Glauber J H, Fuhlbrigge A L, Finkelstein J A, Homer C J, Weiss S T
Clinical Effectiveness Program, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Chest. 2001 Nov;120(5):1485-92. doi: 10.1378/chest.120.5.1485.
Increasing morbidity due to asthma and antimicrobial resistance among human pathogens are both major public-health concerns. Numerous studies describe the overuse of antibiotics in general populations and underuse of anti-inflammatory medications by asthmatic patients. However, little is known about the relationship between asthma medication and antibiotic use in asthmatics. Specifically, we tested the hypothesis that higher use of bronchodilator and anti-inflammatory medication by asthmatics, as a marker of problematic asthma, is associated with greater antibiotic use. We also test the hypothesis that physicians who are low prescribers of anti-inflammatory medications are high prescribers of antibiotics.
We conducted a retrospective cohort study evaluating asthma medication and antibiotic use by children and adults with asthma and the prescribing of these medications by primary-care physicians.
SETTING/PATIENTS: Subjects were continuously enrolled asthma patients aged 6 to 55 years receiving care in an urban, group-model, health maintenance organization.
None.
Main outcome measures were (1) antibiotic use by asthmatics stratified by low, moderate, and high bronchodilator use; (2) antibiotic use by asthmatics stratified by no, intermittent, and long-term anti-inflammatory use; and (3) correlation between physician-level anti-inflammatory agent to bronchodilator ratio (AIF:BD) and their rate of antibiotic prescribing. We found that (1) high bronchodilator users received 1.72 antibiotics per person-year (95% confidence interval [CI], 1.62 to 1.83), whereas low bronchodilator users received 1.23 antibiotics per person-year (95% CI, 1.19 to 1.27; p < 0.0001); (2) long-term users of anti-inflammatory agents received 1.85 antibiotics per person-year (95% CI, 1.76 to 1.95), whereas those not receiving an anti-inflammatory agent received 0.95 antibiotics per person-year (95% CI, 0.90 to 1.00; p < 0.0001); and (3) despite variations in physician AIF:BDs and antibiotic prescribing, respectively, these measures were not correlated.
Antibiotic use and asthma medication use are positively associated in a cohort of asthma patients. Greater effort is needed to define the appropriate role of antibiotics in asthma management.
哮喘导致的发病率上升以及人类病原体中的抗菌药物耐药性都是主要的公共卫生问题。众多研究描述了普通人群中抗生素的过度使用以及哮喘患者抗炎药物的使用不足。然而，关于哮喘药物使用与哮喘患者抗生素使用之间的关系却知之甚少。具体而言，我们检验了以下假设：哮喘患者更高频率地使用支气管扩张剂和抗炎药物作为哮喘问题的一个标志，与更多的抗生素使用相关。我们还检验了另一个假设：抗炎药物处方量低的医生是抗生素高处方量医生。
我们进行了一项回顾性队列研究，评估哮喘儿童和成人的哮喘药物使用及抗生素使用情况，以及初级保健医生对这些药物的处方情况。
研究地点/患者：研究对象为在一家城市集团模式健康维护组织接受治疗的6至55岁持续性登记哮喘患者。
无。
主要结局指标为：(1) 根据支气管扩张剂使用量低、中、高对哮喘患者的抗生素使用情况进行分层；(2) 根据未使用、间歇性使用和长期使用抗炎药物对哮喘患者的抗生素使用情况进行分层；(3) 医生层面的抗炎药物与支气管扩张剂使用比例（AIF:BD）与其抗生素处方率之间的相关性。我们发现：(1) 支气管扩张剂高使用量患者每人每年使用1.72种抗生素（95%置信区间[CI]，1.62至1.83），而支气管扩张剂低使用量患者每人每年使用1.23种抗生素（95%CI，1.19至1.27；p<0.0001）；(2) 长期使用抗炎药物的患者每人每年使用1.85种抗生素（95%CI，1.76至1.95），而未使用抗炎药物的患者每人每年使用0.95种抗生素（95%CI，0.90至1.00；p<0.0001）；(3) 尽管医生的AIF:BD和抗生素处方情况各自存在差异，但这些指标并无相关性。
在一组哮喘患者中，抗生素使用与哮喘药物使用呈正相关。需要做出更大努力来明确抗生素在哮喘管理中的适当作用。
