O'Brien Kathryn, Bellis Thomas Wyn, Kelson Mark, Hood Kerenza, Butler Christopher C, Edwards Adrian
Division of Population Medicine.
Great Western Hospital, Swindon.
Br J Gen Pract. 2015 Sep;65(638):e585-92. doi: 10.3399/bjgp15X686497.
Antibiotic overuse and inappropriate prescribing drive antibiotic resistance. Children account for a high proportion of antibiotics prescribed in primary care.
To determine the predictors of antibiotic prescription in young children presenting to UK general practices with acute illness.
Prospective observational study in general practices in Wales.
A total of 999 children were recruited from 13 practices between March 2008 and July 2010. Multilevel, multivariable logistic regression analysis was performed to determine predictors of antibiotic prescribing.
Oral antibiotics were prescribed to 261 children (26.1%). Respiratory infections were responsible for 77.4% of antibiotic prescriptions. The multivariable model included 719 children. Children were more likely to be prescribed antibiotics if they were older (odds ratio [OR] 1.3; 95% confidence intervals [CI] = 1.1 to 1.7); presented with poor sleep (OR 2.7; 95% CI = 1.5 to 5.0); had abnormal ear (OR 6.5; 95% CI = 2.5 to 17.2), throat (OR 2.2; 95% CI = 1.1 to 4.5) or chest examination (OR 13.6; 95% CI = 5.8 to 32.2); were diagnosed with lower respiratory tract infection (OR 9.5; 95% CI = 3.7 to 25.5), tonsillitis/sore throat (OR 119.3; 95% CI = 28.2 to 504.6), ear infection (OR 26.5; 95% CI = 7.4 to 95.7) or urinary tract infection (OR 12.7; 95% CI = 4.4 to 36.5); or if the responsible clinician perceived the child to be moderately to severely unwell (OR 4.0; 95% CI = 1.4 to 11.4). The area under the receiver operating characteristic curve was 0.9371.
Respiratory infections were responsible for 74.4% of antibiotic prescriptions. Diagnoses of tonsillitis, sore throat, or ear infection were associated most with antibiotic prescribing. Diagnosis seemed to be more important than abnormal examination findings in predicting antibiotic prescribing, although these were correlated.
抗生素的过度使用和不恰当处方导致了抗生素耐药性。在初级医疗保健中，儿童开具的抗生素处方占比很高。
确定在英国全科医疗中因急性疾病就诊的幼儿抗生素处方的预测因素。
威尔士全科医疗的前瞻性观察性研究。
2008年3月至2010年7月期间，从13家医疗机构招募了999名儿童。进行多水平、多变量逻辑回归分析以确定抗生素处方的预测因素。
261名儿童（26.1%）开具了口服抗生素。呼吸道感染占抗生素处方的77.4%。多变量模型纳入了719名儿童。年龄较大的儿童更有可能开具抗生素（比值比[OR]1.3；95%置信区间[CI]=1.1至1.7）；睡眠不佳（OR 2.7；95%CI=1.5至5.0）；耳部（OR 6.5；95%CI=2.5至17.2）、咽喉部（OR 2.2；95%CI=1.1至4.5）或胸部检查异常（OR 13.6；95%CI=5.8至32.2）；被诊断为下呼吸道感染（OR 9.5；95%CI=3.7至25.5）、扁桃体炎/咽喉痛（OR 119.3；95%CI=28.2至504.6）、耳部感染（OR 26.5；95%CI=7.4至95.7）或尿路感染（OR 12.7；95%CI=4.4至36.5）；或者如果负责的临床医生认为儿童中度至重度不适（OR 4.0；95%CI=1.4至11.4）。受试者工作特征曲线下面积为0.9371。
呼吸道感染占抗生素处方的74.4%。扁桃体炎、咽喉痛或耳部感染诊断与抗生素处方关联最为密切。在预测抗生素处方方面，诊断似乎比检查异常结果更重要，尽管二者存在相关性。
