de Melker R A, Kuyvenhoven M M
Department of General Practice, University of Utrecht, The Netherlands.
Br J Gen Pract. 1991 Dec;41(353):504-7.
A questionnaire, sent to a 10% random sample of Dutch general practitioners (n = 635) included descriptions of four cases of upper respiratory tract infections (acute tonsillitis, recurrent tonsillitis, acute otitis media and sinusitis). This was used to study the general practitioners' management of upper respiratory tract infections. A total of 376 doctors responded (59%). The majority of general practitioners would prescribe antibiotics for sinusitis (80% of respondents) but only 29% would prescribe antibiotics for acute otitis media. For acute tonsillitis and recurrent tonsillitis the proportions were 52% and 59%, respectively. The low prescription rate for acute otitis media was in accordance with national standards, such as the standard of the Netherlands college of general practitioners. A penicillin (phenoxymethylpenicillin or phenethicillin) was most likely to be selected for the two types of tonsillitis, amoxycillin for acute otitis media and doxycycline for sinusitis. Other antibiotics such as erythromycin, other tetracyclines and ampicillin, were seldom selected. Most respondents would prescribe antibiotics for seven days, but there was considerable variation. The influence of the characteristics of the general practitioners and their practices on their antibiotic prescribing was small. Only type of practice correlated with antibiotic treatment, in that general practitioners in single-handed practices would prescribe antibiotics more often than their colleagues in health centres. Among those who would prescribe symptomatic treatment nearly all would prescribe nosedrops for acute otitis media and sinusitis. Eighty five per cent of the respondents would refer the patient with recurrent tonsillitis, while 10% would refer the patient with acute otitis media. The results suggest that some aspects of the prescribing behaviour of Dutch general practitioners might be improved.
一份问卷被发送给荷兰全科医生的10%随机样本（n = 635），其中包含4例上呼吸道感染病例（急性扁桃体炎、复发性扁桃体炎、急性中耳炎和鼻窦炎）的描述。这被用于研究全科医生对上呼吸道感染的治疗情况。共有376名医生回复（59%）。大多数全科医生会为鼻窦炎开抗生素（80%的受访者），但只有29%会为急性中耳炎开抗生素。对于急性扁桃体炎和复发性扁桃体炎，这一比例分别为52%和59%。急性中耳炎的低处方率符合国家标准，如荷兰全科医生学院的标准。对于两种扁桃体炎，最有可能选择青霉素（苯氧甲基青霉素或苯乙青霉素），急性中耳炎选择阿莫西林，鼻窦炎选择强力霉素。很少选择其他抗生素，如红霉素、其他四环素和氨苄青霉素。大多数受访者会开7天的抗生素，但存在相当大的差异。全科医生及其诊疗行为的特征对抗生素处方的影响很小。只有诊疗类型与抗生素治疗相关，即个体执业的全科医生比健康中心的同行更常开抗生素。在那些会开对症治疗药物的人中，几乎所有人都会为急性中耳炎和鼻窦炎开滴鼻剂。85%的受访者会转诊复发性扁桃体炎患者，而10%会转诊急性中耳炎患者。结果表明，荷兰全科医生的处方行为的某些方面可能需要改进。
