Gjelstad Svein, Dalen Ingvild, Lindbaek Morten
Department of General Practice and Community Medicine, Antibiotic Centre for Primary Care, University of Oslo, Norway.
Scand J Prim Health Care. 2009;27(4):208-15. doi: 10.3109/02813430903438718.
Inappropriate use of antibiotics is associated with increased antibiotic resistance in the community. About 90% of all antibiotic prescriptions in Norway are issued by general practitioners and in 60% issued for respiratory tract infections. The article describes and analyses antibiotic prescription patterns by general practitioners in Vestfold, Norway.
Prospective cohort study.
A total of 145 list-holding general practitioners in Vestfold, Norway in February to March 2003.
Merging of two electronic administrative data sets: antibiotic prescriptions dispensed in pharmacies and general practitioners' electronic bills from the National Insurance Agency.
Proportion and type of antibiotic prescribed for different respiratory tract infectious diagnoses.
We found large variations among general practitioners' antibiotic prescription habits. In 27% of consultations with RTI diagnoses, an antibiotic was prescribed; 37% were for Penicillin V and 28% for a macrolide. Quinolones and cephalosporins were only rarely prescribed. In a logistic regression analysis the following factors were independently associated with antibiotic prescription rate: type of infection, type of contact, being a general practitioner specialist, and years since medical exam. In another logistic regression analysis the following factors were independently associated with broad-spectrum antibiotic prescription: type of infection, age of patient, type of contact, being a specialist, length of list, and being a high prescriber of antibiotics.
The variation in proportion of total antibiotic prescribing and broad-spectrum prescription for respiratory tract infections is high, and reveals potentials to change general practitioners' prescription behaviour, in order to maintain the positive situation in Norway as to antibiotic resistance.
抗生素的不当使用与社区抗生素耐药性增加有关。挪威约90%的抗生素处方由全科医生开具，其中60%用于呼吸道感染。本文描述并分析了挪威韦斯特福尔郡全科医生的抗生素处方模式。
前瞻性队列研究。
2003年2月至3月期间挪威韦斯特福尔郡的145名在册全科医生。
合并两个电子管理数据集：药房配发的抗生素处方和国家保险机构提供的全科医生电子账单。
针对不同呼吸道感染诊断开具的抗生素比例和类型。
我们发现全科医生的抗生素处方习惯差异很大。在诊断为呼吸道感染的会诊中，27%的患者开具了抗生素；37%为青霉素V，28%为大环内酯类。喹诺酮类和头孢菌素类很少开具。在逻辑回归分析中，以下因素与抗生素处方率独立相关：感染类型、接触类型、是否为全科医生专家以及从医学考试后至今的年限。在另一项逻辑回归分析中，以下因素与广谱抗生素处方独立相关：感染类型、患者年龄、接触类型、是否为专家、名单长度以及是否为高抗生素处方者。
呼吸道感染的抗生素总处方比例和广谱处方比例差异很大，这表明有改变全科医生处方行为的潜力，以维持挪威在抗生素耐药性方面的良好状况。
