Centre for Research in Evidence-Based Practice, Bond University , Gold Coast, QLD , Australia.
Discipline of General Practice, School of Medicine, University of Queensland , Brisbane, QLD , Australia.
Front Public Health. 2015 Feb 24;3:35. doi: 10.3389/fpubh.2015.00035. eCollection 2015.
Numerous opportunities are available in primary care for alleviating the crisis of increasing antibiotic resistance. Preventing patients from developing an acute respiratory infection (ARI) will obviate any need for antibiotic use downstream. Hygiene measures such as physical barriers and hand hygiene, and possibly vaccination and exercise, may be effective. Also, a large range of complementary and alternative medicines (e.g. zinc, vitamin C and probiotics) are proposed for preventing and treating ARIs, but evidence for efficacy is scarce. General practitioners' (GPs) attitudes towards antibiotic prescribing are a major factor in the prescribing for ARIs. Professional interventions with educational components are effective, although they have modest effects, and are expensive. GPs' perceptions - that mistakenly assume as a default that patients want antibiotics for their ARIs - are often wrong. Shared decision making might be a solution, as it enables clinician and patient to participate jointly in making a health decision, having discussed the options together with the evidence for their harms as well as benefits. Furthermore, GPs' diagnostic uncertainty - often leading to an antibiotic prescription "just in case" - might be addressed by exploiting strategies such as safety-netting, e.g., establishing with the patient a priori clearly defined actions to take if the course of the illness deviates from the expected. None of these strategies or interventions on their own will greatly improve the use of antibiotics for ARIs. However, used in concert, combinations are likely to enable clinicians and health care systems to implement the strategies that will reduce antimicrobial resistance in the future.
初级保健中有许多机会可以缓解抗生素耐药性不断增加的危机。预防患者发生急性呼吸道感染 (ARI) 将避免下游抗生素的使用需求。卫生措施，如物理屏障和手部卫生，以及可能的疫苗接种和运动，可能是有效的。此外，大量的补充和替代医学（例如锌、维生素 C 和益生菌）被提议用于预防和治疗 ARI，但疗效证据很少。全科医生 (GP) 对抗生素处方的态度是 ARI 处方的主要因素。具有教育成分的专业干预措施是有效的，尽管它们的效果有限，而且成本高昂。全科医生的看法——错误地认为患者默认需要抗生素来治疗他们的 ARI——往往是错误的。共同决策可能是一种解决方案，因为它使临床医生和患者能够共同参与做出健康决策，共同讨论利弊以及证据。此外，全科医生的诊断不确定性——通常导致开抗生素处方“以防万一”——可以通过利用安全网等策略来解决，例如，与患者事先明确界定如果疾病进程偏离预期应采取的行动。这些策略或干预措施本身都不会极大地改善 ARI 中抗生素的使用。然而，协同使用时，组合可能使临床医生和医疗保健系统能够实施未来将减少抗生素耐药性的策略。
