Adeli Mehdi, Bender Malinda J, Sheridan Michael J, Schwartz Richard H
Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia, USA.
Ann Allergy Asthma Immunol. 2008 Apr;100(4):377-83. doi: 10.1016/S1081-1206(10)60602-3.
The Centers for Disease Control and Prevention (CDC), the American Academy of Family Practice, and the American Academy of Pediatrics published guidelines for judicious antibiotic use: antibiotics are injudicious for the treatment of short-term purulent rhinorrhea, otitis media with effusion, and acute wheezy bronchitis.
To determine how academic, pediatric, and adult clinical allergists differed in use of antibiotics for upper respiratory tract infections (URIs).
Surveys were sent to 424 allergists in private clinical practice and 156 allergists in academic settings. Three clinical pediatric vignettes were described. Questions about possible antibiotic use followed. Vignettes were as follows: simple URI in a toddler, the same child with short-duration green rhinorrhea, and the same child with otitis media with effusion.
Of 580 mailed surveys, 358 were returned, for an overall response rate of 61.7%. Thirty-nine of these surveys did not meet inclusion criteria, reducing the response rate to 55.0%. Of these, 47.0% (n=150) were familiar with the guidelines: 85.3% answered that they usually adhered to them in practice. The academic allergist respondents demonstrated the best adherence to the guidelines for the 3 vignettes, followed closely by the clinical pediatric allergist respondents. For the population surveyed, adult clinical allergists were more likely than the other 2 groups to prescribe antibiotics for a simple URI (P < .001) and for a URI with short-duration green rhinorrhea (P = .004).
Academic allergists adhered to the CDC guidelines more closely than did adult allergists. Pediatric allergists in clinical practice were in agreement with the academic allergists. Despite self-reported knowledge of the CDC guidelines, many adult allergists in clinical practice did not adhere to them in their answers to the questions after several vignettes.
美国疾病控制与预防中心（CDC）、美国家庭医生学会以及美国儿科学会发布了明智使用抗生素的指南：抗生素不适用于治疗短期脓性鼻漏、渗出性中耳炎和急性喘息性支气管炎。
确定学术型、儿科和成人临床过敏症专科医生在上呼吸道感染（URI）抗生素使用方面的差异。
向424名私人临床执业过敏症专科医生和156名学术机构过敏症专科医生发送调查问卷。描述了三个临床儿科病例。随后是关于可能使用抗生素的问题。病例如下：幼儿单纯性URI、同一儿童伴有短期绿色鼻漏、同一儿童伴有渗出性中耳炎。
在580份邮寄的调查问卷中，358份被退回，总体回复率为61.7%。其中39份调查问卷不符合纳入标准，回复率降至55.0%。在这些回复中，47.0%（n = 150）熟悉指南：85.3%回答他们在实践中通常遵循这些指南。学术型过敏症专科医生对三个病例的指南遵循情况最佳，其次是临床儿科过敏症专科医生。在接受调查的人群中，成人临床过敏症专科医生比其他两组更有可能为单纯性URI（P < .001）和伴有短期绿色鼻漏的URI（P = .004）开具抗生素。
学术型过敏症专科医生比成人过敏症专科医生更严格地遵循CDC指南。临床实践中的儿科过敏症专科医生与学术型过敏症专科医生意见一致。尽管自称了解CDC指南，但许多临床实践中的成人过敏症专科医生在回答几个病例后的问题时并未遵循这些指南。
