教育干预对儿童上呼吸道感染抗生素处方行为的影响：一项多中心研究

Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study.

作者信息

Razon Yaron, Ashkenazi Shai, Cohen Avner, Hering Eli, Amzel Shlomo, Babilsky Hanan, Bahir Arie, Gazala Eli, Levy Itzhak

机构信息

Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tiqva 49202, Israel.

出版信息

J Antimicrob Chemother. 2005 Nov;56(5):937-40. doi: 10.1093/jac/dki339. Epub 2005 Sep 27.

DOI:10.1093/jac/dki339

PMID:16188917

Abstract

OBJECTIVES

To evaluate the impact of an educational intervention on judicious antibiotic prescription for upper respiratory diseases in children.

METHODS

A multicentre before-and-after study was conducted in five major community child healthcentres in Israel. Antibiotic prescription data were collected for all visits of patients aged 3 months to 18 years with a diagnosis of acute otitis media, tonsillopharyngitis, sinusitis or upper respiratory tract infection from November 1999 through February 2000 (pre-intervention period) and from November 2000 through February 2001 (post-intervention period). The intervention consisted of a 1 day seminar on the diagnosis and judicious treatment of respiratory tract infections in children according to the recommendations of the Centers of Disease Control and Prevention. The patient files were reviewed for patient characteristics, specific respiratory disease, and specific antibiotics prescribed. The main outcome measures were the rates and appropriateness of antibiotic prescribing for the different respiratory diseases before and after an educational intervention for practising paediatricians.

RESULTS

A total of 4580 clinic visits were eligible for analysis in the pre-intervention period and 4364 in the post-intervention period. From the pre- to the post-intervention period, the odds ratio for appropriate antibiotic treatment was 1.8 for acute otitis media (95% CI 1.52-2.11, P < 0.01) and 1.35 for pharyngitis (95% CI 1.13-1.61, P < 0.01). Overall, use of antibiotics for acute otitis media decreased from 93% to 87.4% (P < 0.05), and for upper respiratory tract infection, from 13.8% to 11.5% (P < 0.05). There were no significant changes in these factors for sinusitis.

CONCLUSIONS

A targeted educational intervention can improve antibiotic prescription practices for respiratory infections in children and decrease unnecessary antibiotic use. Such studies can also pinpoint areas that require further attention.

摘要

目的

评估一项教育干预措施对儿童上呼吸道疾病合理使用抗生素的影响。

方法

在以色列的五个主要社区儿童健康中心开展了一项多中心前后对照研究。收集了1999年11月至2000年2月（干预前期）以及2000年11月至2001年2月（干预后期）期间，年龄在3个月至18岁、诊断为急性中耳炎、扁桃体咽炎、鼻窦炎或上呼吸道感染的所有患者就诊时的抗生素处方数据。干预措施包括根据疾病控制与预防中心的建议，举办为期1天的关于儿童呼吸道感染诊断与合理治疗的研讨会。对患者档案进行审查，以了解患者特征、具体呼吸道疾病以及所开具的具体抗生素。主要结局指标是在对执业儿科医生进行教育干预前后，不同呼吸道疾病抗生素处方的比例及合理性。

结果

干预前期共有4580次门诊就诊符合分析条件，干预后期为4364次。从干预前期到干预后期，急性中耳炎合理使用抗生素的优势比为1.8（95%可信区间1.52 - 2.11，P < 0.01），咽炎为1.35（95%可信区间1.13 - 1.61，P < 0.01）。总体而言，急性中耳炎的抗生素使用率从93%降至87.4%（P < 0.05），上呼吸道感染的抗生素使用率从13.8%降至11.5%（P < 0.05）。鼻窦炎的这些因素无显著变化。