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[秘鲁利马城郊地区基层医疗中心医生对五岁以下儿童抗生素使用的偏好]

[Preferences of antibiotic use in children less than five in physicians working health centers of primary level in peri-urban areas of Lima, Peru].

作者信息

Ecker Lucie, Ochoa Theresa J, Vargas Martha, Del Valle Luis J, Ruiz Joaquim

机构信息

Instituto de Investigación Nutricional, Lima, Perú

出版信息

Rev Peru Med Exp Salud Publica. 2013 Apr;30(2):181-9.

Abstract

OBJECTIVES

To describe physicians' preferences of antibiotic use in children less than 5 years in health centers of primary level in three periurban districts in Lima, Perú.

MATERIAL AND METHODS

A structured survey was applied to 218 general practitioners from three health networks of Lima. The survey included six typical clinical cases in children under 5 years with questions about antibiotic use: the cases were common cold, pharyngitis, pneumonia, bronchial obstructive syndrome, watery diarrhea and dysentery.

RESULTS

81.6% of the physicians responded that more than a quarter of the patients they attended were children under five years. 15.6% of the general physicians would use an antibiotic for common cold treatment. For dysentery treatment 90.4% would use antibiotics, the frequently used were Trimethoprim-Sulfamethoxazole (TMP-SMX) and Furazolidone. 86.2% of physicians would recommend an antibiotic for pharyngitis. In a watery diarrhea case 32.7% of the doctors would use. In the case of bronchospasm, 73% of the doctors would recommend an antibiotic. 96.3% would recommend antibiotics for pneumonia. The perception of the degree of mother's satisfaction increased the risk of inappropriate prescription of antibiotics OR: 1.6, p=0.031, 95% CI: 1.1-2.6).

CONCLUSIONS

There is tendency to overuse antibiotics for diagnoses such as pharyngitis and bronchospasm, as well as in cases of watery diarrhea and common cold, the reason could be that a large number of children under five years are treated by general practitioners without training in pediatric care.

摘要

目的

描述秘鲁利马三个城郊地区基层医疗中心5岁以下儿童抗生素使用方面医生的偏好。

材料与方法

对利马三个医疗网络的218名全科医生进行了结构化调查。该调查包括5岁以下儿童的六个典型临床病例,并就抗生素使用提出问题:病例分别为普通感冒、咽炎、肺炎、支气管阻塞综合征、水样腹泻和痢疾。

结果

81.6%的医生表示,他们诊治的患者中有超过四分之一是5岁以下儿童。15.6%的全科医生会使用抗生素治疗普通感冒。对于痢疾治疗,90.4%的医生会使用抗生素,常用的是甲氧苄啶 - 磺胺甲恶唑(TMP - SMX)和呋喃唑酮。86.2%的医生会为咽炎推荐使用抗生素。在水样腹泻病例中,32.7%的医生会使用。对于支气管痉挛病例,73%的医生会推荐使用抗生素。96.3%的医生会为肺炎推荐使用抗生素。母亲满意度程度的认知增加了抗生素不适当处方的风险(比值比:1.6,p = 0.031,95%置信区间:1.1 - 2.6)。

结论

对于咽炎、支气管痉挛以及水样腹泻和普通感冒等诊断存在过度使用抗生素的倾向,原因可能是大量5岁以下儿童由未接受过儿科护理培训的全科医生治疗。

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