Rufener Justin B, Yaremchuk Kathleen L, Payne Spencer C
Department of Otolaryngology, Head & Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA.
Laryngoscope. 2006 Oct;116(10):1727-9. doi: 10.1097/01.mlg.0000231310.90344.44.
The objectives of this study were to evaluate practice patterns for treatment of patients with pharyngitis with regard to testing for group A beta hemolytic streptococcal (GABHS) infection, frequency of antibiotic use, and appropriate choice of antibiotics.
The authors conducted a retrospective review of billing data for 10,482 office visits for pharyngitis.
The 2004 billing database for a tertiary institution was queried for outpatient visits for pharyngitis or tonsillitis, group A Streptococcus tests (GAST), and antibiotic prescriptions filled after the visit. Patients were separated by age group and analyzed for the proportion of patients that received a GAST and proportion prescribed an antibiotic. Antibiotic prescriptions were also analyzed to determine whether they were appropriate for treatment of GABHS.
A total of 68.7% of all patients and 82.2% of pediatric patients were tested for GAST. A total of 47.1% of adult patients and 44.9% of pediatric patients received an antibiotic. For adult patients for whom GAST was obtained, 48.6% were prescribed an antibiotic versus 53.6% of those not tested. Streptococcus testing was a significant predictor of antibiotic use (P < .0001), whereas age was not (P = .22). A total of 82.1% of all antibiotics prescribed were recommended for treatment of GABHS.
Most patients seen for pharyngitis were tested for GABHS, but pediatric patients were tested more frequently than adults. Patients who received a GAST were less likely to receive antibiotics. The rates experienced in our tertiary academic institution are higher than previously quoted for community practice. When antibiotics were prescribed, they were usually appropriate for the treatment of GABHS based on current recommendations.
本研究的目的是评估咽炎患者在A组β溶血性链球菌（GABHS）感染检测、抗生素使用频率以及抗生素的合理选择方面的治疗模式。
作者对10482例咽炎门诊就诊的计费数据进行了回顾性分析。
查询某三级医疗机构2004年的计费数据库，以获取咽炎或扁桃体炎的门诊就诊、A组链球菌检测（GAST）以及就诊后开具的抗生素处方。患者按年龄组进行分类，并分析接受GAST检测的患者比例以及开具抗生素的患者比例。还对抗生素处方进行分析，以确定其是否适合治疗GABHS。
所有患者中有68.7%、儿科患者中有82.2%接受了GAST检测。成年患者中有47.1%、儿科患者中有44.9%接受了抗生素治疗。对于接受GAST检测的成年患者，48.6%的患者开具了抗生素，而未接受检测的患者中这一比例为53.6%。链球菌检测是抗生素使用的显著预测因素（P <.0001），而年龄则不是（P = 0.22）。所有开具的抗生素中，有82.1%被推荐用于治疗GABHS。
大多数咽炎患者接受了GABHS检测，但儿科患者的检测频率高于成年人。接受GAST检测的患者接受抗生素治疗的可能性较小。我们三级学术机构的检测率高于先前报道的社区医疗机构。根据当前建议，当开具抗生素时，通常适合治疗GABHS。
