Primary Care and Population Sciences Division, University of Southampton.
Nuffield Department of Primary Care Health Sciences, University of Oxford.
Br J Gen Pract. 2017 Sep;67(662):e623-e633. doi: 10.3399/bjgp17X692333. Epub 2017 Aug 14.
Guidelines recommend 10-day treatment courses for acute sore throat, but shorter courses may be used in practice.
To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care.
A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study of 12 829 adults presenting in UK general practice with acute sore throat.
A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review, a sample also completed a symptom diary. The primary outcome was re-consultation with new/non-resolving symptoms within 1 month. The secondary outcome was 'global' poorer symptom control (longer than the median duration or higher than median severity).
Antibiotics were prescribed for 62% (7872/12 677) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were largely for 5 (20%), 7 (57%), or 10 (22%) days. Compared with 5-day courses, those receiving longer courses were less likely to re-consult with new or non-resolving symptoms (5 days 15.3%, 7 days 13.9%, 10 days 12.2%, 7-day course adjusted risk ratio (RR) 0.92 [95% confidence interval [CI] = 0.76 to 1.11] and 10-days RR 0.86 [95% CI = 0.59 to 1.23]) but these differences did not reach statistical significance.
In adults prescribed antibiotics for sore throat, the authors cannot rule out a small advantage in terms of reduced re-consultation for a 10-day course of penicillin, but the effect is likely to be small.
指南建议急性咽痛的治疗疗程为 10 天，但在实践中可能会使用更短的疗程。
确定在常规护理中，抗生素疗程是否可预测成人急性咽痛的不良结局。
对英国普通诊所中 12829 例急性咽痛成人进行的 DESCARTE（急性红喉症状和并发症决策规则）前瞻性队列研究的二次分析。
使用简短的临床表格收集就诊时的症状严重程度和检查结果。通过病历回顾收集结局，部分患者还填写了症状日记。主要结局是 1 个月内再次出现新的/未缓解的症状。次要结局为“整体”症状控制较差（持续时间长于中位数或严重程度高于中位数）。
抗生素用于 62%（7872/12677）的患者。最常开的抗生素是苯氧甲基青霉素（76%，5656/7474），处方疗程主要为 5（20%）、7（57%）或 10（22%）天。与 5 天疗程相比，接受更长疗程的患者再次出现新的或未缓解症状的可能性较小（5 天为 15.3%，7 天为 13.9%，10 天为 12.2%，7 天疗程调整后的风险比（RR）为 0.92[95%置信区间（CI）为 0.76 至 1.11]，10 天 RR 为 0.86[95% CI = 0.59 至 1.23]），但差异无统计学意义。
在开具抗生素治疗咽痛的成人中，作者不能排除青霉素 10 天疗程在减少再次就诊方面有较小优势，但这种效果可能很小。
