成人急性咽痛抗生素处方策略的症状反应：英国普通实践中 DESCARTES 前瞻性队列研究。
Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice.
机构信息
Primary Care and Population Sciences Division, University of Southampton.
Nuffield Department of Primary Care Health Sciences, University of Oxford.
出版信息
Br J Gen Pract. 2017 Sep;67(662):e634-e642. doi: 10.3399/bjgp17X692321. Epub 2017 Aug 14.
BACKGROUND
A delayed or 'just in case' prescription has been identified as having potential to reduce antibiotic use in sore throat.
AIM
To determine the symptomatic outcome of acute sore throat in adults according to antibiotic prescription strategy in routine care.
DESIGN AND SETTING
A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study comprising adults aged ≥16 years presenting with acute sore throat (≤2 weeks' duration) managed with treatment as usual in primary care in the UK.
METHOD
A random sample of 2876 people from the full cohort were requested to complete a symptom diary. A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcome details were collected by notes review and a detailed symptom diary. The primary outcome was poorer 'global' symptom control (defined as longer than the median duration or higher than median symptom severity). Analyses controlled for confounding by indication (propensity to prescribe antibiotics).
RESULTS
A total of 1629/2876 (57%) of those requested returned a symptom diary, of whom 1512 had information on prescribing strategy. The proportion with poorer global symptom control was greater in those not prescribed antibiotics 398/587 (68%) compared with those prescribed immediate antibiotics 441/728 (61%) or delayed antibiotic prescription 116/197 59%); adjusted risk ratio (RR) (95% confidence intervals [CI]): immediate RR 0.87 (95% CI = 0.70 to 0.96), = 0.006; delayed RR 0.88 (95% CI = 0.78 to 1.00), = 0.042.
CONCLUSION
In the routine care of adults with sore throat, a delayed antibiotic strategy confers similar symptomatic benefits to immediate antibiotics compared with no antibiotics. If a decision is made to prescribe an antibiotic, a delayed antibiotic strategy is likely to yield similar symptomatic benefit to immediate antibiotics.
背景
延迟或“以防万一”的处方被认为有可能减少喉咙痛的抗生素使用。
目的
根据常规护理中的抗生素处方策略，确定成年人急性喉咙痛的症状结果。
设计和设置
对 DESCARTE（日常实践中急性红喉症状和并发症的决策规则）前瞻性队列研究进行二次分析，该研究包括在英国初级保健中接受常规治疗的年龄≥16 岁的急性喉咙痛（<2 周）患者。
方法
从完整队列中随机抽取 2876 人要求他们填写症状日记。使用简短的临床方案在就诊时收集症状严重程度和检查结果。通过病历回顾和详细的症状日记收集结局详细信息。主要结局是较差的“整体”症状控制（定义为持续时间长于中位数或症状严重程度高于中位数）。分析通过指示性混杂因素（抗生素处方倾向）进行控制。
结果
共 2876 人中，有 1629 人/2876 人（57%）返回了症状日记，其中 1512 人有处方策略信息。与未开具抗生素的患者相比，未开具抗生素的患者（398/587[68%]）整体症状控制较差的比例更高，而立即开具抗生素的患者（441/728[61%]）或延迟开具抗生素的患者（116/197[59%]）；调整后的风险比（RR）（95%置信区间[CI]）：立即 RR 0.87（95% CI = 0.70 至 0.96），P=0.006；延迟 RR 0.88（95% CI = 0.78 至 1.00），P=0.042。
结论
在成年人喉咙痛的常规护理中，与不使用抗生素相比，延迟抗生素策略与立即使用抗生素相比具有相似的症状益处。如果决定开抗生素，延迟抗生素策略可能与立即使用抗生素产生相似的症状益处。
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