Mathan Jeremy J, Ekart Jozsef, Houlding Anthony, Payinda Gary, Mills Clair
Medical Student, Auckland University, Auckland.
Clinical Audit Manager, Northland DHB, Whangarei.
N Z Med J. 2017 Jun 16;130(1457):58-68.
Rates of acute rheumatic fever in the Northland region are historically among the highest in New Zealand, impacting disproportionately on Māori children and youth. The primary aim of this study was to determine patient persistence to antibiotic treatment for group A streptococcus (GAS) pharyngitis in patients presenting with sore throat to the Whangarei Hospital Emergency Department. Secondarily, this study sought to determine prescriber adherence to the national antibiotic guideline for sore throat management.
A retrospective audit of patients presenting to ED with presumed GAS pharyngitis between 1 May 2016 and 31 August 2016 was carried out. Data on patient demographics, clinical examination findings, investigations and antibiotic prescription were extracted from electronic medical records. Patients were contacted and after obtaining consent, were asked about their antibiotic treatment using a standardised telephone interview script.
The patient population audited reflects those at high risk for acute rheumatic fever. All patients were discharged on the recommended medication, but only 82.7% (62/75) received the correct length (10 days) of oral antibiotics. Of the total of 75 patients audited, 61 (81%) had a swab taken and 41% (25/61) of these were confirmed positive for GAS. Patients were either advised to commence medication without waiting for a swab result (96%, 72/75) or delay treatment and commence only if no improvement in symptoms (4%, 3/75). Of those advised to commence medication immediately, 94% (67/72) obtained their medication from a community pharmacy. Three patients were advised to stop treatment after confirmation of a negative result. Of those patients assessable for medication persistence (n=65), 73.8% (48/65) of patients were compliant in completing the full course of antibiotic therapy.
This is the first study to assess patient persistence to an antibiotic course for GAS after presentation at an emergency department in Northland and possibly New Zealand. The results indicate a relatively high persistence rate with oral antibiotic treatment by patients treated for suspected GAS pharyngitis. An important finding is that community pharmacy dispensing does not appear to be a major barrier to patients acquiring medications. Additionally, the study shows low levels of follow up of patients with negative throat swab results, resulting in these patients completing the course of antibiotics unnecessarily.
从历史数据来看，新西兰北地地区的急性风湿热发病率在全国处于最高水平，对毛利儿童和青少年的影响尤为严重。本研究的主要目的是确定旺阿雷医院急诊科中因咽痛前来就诊的A组链球菌（GAS）咽炎患者对抗生素治疗的依从性。其次，本研究旨在确定开处方者对国家咽痛管理抗生素指南的遵循情况。
对2016年5月1日至2016年8月31日期间到急诊科就诊且疑似患有GAS咽炎的患者进行回顾性审核。从电子病历中提取患者人口统计学数据、临床检查结果、检查情况及抗生素处方信息。在征得患者同意后，通过标准化电话访谈脚本联系患者，询问其抗生素治疗情况。
接受审核的患者群体反映出急性风湿热的高危人群特征。所有患者均按推荐药物出院，但只有82.7%（62/75）的患者接受了正确疗程（10天）的口服抗生素治疗。在总共75名接受审核的患者中，61名（81%）进行了咽拭子采样，其中41%（25/61）被确诊为GAS阳性。患者要么在未等待咽拭子结果的情况下就被建议开始用药（96%，72/75），要么推迟治疗，仅在症状无改善时才开始用药（4%，3/75）。在被建议立即开始用药的患者中，94%（67/72）从社区药房获取了药物。3名患者在确认结果为阴性后被建议停止治疗。在可评估用药依从性的患者中（n = 65），73.8%（48/65）的患者依从性良好，完成了整个抗生素疗程。
这是第一项评估北地地区乃至新西兰急诊科就诊后GAS患者抗生素疗程依从性的研究。结果表明，疑似GAS咽炎患者口服抗生素治疗的依从率相对较高。一个重要发现是，社区药房配药似乎并非患者获取药物的主要障碍。此外，该研究显示，咽拭子结果为阴性的患者随访水平较低，导致这些患者不必要地完成了抗生素疗程。
