Botica Marija Vrca, Botica Iva, Stamenić Valerija, Andrasević Arjana Tambić, Kern Josipa, Spehar Stanislava Stojanović
University of Zagreb, School of Public Health "Andrija Stampar", Department of Family Medicine, Zagreb, Croatia.
Coll Antropol. 2013 Jun;37(2):449-54.
Overprescribing of antibiotics in primary care has been recognized as public health problem. We investigated visits prescription rate of antibiotics to patients with upper respiratory tract infections (URTI) and unnecessary prescription for tonsillopharyngitis, in Croatia. In prospective observational study in November 2007. 25 GPs in Croatia recorded all patients' visits with URTI episode according ICPC-2. Clinical status of patients with tonsillopharyngitis were categorized according to Centor Criteria. 689 visits were analysed, 82% of visits were initial. Antibiotics were prescribed in 44.7% visits with URTI. There were no significant differences in antibiotic prescription rates regarding non-clinical factors. Antibiotics were prescribed to patients with tonsillopharyngitis in 62.2% visits. Unnecessary antibiotics were prescribed (Centor 1,2) in 49.6% visits with tonsillopharyngitis. Logistic regression analysis showed significant differences in unnecessary antibiotic prescription rates only with respect to the workday--Wednesday, CI (1.117-2.671), p = 0.0139. Leading antibiotic was amoxicillin + clavulonic acid, second was amoxicillin, the third were macrolides, the fourth was narrow spectrum penicillin and fifth were cephalosporins. This study shows over prescription for URTI. Unnecessary prescription for tonsillopharyngitis depend on non clinical factor--day of the week. This should be further explored and help to improved prescribe antibiotics.
基层医疗中抗生素的过度处方已被视为一个公共卫生问题。我们调查了克罗地亚上呼吸道感染（URTI）患者的抗生素就诊处方率以及扁桃体咽炎的不必要处方情况。在2007年11月的一项前瞻性观察研究中，克罗地亚的25名全科医生根据国际初级保健分类标准第二版（ICPC - 2）记录了所有患有URTI发作的患者就诊情况。根据森托标准对扁桃体咽炎患者的临床状况进行分类。共分析了689次就诊，其中82%为初次就诊。44.7%的URTI就诊患者被开具了抗生素。在抗生素处方率方面，非临床因素没有显著差异。62.2%的扁桃体咽炎就诊患者被开具了抗生素。在49.6%的扁桃体咽炎就诊中，对森托标准为1、2级的患者开具了不必要的抗生素。逻辑回归分析显示，仅在工作日——周三，不必要抗生素处方率存在显著差异，置信区间（1.117 - 2.671），p = 0.0139。主要使用的抗生素是阿莫西林 + 克拉维酸，其次是阿莫西林，第三是大环内酯类，第四是窄谱青霉素，第五是头孢菌素类。这项研究表明URTI存在过度处方情况。扁桃体咽炎的不必要处方取决于非临床因素——一周中的日期。对此应进一步探究，以有助于改进抗生素处方。
