Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care
Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care
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DOI：
10.1093/jac/dkx502
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发表时间：
2018-02-01
影响因子：
5.2
通讯作者：
Smieszek, Timo
中科院分区：
文献类型：
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作者：
Pouwels, Koen B.;Dolk, F. Christiaan K.;Smieszek, Timo
先前基于指南和专家意见的工作确定了“理想”处方比例-应导致抗生素处方的咨询的总体比例-用于常见传染病。在这里，实际情况下，具体的处方比例在初级保健在英格兰比较理想的处方比例确定的专家。所有2013- 2015年常见感染性疾病（咳嗽、支气管炎、哮喘或慢性阻塞性肺病加重、喉咙痛、鼻窦炎、中耳炎、下呼吸道感染、上呼吸道感染、流感样疾病、尿路感染、脓疱疮、痤疮、胃肠炎）的问诊记录均提取自The Health Improvement Network （THIN）数据库。确定了导致抗生素处方的咨询比例，集中在没有相关合并症的患者的急性表现。然后将这些实际处方比例与先前建立的“理想”比例进行比较。在大多数情况下，咨询导致抗生素处方的比例大大高于根据专家意见认为适当的比例。在所有急性咳嗽咨询中，有41%的人开了抗生素，而专家建议的比例为10%。对于其他疾病，比例为：支气管炎（实际82%对理想13%）；喉咙痛（实际59%，理想13%）；鼻窦炎（实际88%，理想11%）；2至18岁的急性中耳炎（实际为92%，理想为17%）。在实践之间发现了很大的差异。这项工作已经确定了英国初级保健中抗生素的大量过量处方，并强调了这种情况最明显的情况，特别是呼吸道疾病。
Previous work based on guidelines and expert opinion identified 'ideal' prescribing proportions-the overall proportion of consultations that should result in an antibiotic prescription-for common infectious conditions. Here, actual condition-specific prescribing proportions in primary care in England were compared with ideal prescribing proportions identified by experts.All recorded consultations for common infectious conditions (cough, bronchitis, exacerbations of asthma or chronic obstructive pulmonary disease, sore throat, rhinosinusitis, otitis media, lower respiratory tract infection, upper respiratory tract infection, influenza-like illness, urinary tract infection, impetigo, acne, gastroenteritis) for 2013-15 were extracted from The Health Improvement Network (THIN) database. The proportions of consultations resulting in an antibiotic prescription were established, concentrating on acute presentations in patients without relevant comorbidities. These actual prescribing proportions were then compared with previously established 'ideal' proportions by condition.For most conditions, substantially higher proportions of consultations resulted in an antibiotic prescription than was deemed appropriate according to expert opinion. An antibiotic was prescribed in 41% of all acute cough consultations when experts advocated 10%. For other conditions the proportions were: bronchitis (actual 82% versus ideal 13%); sore throat (actual 59% versus ideal 13%); rhinosinusitis (actual 88% versus ideal 11%); and acute otitis media in 2- to 18-year-olds (actual 92% versus ideal 17%). Substantial variation between practices was found.This work has identified substantial overprescribing of antibiotics in English primary care, and highlights conditions where this is most pronounced, particularly in respiratory tract conditions.