McIsaac W J, Goel V, To T, Low D E
Family Medicine Centre, Mount Sinai Hospital, Toronto, Ont.
CMAJ. 2000 Oct 3;163(7):811-5.
Reducing the number of antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a previously published clinical score for the management of infections of the upper respiratory tract accompanied by sore throat. The study also examined the potential impact of this clinical score on the prescribing of antibiotics in community-based family practice.
A total of 97 family physicians in 49 Ontario communities assessed 621 children and adults with a new infection of the upper respiratory tract accompanied by sore throat and recorded their prescribing decisions. A throat swab was obtained for culture. The sensitivity and specificity of the score approach in this population were compared with previously published results for patients seen at an academic family medicine centre. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations.
Of the 621 cases of new upper respiratory tract infection and sore throat, information about prescriptions given was available for only 619; physicians prescribed antibiotics in 173 (27.9%) of these cases. Of the 173 prescriptions, 109 (63.0%) were given to patients with culture-negative results for group A Streptococcus. Using the score to determine management would have reduced prescriptions to culture-negative patients by 63.7% and overall antibiotic prescriptions by 52.3% (both p < 0.01). Culturing of throat samples would have been reduced by 35.8% (p < 0.01). There was no statistically significant difference in the sensitivity or specificity of the score approach between this community-based population (sensitivity 85.0%, specificity 92.1%) and an academic family medicine centre (sensitivity 83.1%, specificity 94.3%).
An explicit clinical score approach to the management of patients presenting with an upper respiratory tract infection and sore throat is valid in community-based family practice and could substantially reduce the unnecessary prescribing of antibiotics for these conditions.
减少常见呼吸道感染的抗生素处方数量被推荐为限制细菌耐药性的一种方法。本研究评估了先前发表的用于管理伴有咽痛的上呼吸道感染的临床评分的有效性。该研究还考察了这一临床评分对社区家庭医疗中抗生素处方开具的潜在影响。
安大略省49个社区的97名家庭医生评估了621名患有新发上呼吸道感染并伴有咽痛的儿童和成人，并记录了他们的处方决策。采集咽喉拭子进行培养。将该评分方法在这一人群中的敏感性和特异性与先前在学术性家庭医学中心就诊患者的发表结果进行比较。此外，将医生的处方行为及其获取咽喉拭子的建议与基于评分的建议进行比较。
在621例新发上呼吸道感染和咽痛病例中，仅619例有关于所开处方的信息；医生在其中173例（27.9%）中开具了抗生素。在这173张处方中，109例（63.0%）给予了A组链球菌培养结果为阴性的患者。使用该评分来确定治疗方案可使培养结果为阴性的患者的处方减少63.7%，总体抗生素处方减少52.3%（均p<0.01）。咽喉样本的培养可减少35.8%（p<0.01）。该社区人群（敏感性85.0%，特异性92.1%）与学术性家庭医学中心（敏感性83.1%，特异性94.3%）之间，评分方法的敏感性或特异性无统计学显著差异。
对于出现上呼吸道感染和咽痛的患者，明确的临床评分方法在社区家庭医疗中是有效的，并且可以大幅减少这些情况下不必要的抗生素处方。
