Faryna A, Wergowske G L, Goldenberg K
J Gen Intern Med. 1987 Mar-Apr;2(2):102-7. doi: 10.1007/BF02596306.
Inappropriate use of antibiotics has been well documented for inpatient settings, but there are few studies in ambulatory patients. In a prospective study, the authors monitored the outpatient prescribing patterns of internal medicine residents and evaluated the effect of placing a one-page set of antibiotic guidelines in each patient examining room. Appropriateness of antibiotic choices was scored periodically. A 12-month pre-intervention survey of antibiotic use showed that 50% of the choices were inappropriate. Comparison of a four-month post-intervention analysis with the same four-month interval in the pre-intervention period showed no significant difference between the percentages of inappropriate prescriptions. The most common reasons for inappropriate use were: 1) failure to document a clinically significant bronchial infection, and 2) inadequate evaluation of nonspecific urinary tract complaints. The authors conclude that the ready availability of information about appropriate antibiotic use is not effective in changing antibiotic choices, and that educational strategies regarding antibiotic use must also address diagnostic evaluation.
抗生素在住院环境中的不当使用已有充分记录，但针对门诊患者的研究较少。在一项前瞻性研究中，作者监测了内科住院医师的门诊处方模式，并评估了在每个患者检查室放置一套单页抗生素指南的效果。定期对抗生素选择的合理性进行评分。一项为期12个月的干预前抗生素使用调查显示，50%的选择是不合适的。将干预后四个月的分析结果与干预前相同四个月期间进行比较，发现不合适处方的百分比之间没有显著差异。不当使用的最常见原因是：1）未记录具有临床意义的支气管感染，以及2）对非特异性泌尿系统症状的评估不足。作者得出结论，关于适当使用抗生素的信息随时可得，这在改变抗生素选择方面并不有效，并且关于抗生素使用的教育策略还必须涉及诊断评估。
