Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.
Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Eur J Gen Pract. 2022 Dec;28(1):142-149. doi: 10.1080/13814788.2022.2083105.
Acute upper respiratory infections are the most common reason for primary physician visits in the community. This study investigated whether the type of antibiotic used to treat streptococcal tonsillitis can reduce the burden by affecting the number of additional visits.
To assess the effect of different antibiotic treatments for tonsillitis on the number of additional primary physician visits and the development of infectious or inflammatory sequels.
This retrospective study included first cases of culture-confirmed streptococcal tonsillitis ( = 242,366, 55.3% females, 57.6% aged 3-15 years) treated in primary clinics throughout Israel between the years 2010 and 2019. Primary outcomes were the number of additional primary physician visits, due to any cause or due to specific upper airway infections. Secondary outcomes were the number of developed complications, such as peritonsillar abscess, post-streptococcal glomerulonephritis, rheumatic fever, post-streptococcal arthritis, chorea and death.
Compared to penicillin-V, adjusted incidence rate ratios (IRR) for additional primary physician visits at 30-days were highest for IM benzathine-benzylpenicillin (IRR = 1.46, CI 1.33-1.60, < .001) and cephalosporin treatment (IRR = 1.27, CI 1.24-1.30, < .001). Similar results were noted for visits due to specific diagnoses such as recurrent tonsillitis, otitis media and unspecified upper respiratory tract infection. Amoxicillin showed decreased adjusted odds ratio (aOR) of developing complications (aOR = 0.68, CI 0.52-0.89, < .01 for any complication. aOR = 0.75, CI 0.55-1.02, = .07 for peritonsillar or retropharyngeal abscess).
Penicillin-V treatment is associated with fewer additional primary physician visits compared to other antibiotic treatments. Amoxicillin and penicillin-V are associated with fewer complications. These findings are limited by the retrospective nature of the study and lack of adjustment for illness severity. Further prospective studies may be warranted to validate results.
急性上呼吸道感染是社区初级保健医生就诊的最常见原因。本研究旨在探讨治疗链球菌性扁桃体炎时使用的抗生素类型是否会通过影响就诊次数来减轻负担。
评估不同抗生素治疗扁桃体炎对额外就诊次数和感染或炎症后遗症发展的影响。
本回顾性研究纳入了 2010 年至 2019 年期间以色列各地初级诊所中经培养证实的 242366 例（55.3%为女性，57.6%年龄为 3-15 岁）链球菌性扁桃体炎首诊病例。主要结局是因任何原因或特定上呼吸道感染而额外就诊的次数。次要结局是开发并发症的数量，如扁桃体周围脓肿、链球菌后肾小球肾炎、风湿热、链球菌后关节炎、舞蹈病和死亡。
与青霉素-V 相比，30 天时因任何原因或特定诊断（如复发性扁桃体炎、中耳炎和未特指的上呼吸道感染）就诊的次数，肌注苄星青霉素（IRR = 1.46，95%CI 1.33-1.60，<0.001）和头孢菌素治疗的调整发病率比（IRR）最高。对于特定诊断，如复发性扁桃体炎、中耳炎和未特指的上呼吸道感染，也观察到类似的就诊次数。与其他抗生素治疗相比，阿莫西林显示出降低的并发症（任何并发症的调整比值比[aOR] = 0.68，95%CI 0.52-0.89，<0.01。aOR = 0.75，95%CI 0.55-1.02，=0.07 对于扁桃体周围或咽后脓肿）的调整优势比（aOR）。
与其他抗生素治疗相比，青霉素-V 治疗与较少的额外就诊次数相关。阿莫西林和青霉素-V 与较少的并发症相关。这些发现受到研究回顾性的限制，并且缺乏对疾病严重程度的调整。可能需要进一步的前瞻性研究来验证结果。
