Linder J A, Stafford R S
General Medicine Division, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA.
JAMA. 2001 Sep 12;286(10):1181-6. doi: 10.1001/jama.286.10.1181.
Most sore throats are due to viral upper respiratory tract infections. Group A beta-hemolytic streptococci (GABHS), the only common cause of sore throat warranting antibiotics, is cultured in 5% to 17% of adults with sore throat. The frequency of antibiotic use for pharyngitis has greatly exceeded the prevalence of GABHS, but less is known about specific classes of antibiotics used. Only penicillin and erythromycin are recommended as first-line antibiotics against GABHS.
To measure trends in antibiotic use for adults with sore throat and to determine predictors of antibiotic use and nonrecommended antibiotic use.
DESIGN, SETTING, AND SUBJECTS: Retrospective analysis of 2244 visits to primary care physicians in office-based practices in the National Ambulatory Medical Care Survey, 1989-1999, by adults with a chief complaint of sore throat.
Treatment with antibiotics and treatment with nonrecommended antibiotics, extrapolated to US annual national rates.
There were an estimated 6.7 million annual visits in the United States by adults with sore throat between 1989 and 1999. Antibiotics were used in 73% (95% confidence interval [CI], 70%-76%) of visits. Patients treated with antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%) of visits. From 1989 to 1999, there was a significant decrease in use of penicillin and erythromycin and an increase in use of nonrecommended antibiotics, especially extended-spectrum macrolides and extended-spectrum fluoroquinolones (P<.001 for all trends). In multivariable modeling, increasing patient age (odds ratio [OR], 0.86 per decade; 95% CI, 0.79-0.94) and general practice specialty (OR, 1.54 compared with family practice specialty; 95% CI, 1.10-2.14) were independent predictors of antibiotic use. Among patients receiving antibiotics, nonrecommended antibiotic use became more frequent over time (OR, 1.17 per year; 95% CI, 1.11-1.24).
More than half of adults are treated with antibiotics for sore throat by community primary care physicians. Use of nonrecommended, more expensive, broader-spectrum antibiotics is frequent.
大多数咽喉痛是由病毒性上呼吸道感染引起的。A组β溶血性链球菌（GABHS）是唯一需要使用抗生素治疗的常见咽喉痛病因，在5%至17%的咽喉痛成人患者中可培养出该病菌。咽炎的抗生素使用频率大大超过了GABHS的患病率，但对于具体使用的抗生素类别了解较少。仅推荐青霉素和红霉素作为抗GABHS的一线抗生素。
衡量成人咽喉痛患者抗生素使用的趋势，并确定抗生素使用及不推荐使用抗生素的预测因素。
设计、场所和研究对象：对1989 - 1999年全国门诊医疗护理调查中以咽喉痛为主诉的成人患者到基层医疗医生办公室就诊的2244例进行回顾性分析。
抗生素治疗及不推荐使用的抗生素治疗情况，推算为美国每年的全国发生率。
1989年至1999年期间，美国成人咽喉痛患者每年估计就诊670万次。73%（95%置信区间[CI]，70% - 76%）的就诊患者使用了抗生素。接受抗生素治疗的患者中，68%（95%CI，64% - 72%）的就诊使用了不推荐的抗生素。从1989年到1999年，青霉素和红霉素的使用显著减少，不推荐使用的抗生素使用增加，尤其是广谱大环内酯类和广谱氟喹诺酮类（所有趋势P<0.001）。在多变量模型中，患者年龄增加（比值比[OR]，每十年0.86；95%CI，0.79 - 0.94）和全科医学专业（与家庭医学专业相比，OR为1.54；95%CI，1.10 - 2.14）是抗生素使用的独立预测因素。在接受抗生素治疗的患者中，不推荐使用抗生素的情况随时间变得更加频繁（OR，每年1.17；95%CI，1.11 - 1.24）。
社区基层医疗医生对超过一半的咽喉痛成人患者使用了抗生素。不推荐使用、更昂贵、更广谱的抗生素使用频繁。
