antivirals to patients with symptoms for 2 or fewer days, but also commonly prescribe antivirals inappropriately.
