Changing use of antibiotics in community-based outpatient practice, 1991-1999
Changing use of antibiotics in community-based outpatient practice, 1991-1999
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DOI：
10.7326/0003-4819-138-7-200304010-00008
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发表时间：
2003-04-01
影响因子：
39.2
通讯作者：
Landefeld, CS
中科院分区：
文献类型：
--
作者：
Steinman, MA;Gonzales, R;Landefeld, CS
背景：合理使用抗生素可以减缓耐药性的传播。然而，门诊患者抗生素使用的总体模式尚不清楚。目的：研究美国门诊抗生素使用模式，重点关注广谱抗生素。设计：三个2年期的横断面调查（1991 - 1992年、1994 - 1995年和1998 - 1999年）。背景：全国门诊医疗调查，社区门诊就诊的全国代表性样本。患者：患者访问以社区为基础的门诊诊所。测量：总的抗生素使用率和使用广谱抗生素（阿奇霉素和克拉霉素，喹诺酮类，阿莫西林-克拉维酸，第二代和第三代头孢菌素）。结果：1991 - 1992年和1998 - 1999年，抗生素在治疗急性呼吸道感染（如感冒和咽炎）中的使用频率较低。然而，广谱药物的使用在成人中从24%增加到48%（P <0.001），在儿童中从23%增加到40%（P <0.001）。广谱抗生素的使用在许多情况下都有所增加，在成人和儿童的各种诊断中，抗生素总使用量的百分比增加了两到三倍。到1998年至1999年，22%的成人和14%的儿科处方广谱抗生素的普通感冒，不明上呼吸道感染，急性支气管炎，条件，主要是viral.Conclusions：抗生素的使用在门诊患者在美国正在减少。然而，医生们越来越多地转向昂贵的广谱药物，即使它们的使用几乎没有临床依据。
Background: Judicious use of antibiotics can slow the spread of antimicrobial resistance. However, overall patterns of antibiotic use among ambulatory patients are not well understood.Objective: To study patterns of outpatient antibiotic use in the United States, focusing on broad-spectrum antibiotics.Design: Cross-sectional survey in three 2-year periods (1991-1992, 1994-1995, and 1998-1999).Setting: The National Ambulatory Medical Care Survey, a nationally representative sample of community-based outpatient visits.Patients: Patients visiting community-based outpatient clinics.Measurements: Rates of overall antibiotic use and use of broad-spectrum antibiotics (azithromycin and clarithromycin, quinolones, amoxicillin-clavulanate, and second- and third-generation cephalosporins). All comparisons were made between the first study period (1991-1992) and the final study period (1998-1999).Results: Between 1991-1992 and 1998-1999, antibiotics were used less frequently to treat acute respiratory tract infections, such as the common cold and pharyngitis. However, use of broad-spectrum agents increased from 24% to 48% of antibiotic prescriptions in adults (P < 0.001) and from 23% to 40% in children (P < 0.001). Use of broad-spectrum antibiotics increased across many conditions, increasing two- to threefold as a percentage of total antibiotic use for a variety of diagnoses in both adults and children. By 1998-1999, 22% of adult and 14% of pediatric prescriptions for broad-spectrum antibiotics were for the common cold, unspecified upper respiratory tract infections, and acute bronchitis, conditions that are primarily viral.Conclusions: Antibiotic use in ambulatory patients is decreasing in the United States. However, physicians are increasingly turning to expensive, broad-spectrum agents, even when there is little clinical rationale for their use.