Treebupachatsakul Pornpit, Tiengrim Surapee, Thamlikitkul Visanu
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2006 Aug;89(8):1178-86.
Antibiotics are over-prescribed for Upper Respiratory tract Infection (URI). Uncertainty in differentiating bacterial from viral infection is the main reason for this practice. More evidence is needed to encourage proper use of antibiotics for URI.
A prospective study was conducted on adult out-patients with URI at Siriraj Hospital from April to October 2004. Throat swab cultures were performed in all participants. Patients were assessed and managed according to CPG adapted from principles of appropriate antibiotic use for treatment of acute upper respiratory tract infections in adults endorsed by the Centers for Disease Control and Prevention, USA. Clinical outcomes were evaluated by telephone interviews.
Out of 292 patients enrolled, 55.5% had non-specific URI/common cold, 32.2% had pharyngitis/ tonsillitis, 11% had acute bronchitis and only 1.4% had acute sinusitis. The overall prevalence of GAS infection was 7.9%. GAS was isolated in 16% of the patients with pharyngitis/tonsillitis; and only 3.7% and 3.1% of the patients with non-specific URI/common cold and acute bronchitis respectively. Clinical manifestations associated with GAS were: 1)fever (T > or = 37.8 C), 2) exudate on the pharynx or tonsil, 3) tender cervical lymphadenopathy, and 4) absence of cough. The presence of < or = 3 of 4 criteria had high negative predictive value of 94.2%. None of the patients with non-specific URI/common cold, acute bronchitis and acute sinusitis had > or = 3 of 4 criteria. The clinical responses were not significantly different between those who received or did not receive antibiotics. Most of the patients had good clinical response by day 7.
The prevalence of GAS infection in adults with URI was 7.9%. The clinical features of T > or = 37.8 C, exudate on pharynx or tonsil, tender cervical lymphadenopathy, and absence of cough were significantly found in the patients with GAS infection. Management of adults with URI using the CPG was effective and safe.
上呼吸道感染（URI）的抗生素处方过量。难以区分细菌感染和病毒感染是导致这种情况的主要原因。需要更多证据来鼓励对上呼吸道感染合理使用抗生素。
1）确定患有上呼吸道感染的成年人中A组β溶血性链球菌（GAS）的患病率以及与GAS感染相关的临床特征。2）评估使用临床实践指南（CPG）管理患有上呼吸道感染的成年人的有效性。
2004年4月至10月在诗里拉吉医院对患有上呼吸道感染的成年门诊患者进行了一项前瞻性研究。对所有参与者进行咽拭子培养。根据美国疾病控制与预防中心认可的成人急性上呼吸道感染适当抗生素使用原则改编的CPG对患者进行评估和管理。通过电话访谈评估临床结果。
在292名登记患者中，55.5%患有非特异性上呼吸道感染/普通感冒，32.2%患有咽炎/扁桃体炎，11%患有急性支气管炎，仅有1.4%患有急性鼻窦炎。GAS感染的总体患病率为7.9%。咽炎/扁桃体炎患者中16%分离出GAS；非特异性上呼吸道感染/普通感冒患者和急性支气管炎患者中分别仅为3.7%和3.1%。与GAS相关的临床表现为：1）发热（体温≥37.8℃），2）咽部或扁桃体有渗出物，3）颈部淋巴结压痛，4）无咳嗽。4项标准中满足≤3项具有94.2%的高阴性预测值。非特异性上呼吸道感染/普通感冒、急性支气管炎和急性鼻窦炎患者中无一满足4项标准中的≥3项。接受或未接受抗生素治疗的患者临床反应无显著差异。大多数患者在第7天时临床反应良好。
患有上呼吸道感染的成年人中GAS感染的患病率为7.9%。GAS感染患者中显著出现体温≥37.8℃、咽部或扁桃体有渗出物、颈部淋巴结压痛和无咳嗽等临床特征。使用CPG管理患有上呼吸道感染的成年人是有效且安全的。
