Ong David S Y, Kuyvenhoven Marijke M, van Dijk Liset, Verheij Theo J M
Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
J Antimicrob Chemother. 2008 Sep;62(3):587-92. doi: 10.1093/jac/dkn230. Epub 2008 Jun 10.
To describe specific diagnoses for which systemic antibiotics are prescribed, to assess adherence of antibiotic choice to national guidelines and to assess consistency among general practitioners (GPs) in prescribed volumes of antibiotics for respiratory, ear and urinary tract disorders.
The cross-sectional study included 174 GPs from 89 general practices. Data were derived from the Second Dutch National Survey of General Practice (DNSGP-2) in 2001. Outcome measures were the antibiotic prescriptions for respiratory, ear and urinary tract disorders defined according to the International Classification of Primary Care codes, the percentage of first-choice antibiotics complying with national guidelines and the number of antibiotic prescriptions per 1000 patients per GP per year.
The most antibiotics for respiratory tract infection (RTI) were prescribed for acute bronchitis (25%), sinusitis (22%) and acute upper RTI (14%). The most antibiotics were prescribed for acute otitis media (77% of ear disorders) and cystitis (95% of urinary tract disorders). First-choice antibiotics were prescribed in approximately 75% of the cases, whereas macrolides and amoxicillin/clavulanate (second-choice antibiotics) were prescribed in approximately 25%, especially in lower RTIs. The correlations (Spearman rho) between prescribed volumes for the three main groups of disorders varied from 0.39 to 0.67.
GPs were consistent in prescribing antibiotics for the three groups of diseases. Improvement strategies should focus on the management of acute upper RTIs and acute bronchitis and also on the use of amoxicillin/clavulanate and macrolides, these being mostly second-choice antibiotics in national guidelines.
描述开具全身性抗生素的具体诊断情况，评估抗生素选择是否符合国家指南，并评估全科医生（GP）在开具用于呼吸道、耳部和泌尿系统疾病的抗生素剂量方面的一致性。
这项横断面研究纳入了来自89家全科诊所的174名全科医生。数据源自2001年第二次荷兰全国全科医疗调查（DNSGP - 2）。结局指标包括根据初级保健国际分类代码定义的呼吸道、耳部和泌尿系统疾病的抗生素处方、符合国家指南的首选抗生素百分比以及每位全科医生每年每1000名患者的抗生素处方数量。
呼吸道感染（RTI）中，开具抗生素最多的是急性支气管炎（25%）、鼻窦炎（22%）和急性上呼吸道感染（14%）。耳部疾病中，开具抗生素最多的是急性中耳炎（占耳部疾病的77%）；泌尿系统疾病中，开具抗生素最多的是膀胱炎（占泌尿系统疾病的95%）。约75%的病例开具了首选抗生素，而大环内酯类和阿莫西林/克拉维酸（次选抗生素）的开具比例约为25%，尤其是在下呼吸道感染中。三类主要疾病的处方剂量之间的相关性（Spearman等级相关系数）在0.39至0.67之间。
全科医生在为三类疾病开具抗生素方面具有一致性。改进策略应侧重于急性上呼吸道感染和急性支气管炎的管理，以及阿莫西林/克拉维酸和大环内酯类药物的使用，这些在国家指南中大多为次选抗生素。
