ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK.
Department of Medical Statistics, London School of Hygiene.
Rhinology. 2019 Dec 1;57(6):420-429. doi: 10.4193/Rhin19.136.
The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed.
We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10).
From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident.
While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management.
本研究旨在分析英格兰和威尔士初级保健中慢性鼻-鼻窦炎（CRS）的抗生素使用情况，并确定所开抗生素的选择趋势。
我们使用初级保健电子病历中的关联数据，诊断采用同意参与的常规实践中使用的 Read 术语（临床实践研究数据链接）进行编码，并结合（2）医院护理管理记录（使用 ICD-10 记录的医院入院统计）。
在总共确定的 88317 例 CRS 病例中，有 40462 例（46%）在首次 CRS 诊断后 5 天内开具了抗生素处方。在首次 CRS 诊断后 5 天内接受一线抗生素治疗的患者中，在每个 CRS 组中，超过 80%的患者随后又开具了抗生素处方。在诊断后的 5 年内，估计有 9%的患者在与 CRS 相关就诊后的 5 天内接受了 5 种或更多种抗生素治疗。由于数据涵盖了近 20 年的时间，因此可以发现抗生素处方的趋势，大环内酯类和四环素类的开具明显呈上升趋势。
虽然抗生素可能已被开用于急性加重期，但我们发现一些 CRS 患者在初级保健中反复开具抗生素的情况较高。需要更多关于抗生素在 CRS 管理中的作用的证据。
