Gonzales R, Bartlett J G, Besser R E, Cooper R J, Hickner J M, Hoffman J R, Sande M A
Divisin of General Internal Medicine, University of Colorado Health Sciences Center, Denver, 80262, USA.
Ann Emerg Med. 2001 Jun;37(6):690-7.
The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae. The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold). For each of these conditions--especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)--a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults." These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.This paper describes the background and specific aims of and methods used to develop these principles. The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question.
耐抗生素肺炎链球菌的流行加剧，使得减少门诊过度使用抗生素的需求更为迫切。在美国，门诊为成年人开具的抗生素大多用于治疗急性鼻窦炎、急性咽炎、急性支气管炎及非特异性上呼吸道感染（包括普通感冒）。对于这些病症中的每一种——尤其是感冒、非特异性上呼吸道感染和急性支气管炎（不建议常规使用抗生素治疗）——所开具的抗生素中有很大一部分不太可能给患者带来临床益处。鉴于减少社区抗生素使用是应对社区获得性耐抗生素感染增加的一项重要策略，美国疾病控制与预防中心召集了一个由来自内科、家庭医学、急诊医学和传染病学领域的医生组成的小组，以制定一系列“成人急性呼吸道感染的合理抗生素使用原则”。这些原则为评估和治疗患有急性呼吸道疾病的成年人提供了循证建议。本文介绍了这些原则的背景、具体目标以及制定过程中所采用的方法。这些原则的目标是为临床医生提供实用策略，以便将抗生素使用限制在最可能从中受益的患者身上。这些原则应与有效的患者教育活动以及改善医疗服务体系相结合使用，后者有助于对相关病症进行非抗生素治疗。
