Al-Baghli Nadira A, Al Saif Ahmed Z, Al Dorazi Shorok A, Zainaldeen Mariam H, Alameer AbdulMuhsen H, Albaghli Slava, Al-Dawood Ahmad M, Buhelaiga Salma M, Alsalim Batool S, Rabaan Ali A
Public Health Administration, Dammam Health Network, Dammam, SAU.
Keep Well, Model of Care, Eastern Health Cluster, Dammam, SAU.
Cureus. 2023 Aug 28;15(8):e44298. doi: 10.7759/cureus.44298. eCollection 2023 Aug.
Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests (RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.
上呼吸道感染（URTIs）是门诊医疗中最常见的诊断疾病。其中一些感染可通过抗生素得到恰当治疗，但有证据表明在URTI的治疗中存在抗生素使用不当的过度现象。这种过度使用与抗生素耐药性、药物相关不良反应及成本增加有关。
本研究评估了沙特阿拉伯达曼市妇幼医院（MCH）的初级医疗保健中心（PHCCs）和儿科急诊科（ED）中出现URTI症状患者抗生素处方的患病率及预测因素。
在MCH的PHCCs和儿科ED进行了一项前瞻性研究。经过培训的医生收集了3岁及以上有URTI症状患者的数据。根据改良的森托标准计算得分，并对所有研究参与者进行快速抗原检测（RADTs）。
在469例URTI患者中，141例（30.1%）接受了抗生素处方，PHCCs中的比例（n = 85；24.4%）低于儿科ED（n = 56；46.3%）。就优势比（OR）和95%置信区间（95%CI）而言，抗生素处方的主要显著预测因素为RADT结果呈阳性（OR = 41.75，95%CI = 4.76 - 366.28）、存在扁桃体渗出物（OR = 5.066，95%CI = 3.08 - 8.33）、颈前淋巴结压痛和/或肿大（OR = 4.537，95%CI = 1.96 - 10.54）以及发热（OR = 3.519，95%CI = 2.33 - 5.31）。较高的森托评分也是一个预测因素（2至5分与 -1至1分相比）（OR = 2.72，95%CI = 1.8 - 4.12）。无咳嗽并非显著预测因素（OR = 1.13，95%CI = 0.74 - 1.72）。
尽管RADT结果呈阳性增加了患者在评估时接受抗生素处方的可能性，但大多数抗生素处方并无合理依据。为控制费用、预防不良反应并限制抗生素耐药性的传播，应努力减少不必要的高抗生素使用情况。
