Gonzales R, Malone D C, Maselli J H, Sande M A
Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA.
Clin Infect Dis. 2001 Sep 15;33(6):757-62. doi: 10.1086/322627. Epub 2001 Aug 21.
Estimating the amount and cost of excess antibiotic use in ambulatory practice and identifying the conditions that account for most excess use are necessary to guide intervention and policy decisions. Data from the 1998 National Ambulatory Medical Care Survey, a sample survey of United States ambulatory physician practices, was used to estimate primary care office visits and antibiotic prescription rates for acute respiratory infections. Weight-averaged antibiotic costs were calculated with use of 1996 prescription marketing data and adjusted for inflation. In 1998, an estimated 76 million primary care office visits for acute respiratory infections resulted in 41 million antibiotic prescriptions. Antibiotic prescriptions in excess of the number expected to treat bacterial infections amounted to 55% (22.6 million) of all antibiotics prescribed for acute respiratory infections, at a cost of approximately $726 million. Upper respiratory tract infections (not otherwise specified), pharyngitis, and bronchitis were the conditions associated with the greatest amount of excess use. This study documents that the amount and cost of excessive antibiotic use for acute respiratory infections by primary care physicians are substantial and establishes potential target rates for antibiotic treatment of selected conditions.
估算门诊医疗中抗生素过度使用的数量和成本，并确定导致大部分过度使用的疾病，对于指导干预措施和政策决策是必要的。1998年全国门诊医疗调查的数据来自对美国门诊医生执业情况的抽样调查，用于估算急性呼吸道感染的初级保健门诊就诊次数和抗生素处方率。使用1996年的处方销售数据计算加权平均抗生素成本，并对通货膨胀进行调整。1998年，估计有7600万次因急性呼吸道感染进行的初级保健门诊就诊导致了4100万份抗生素处方。超过预期治疗细菌感染数量的抗生素处方占所有急性呼吸道感染抗生素处方的55%（2260万份），成本约为7.26亿美元。上呼吸道感染（未另作说明）、咽炎和支气管炎是与过度使用量最大相关的疾病。这项研究表明，初级保健医生对急性呼吸道感染过度使用抗生素的数量和成本相当可观，并确定了特定疾病抗生素治疗的潜在目标率。
