School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia.
BMJ Open. 2019 Oct 28;9(10):e031527. doi: 10.1136/bmjopen-2019-031527.
To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).
A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.
ReCEnT is an ongoing multisite cohort study of Australian registrars' in-consultation clinical practice across five Australian states.
Registrars participating in ReCEnT from 2010 to 2017.
Management of impetigo with systemic antibiotics.
1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).
Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
确定初级全科医生（全科住院医师头 18 个月）开具脓疱疮全身抗生素处方的流行情况和关联因素。
对 Registrar Clinical Encounters in Training（ReCEnT）研究数据的横断面分析。
ReCEnT 是一项正在进行的多地点队列研究，在澳大利亚五个州对澳大利亚住院医师的门诊临床实践进行了评估。
2010 年至 2017 年参加 ReCEnT 的住院医师。
全身抗生素治疗脓疱疮的方法。
1741 名住院医师（应答率 96%）提供了在 246434 次就诊中确定的 384731 个问题中的数据。脓疱疮初次就诊或复诊时，930 次就诊（0.38%，95%CI 0.35 至 0.40）中给予全身抗生素治疗，占问题的 0.24%（95%CI 0.23 至 0.26）。683 例患者新诊断为脓疱疮，其中 38/683（5.6%）未开抗生素；239/683（35.0%）仅开局部抗生素；306/683（44.8%）仅开全身抗生素，100/683（14.6%）开全身和局部抗生素。最常开的全身抗生素是头孢氨苄（53.5%）。与开具全身抗生素相关的独立变量为：位于内陆地区（与主要城市相比）（OR 1.82，95%CI 1.06 至 3.13；p=0.028）、在咨询过程中寻求信息或建议（OR 2.17，95%CI 1.47 至 3.23；p<0.001）和开病理学检查（OR 2.13，95%CI 1.37 至 3.33；p=0.01）。
澳大利亚初级全科医生（GP）对大多数初始脓疱疮患者开全身抗生素（大多数为广谱抗生素）。脓疱疮指南应明确规定全身抗生素处方和个体抗生素选择的标准。还需要进一步探讨非抗生素治疗和局部抗菌剂的作用。
