Takemura Y, Ebisawa K, Kakoi H, Saitoh H, Kure H, Ishida H, Kure M
Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
J Clin Pathol. 2005 Jul;58(7):729-33. doi: 10.1136/jcp.2004.024356.
Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community.
AIM/METHODS: The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).
In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups.
The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.
广谱抗生素的过度使用与社区中耐药菌株的传播有关。
目的/方法：在急性感染患者中，研究立即检测C反应蛋白（CRP）和白细胞计数（WBC）对医生选择抗生素的影响。急性发热的新门诊患者被随机分为两组：第1组（147例患者）在初次会诊前进行CRP和WBC检测（提前检测）。将其处方与第2组（无提前检测；154例患者）的处方进行比较。
在非肺炎性急性呼吸道感染中，第1组和第2组分别有61例（58%）和122例（91%）患者使用了抗生素。头孢丙烯匹伏酯（第三代头孢菌素）和阿莫西林分别是第1组和第2组最常选用的药物。第1组中新型广谱抗生素（头孢丙烯匹伏酯和克拉霉素（新一代大环内酯类））的总处方量减少了25%，尽管由于阿莫西林处方量的减少，其使用率有所上升（41例（67%）对55例（45%）处方）。在第1组中，当白细胞值大于9×10⁹/升时，优先选择头孢丙烯匹伏酯。白细胞不增多的患者处方转向大环内酯类（主要是克拉霉素）。两组患者的治疗结果无显著差异。
初次会诊时可获得CRP和WBC数据，这大大减少了阿莫西林的处方量，但对新型、强效、广谱抗生素的影响较小。
