Department of Primary Care and Public Health, Cardiff University, Cardiff, UK.
Br J Gen Pract. 2010 Dec;60(581):e466-75. doi: 10.3399/bjgp10X544104.
Respiratory tract infections (RTIs) remain the commonest reason for acute consultations in primary care in resource-rich countries. Their spectrum and severity has changed from the time that antibiotics were discovered, largely from improvements in the socioeconomic determinants of health as well as vaccination. The benefits from antibiotic treatment for common RTIs have been shown to be largely overstated. Nevertheless, serious infections do occur. Currently, no clinical features or diagnostic test, alone or in combination, adequately determine diagnosis, aetiology, prognosis, or response to treatment. This narrative review focuses on emerging evidence aimed at helping clinicians reduce and manage uncertainty in treating RTIs. Consultation rate and prescribing rate trends are described, evidence of increasing rates of complications are discussed, and studies and the association with antibiotic prescribing are examined. Methods of improving diagnosis and identifying those patients who are at increased risk of complications from RTIs, using clinical scoring systems, biomarkers, and point of care tests are also discussed. The evidence for alternative management options for RTIs are summarised and the methods for changing public and clinicians' beliefs about antibiotics, including ways in which we can improve clinician-patient communication skills for management of RTIs, are described.
在资源丰富的国家，呼吸道感染 (RTI) 仍然是初级保健中急性就诊最常见的原因。自抗生素被发现以来，它们的范围和严重程度已经发生了变化，这主要归因于健康的社会经济决定因素的改善以及疫苗接种。抗生素治疗常见 RTI 的益处被大大夸大了。然而，严重的感染确实会发生。目前，没有任何临床特征或诊断测试（单独或组合使用）能够充分确定诊断、病因、预后或对治疗的反应。本叙述性综述重点介绍了旨在帮助临床医生减少和管理治疗 RTI 时的不确定性的新证据。描述了咨询率和处方率的趋势，讨论了并发症发生率增加的证据，并研究了与抗生素处方的关联。还讨论了使用临床评分系统、生物标志物和即时检测来改善诊断和识别那些因 RTI 而增加并发症风险的患者的方法。总结了 RTI 替代治疗方案的证据，并描述了改变公众和临床医生对抗生素的看法的方法，包括我们如何提高临床医生与患者沟通技能以管理 RTI 的方法。
