Avorn J, Harvey K, Soumerai S B, Herxheimer A, Plumridge R, Bardelay G
Rev Infect Dis. 1987 May-Jun;9 Suppl 3:S286-96.
The "epidemiology of knowledge" underlying clinical decision making related to antibiotic therapy is one of the most important determinants of how such therapy is used, misused, or not used. A growing literature describes how prescribers and patients acquire the information that influences them in their utilization of these agents. The quality and content of this information ultimately determine whether a given microorganism will ever meet a particular drug. Most evidence indicates that there is considerable room for improvement in such decision making. Research data, including those from randomized controlled trials, have been used to compare the efficacy of several methods of improving the flow of information about proper antibiotic use. While traditional passive forms of education are not powerful means of changing prescribing behavior, innovative approaches, including person-to-person tutorials, can improve the quality of antibiotic prescribing. Benefit-cost analysis documents that these programs can save more than they cost. Additional research on these questions will be a powerful way of maximizing both effectiveness and efficiency in the treatment of infectious diseases.
与抗生素治疗相关的临床决策背后的“知识流行病学”是此类治疗如何被使用、滥用或未被使用的最重要决定因素之一。越来越多的文献描述了开处方者和患者如何获取影响他们使用这些药物的信息。这些信息的质量和内容最终决定了特定微生物是否会接触到某种特定药物。大多数证据表明，此类决策仍有很大的改进空间。包括随机对照试验数据在内的研究数据已被用于比较几种改善正确使用抗生素信息传播方法的疗效。虽然传统的被动教育形式并非改变处方行为的有力手段，但包括面对面辅导在内的创新方法可以提高抗生素处方的质量。效益成本分析表明，这些项目的收益大于成本。对这些问题的进一步研究将是在传染病治疗中最大化有效性和效率的有力途径。
