急性呼吸道疾病患儿门诊使用抗生素的危险因素。
Risk Factors for Outpatient Use of Antibiotics in Children with Acute Respiratory Illnesses.
作者信息
Zhao Sophie R, Griffin Marie R, Patterson Barron L, Mace Rachel L, Wyatt Dayna, Zhu Yuwei, Talbot H Keipp
机构信息
From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
出版信息
South Med J. 2017 Mar;110(3):172-180. doi: 10.14423/SMJ.0000000000000622.
OBJECTIVES
Antibiotics for acute respiratory illness (ARI) constitute most pediatric medication use and contribute to the emergence of antimicrobial resistance. We investigated antibiotic prescription risk factors for ARI in pediatric clinics and clinical follow-up in individuals prescribed and not prescribed antibiotics.
METHODS
In this observational study, we enrolled children ages 2 to 17 years old presenting with ARI with fever to two academic pediatric primary care outpatient clinics during influenza season 2013-2014. We collected information on demographics, initial symptoms, medical conditions, laboratory tests, discharge diagnoses, treatments, and 30 days of follow-up medical encounters. Factors associated with antibiotic prescription receipt were evaluated using logistic regression.
RESULTS
Of 206 consented and enrolled children, 59 (29%) were prescribed antibiotics, 51 of 59 (86%) for indicated diagnoses: 34 for streptococcal pharyngitis, 15 for acute otitis media (AOM), and 2 for pneumonia. Discharge diagnoses were the only factors independently associated with an antibiotic prescription. Of children prescribed/not prescribed an antibiotic, 17%/17% received follow-up telephone calls and 27%/17% had follow-up visits related to ARI within 30 days. Two children with AOM were prescribed a second antibiotic during follow-up, and one developed colitis. Eighteen of 206 (9%) additional children were prescribed antibiotics within 30 days for ARI symptoms, 17 for streptococcal pharyngitis, AOM, pneumonia, or sinusitis; one was prescribed antibiotics for influenza-like illness.
CONCLUSIONS
Among study children 2 to 17 years old with outpatient ARI, 29% were prescribed antibiotics at the initial visit and another 9% were prescribed antibiotics during the 30-day follow-up (most were for appropriate indications). Further decreasing antibiotic use in similar settings will likely require wider implementation of watchful waiting for AOM, a change in guidelines for pharyngitis management, and/or reductions in these diseases.
目的
用于治疗急性呼吸道疾病（ARI）的抗生素在儿科用药中占比最大，且助长了抗菌药物耐药性的出现。我们调查了儿科诊所中ARI的抗生素处方风险因素，以及接受和未接受抗生素处方者的临床随访情况。
方法
在这项观察性研究中，我们纳入了2013 - 2014流感季节期间到两家学术性儿科初级保健门诊就诊、患有ARI且伴有发热症状的2至17岁儿童。我们收集了有关人口统计学、初始症状、医疗状况、实验室检查、出院诊断、治疗情况以及30天随访医疗接触的信息。使用逻辑回归评估与接受抗生素处方相关的因素。
结果
在206名同意参与并被纳入研究的儿童中，59名（29%）接受了抗生素处方，其中51名（86%）的处方是基于明确诊断：34名因链球菌性咽炎，15名因急性中耳炎（AOM），2名因肺炎。出院诊断是与抗生素处方独立相关的唯一因素。接受/未接受抗生素处方的儿童中，17%/17%接到了随访电话，27%/17%在30天内有与ARI相关的随访就诊。两名患有AOM的儿童在随访期间接受了第二种抗生素处方，其中一名发生了结肠炎。在206名儿童中，另有18名（9%）在30天内因ARI症状接受了抗生素处方，17名因链球菌性咽炎、AOM、肺炎或鼻窦炎；一名因流感样疾病接受了抗生素处方。
结论
在2至17岁患有门诊ARI的研究儿童中，29%在初次就诊时接受了抗生素处方，另有9%在30天随访期间接受了抗生素处方（大多数是基于适当的适应症）。在类似情况下进一步减少抗生素使用可能需要更广泛地实施对AOM的观察等待策略、改变咽炎管理指南和/或减少这些疾病的发生。
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