Mainous A G, Zoorob R J, Hueston W J
Department of Family Practice, University of Kentucky, Lexington, USA.
Arch Fam Med. 1996 Feb;5(2):79-83. doi: 10.1001/archfami.5.2.79.
To examine the treatment regimens for acute bronchitis in adults in a Medicaid population seen in ambulatory care settings.
Cross-sectional sample of Kentucky Medicaid claims (July 1, 1993, through June 30, 1994).
Individuals 18 years old or older seen in an ambulatory setting for acute bronchitis. Anyone with a primary diagnosis of asthma or chronic obstructive pulmonary disease within the time frame was excluded. Twelve hundred ninety-four individuals accounted for 1635 separate outpatient and emergency department encounters for acute bronchitis. Outpatient visits accounted for 89% (n=1448) of the encounters.
In 22% (n=358) of the encounters, no medication was prescribed; in 61% (n=997), antibiotics alone were prescribed, in 3% (n=43), bronchodilators alone were prescribed; and in 14% (n=237), both antibiotics and bronchodilators were prescribed. Some type of medication was more likely to be prescribed in emergency departments than in outpatient settings (P=.04), and antibiotic/bronchodilator combination therapy was more likely to be prescribed in rural practices than in urban practices (P<.001). Broad-spectrum were more likely than narrow-spectrum antibiotics to be used in combination with a bronchodilator (P=.001). Penicillins were the most widely used antibiotics (37%), but broad-spectrum agents, such as second- and third-generation cephalosporins (10%) and fluoroquinolones (5%), were also prescribed.
Although evidence suggests that antibiotic treatment is not usually indicated for treatment of acute bronchitis, these results indicate that antibiotics are still the predominant treatment regimen in ambulatory care. Furthermore, the evidence suggesting that bronchodilators are effective symptomatic treatments has not been widely adopted. These results have significant implications for the production of antibiotic-resistant bacteria and suggest investigation into why physicians have not used this information in their treatment of acute bronchitis.
研究在门诊医疗环境中接受医疗补助的成年急性支气管炎患者的治疗方案。
肯塔基州医疗补助索赔的横断面样本（1993年7月1日至1994年6月30日）。
18岁及以上在门诊因急性支气管炎就诊的个体。在该时间段内，任何主要诊断为哮喘或慢性阻塞性肺疾病的个体均被排除。1294名个体因急性支气管炎进行了1635次门诊和急诊科就诊。门诊就诊占就诊次数的89%（n = 1448）。
在22%（n = 358）的就诊中，未开具任何药物；在61%（n = 997）的就诊中，仅开具了抗生素；在3%（n = 43）的就诊中，仅开具了支气管扩张剂；在14%（n = 237）的就诊中，抗生素和支气管扩张剂都开具了。在急诊科比在门诊更有可能开具某种类型的药物（P = 0.04），在农村诊所比在城市诊所更有可能开具抗生素/支气管扩张剂联合治疗（P < 0.001）。与窄谱抗生素相比，广谱抗生素更有可能与支气管扩张剂联合使用（P = 0.00）。青霉素是使用最广泛的抗生素（37%），但也开具了广谱药物，如第二代和第三代头孢菌素（10%）和氟喹诺酮类（5%）。
尽管有证据表明抗生素治疗通常不适用于急性支气管炎的治疗，但这些结果表明抗生素仍然是门诊医疗中的主要治疗方案。此外，提示支气管扩张剂是有效的对症治疗的证据尚未被广泛采用。这些结果对耐药菌的产生具有重要意义，并提示应调查医生在治疗急性支气管炎时未使用该信息的原因。
