Ołdak Elzbieta, Rozkiewicz Dorota, Sulik Artur, Pogorzelska Elzbieta, Al-Hwish Mortada Ali
Akademia Medyczna w Białymstoku, Klinika Obserwacyjno-Zakaźna Dzieci.
Pol Merkur Lekarski. 2006 Feb;20(116):155-8.
Our study aimed to investigate the ambulatory antibiotics use for acute gastroenteritis in children admitted to the hospital in 1998-2000.
The retrospective analysis of medical records was performed in 369 children up to two-years of age; including 87 admitted in 1998, 136 - in 1999 and 146 in 2000 year. Results. Antimicrobials use decreased year after year. In 1998 the antibiotics therapy was included in 44.9% of children, in 1999--in 35.3% and in 2000 year in 32.2% (p = 0.02). In 1998 year, the antibiotics were ordered mainly for children diagnosed as bacterial diarrhea (76.9%) compared to viral etiology (18%). In 2000 year the antibiotics were prescribed for viral gastroenteritis twice more often (61.7%) than for bacterial etiology (29.8). Children with acute gastroenteritis and coexistent signs and symptoms were given antibiotics for treatment diarrhea in the similar percentage as those without any: in 1998--54.2 and 45.8%, in 1999--50.8 and 49.2%, in 2000--40.3 and 59.7%, respectively. Microbiologic examination was not performed in any case before treatment.
This study demonstrates the discrepancies between recommendations and ambulatory practice in the antibiotic treatment of acute diarrhea in children both before and after implementation the healthcare system reform. Education programs are needed for optimal management of acute gastroenteritis in children including training in necessity of coproculture before prescribing antimicrobials.
本研究旨在调查1998 - 2000年住院儿童急性胃肠炎门诊抗生素使用情况。
对369名两岁以下儿童的病历进行回顾性分析；其中1998年入院87例，1999年入院136例，2000年入院146例。结果。抗菌药物使用逐年减少。1998年44.9%的儿童接受了抗生素治疗，1999年为35.3%，2000年为32.2%（p = 0.02）。1998年，抗生素主要用于诊断为细菌性腹泻的儿童（76.9%），而病毒病因的儿童占18%。2000年，因病毒性胃肠炎使用抗生素的频率是细菌性病因的两倍（61.7%比29.8%）。有急性胃肠炎且伴有其他体征和症状的儿童接受抗生素治疗腹泻的比例与无其他症状的儿童相似：1998年分别为54.2%和45.8%，1999年分别为50.8%和49.2%，2000年分别为40.3%和59.7%。治疗前均未进行微生物学检查。
本研究表明，在医疗体系改革前后，儿童急性腹泻抗生素治疗的推荐与门诊实际做法存在差异。需要开展教育项目，以优化儿童急性胃肠炎的管理，包括在开具抗菌药物前培训联合培养的必要性。
