Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
J Infect Dev Ctries. 2021 Mar 31;15(3):415-421. doi: 10.3855/jidc.12822.
Pharyngitis is one of the most common diagnoses for antibiotic prescriptions worldwide. Antibiotics should be prescribed for bacterial pharyngitis to reduce its complications. The aims of this study were to assess antibiotic prescriptions for pharyngitis cases, and their relationship with physicians' knowledge regarding its diagnosis and management.
A cross-sectional study was conducted. First, prescriptions for pharyngitis cases using the modified Centor criteria was evaluated at primary care centers in Saudi Arabia. Second, physicians' knowledge of the modified Centor score and the diagnosis and management of pharyngitis was assessed using a self-administered questionnaire.
Out of 104 pharyngitis cases, 79% (n = 82) were prescribed antibiotics, of which 28% were evidence-based prescriptions. First-line antibiotics were prescribed in 34% of patients, and second-line (broad-spectrum) antibiotics such as amoxicillin/clavulanate were prescribed in half of the patients. The main significant predictors of antibiotic prescriptions were age < 3 years (odds ratio, 0.13; 95% CI, 0.02 to 0.97), tonsillar exudate (odds ratio, 21.14; 95% CI, 2.88 to 155.09), and throat erythema (odds ratio, 9.30; 95% CI, 1.18 to 73.41). Overall, physicians (n = 29) had adequate knowledge about the modified Centor score and the management of pharyngitis.
Most prescribed antibiotics for pharyngitis were unnecessarily prescribed; the majority being broad-spectrum antibiotics. Despite physicians' adequate knowledge of the modified Centor score and the management of pharyngitis, their practice failed to demonstrate that. Induction of the Saudi Antimicrobial Stewardship Program in the primary care centers, accessibility to diagnostic tools, and educational programs may help in reducing unnecessary antibiotic prescriptions.
咽炎是全球范围内最常见的抗生素处方诊断之一。为了减少咽炎的并发症，应该对细菌性咽炎开具抗生素。本研究旨在评估咽炎病例的抗生素处方情况及其与医生对咽炎诊断和管理的相关知识的关系。
进行了一项横断面研究。首先，在沙特阿拉伯的基层医疗中心评估了使用改良 Centor 标准的咽炎病例的处方。其次，通过自我管理问卷评估了医生对改良 Centor 评分以及咽炎诊断和管理的知识。
在 104 例咽炎病例中，79%（n=82）开具了抗生素，其中 28%是基于证据的处方。一线抗生素在 34%的患者中开具，而在一半的患者中开具了二线（广谱）抗生素，如阿莫西林/克拉维酸。抗生素处方的主要显著预测因素为年龄<3 岁（比值比，0.13；95%置信区间，0.02 至 0.97）、扁桃体渗出物（比值比，21.14；95%置信区间，2.88 至 155.09）和喉咙红斑（比值比，9.30；95%置信区间，1.18 至 73.41）。总体而言，医生（n=29）对改良 Centor 评分和咽炎管理有足够的了解。
大多数开具的咽炎抗生素处方都是不必要的，其中大多数是广谱抗生素。尽管医生对改良 Centor 评分和咽炎管理有足够的了解，但他们的实践并未证明这一点。在基层医疗中心引入沙特抗菌药物管理计划、获得诊断工具和教育计划可能有助于减少不必要的抗生素处方。
