Grigoryan Larissa, Zoorob Roger, Shah Jesal, Wang Haijun, Arya Monisha, Trautner Barbara W
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
Baylor College of Medicine, Houston, TX 77030, USA.
Antibiotics (Basel). 2017 Oct 27;6(4):22. doi: 10.3390/antibiotics6040022.
Reducing inappropriate antibiotic prescribing is currently a global health priority. Current guidelines recommend against antibiotic treatment for acute uncomplicated bronchitis. We studied antibiotic prescribing patterns for uncomplicated acute bronchitis and identified predictors of inappropriate antibiotic prescribing. We used the Epic Clarity database (electronic medical record system) to identify all adult patients with acute bronchitis in family medicine clinics from 2011 to 2016. We excluded factors that could justify antibiotic use, such as suspected pneumonia, COPD or immunocompromising conditions. Of the 3616 visits for uncomplicated acute bronchitis, 2244 (62.1%) resulted in antibiotic treatment. The rates of antibiotic prescribing were similar across the years, value for trend = 0.07. Antibiotics were most frequently prescribed in the age group of 18-39 years (66.9%), followed by the age group of 65 years and above (59.0%), and the age group of 40-64 years (58.7%), value < 0.001. Macrolides were significantly more likely to be prescribed for younger adults, while fluoroquinolones were more likely to be prescribed for patients 65 years or older. Duration of antibiotic use was significantly longer in older adults. Sex and race were not associated with antibiotic prescribing. Our findings highlight the urgent need to reduce inappropriate antibiotic use for uncomplicated acute bronchitis, particularly in younger adults.
减少不恰当的抗生素处方目前是全球卫生重点。现行指南不建议对急性单纯性支气管炎进行抗生素治疗。我们研究了急性单纯性支气管炎的抗生素处方模式，并确定了不恰当抗生素处方的预测因素。我们使用Epic Clarity数据库（电子病历系统）来识别2011年至2016年家庭医学诊所中所有患有急性支气管炎的成年患者。我们排除了可能证明使用抗生素合理的因素，如疑似肺炎、慢性阻塞性肺疾病或免疫功能低下情况。在3616次急性单纯性支气管炎就诊中，2244次（62.1%）进行了抗生素治疗。各年份的抗生素处方率相似，趋势值=0.07。抗生素处方最常见于18 - 39岁年龄组（66.9%），其次是65岁及以上年龄组（59.0%），以及40 - 64岁年龄组（58.7%），P值<0.001。大环内酯类药物明显更有可能被开给年轻人，而氟喹诺酮类药物更有可能被开给65岁或以上的患者。老年人的抗生素使用时间明显更长。性别和种族与抗生素处方无关。我们的研究结果凸显了迫切需要减少对急性单纯性支气管炎不恰当的抗生素使用，尤其是在年轻人中。
