Ahmad Azmi, Nor Junainah, Abdullah Ariff Arithra, Tuan Kamauzaman Tuan Hairulnizam, Yazid Mohd Boniami
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Malays J Med Sci. 2021 Apr;28(2):72-83. doi: 10.21315/mjms2021.28.2.7. Epub 2021 Apr 21.
Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs.
This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018-2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate.
A total of 261 cases were included - 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; = 0.003) were significantly associated with inappropriate antibiotic prescription.
Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.
急诊科经常被滥用于处理非紧急情况，如 上呼吸道感染（URTIs）。这些病例的大量涌入可能导致不适当的抗生素处方。本研究的目的是确定与急诊科不适当的上呼吸道感染抗生素处方相关的患者因素。
这项横断面研究涉及2018 - 2019年在马来西亚东海岸一家三级医院急诊科绿色区域就诊的3岁以上上呼吸道感染患者。采用方便抽样法。根据麦克艾萨克评分将患者分为两组：阳性（≥2）或阴性（<2）。给予麦克艾萨克评分为阴性组的抗生素被视为不适当。
共纳入261例病例——127例麦克艾萨克评分为阳性，134例为阴性。最常见的症状是发热和咳嗽。约29%的患者有不适当的抗生素处方，阿莫西林的使用率较高。症状持续时间为一天或更短（比值比18.5；95%置信区间：1.65，207.10；P = 0.018）、寒战（比值比4.36；95%置信区间：1.13，16.88；P = 0.033）和急性扁桃体炎诊断（比值比5.26；95%置信区间：1.76，15.72；P = 0.003）与不适当的抗生素处方显著相关。
应向急诊科医生指出影响不适当抗生素处方的因素，以降低其发生率。
