Mainous A G, Hueston W J, Clark J R
Department of Family Practice, University of Kentucky, Lexington 40536-0284, USA.
J Fam Pract. 1996 Apr;42(4):357-61.
Symptomatic treatment is the only recommended therapy for the uncomplicated "common cold." The purpose of this study was to examine the use of antibiotics and other prescription medications for the common cold in a Medicaid population seen in ambulatory care settings.
A cross-sectional sample of Kentucky Medicaid claims from July 1, 1993, through June 30, 1994, was analyzed. Subjects were patients seen in an ambulatory setting for the common cold, defined as acute nasopharyngitis. A total of 1439 individuals were seen for 2171 separate outpatient and emergency department encounters for the common cold. Outpatient visits accounted for 99% (2144) of the encounters.
Patients in 35% (752) of the encounters did not fill a prescription for medication, 6% (129) filled a prescription for an antihistamine or other symptomatic medication, and 60% (1290) filled a prescription for an antibiotic for the common cold. Nineteen different antibiotics, 54% of which were amoxicillin, were prescribed for the common cold. Less than 2% of the encounters had a secondary diagnosis of either acute sinusitis or otitis media. These encounters were not more likely than the total sample to receive antibiotics. Adults were more likely than children to receive an antibiotic (P<.001), and urban physicians were more likely than rural physicians to prescribe antibiotics (P=.02). A conservative estimate of the annual cost of antibiotic prescribing for the common cold in the United States was $37.5 million.
A majority of persons receiving medical care for the common cold are given prescriptions for an unnecessary antibiotic. Unchecked, this practice may lead to greater antibiotic resistance and unnecessary use of health care resources. Future research should focus on the ability to institute behavioral changes for treatment of the common cold in both closed systems (eg, managed care) and open systems (eg, general community of physicians).
对症治疗是针对单纯性“普通感冒”唯一推荐的疗法。本研究的目的是调查在门诊医疗环境中医疗补助人群治疗普通感冒时抗生素及其他处方药的使用情况。
对1993年7月1日至1994年6月30日期间肯塔基州医疗补助申请进行横断面抽样分析。研究对象为在门诊因普通感冒（定义为急性鼻咽炎）就诊的患者。共有1439人因普通感冒进行了2171次门诊和急诊就诊。门诊就诊占就诊次数的99%（2144次）。
35%（752次）就诊的患者未开具药物处方，6%（129次）开具了抗组胺药或其他对症药物处方，60%（1290次）开具了治疗普通感冒的抗生素处方。共为普通感冒开具了19种不同的抗生素，其中54%为阿莫西林。不到2%的就诊有急性鼻窦炎或中耳炎的二级诊断。这些就诊与总样本相比，接受抗生素治疗的可能性并无更高。成年人比儿童更有可能接受抗生素治疗（P<0.001），城市医生比农村医生更有可能开具抗生素（P=0.02）。据保守估计，美国每年因普通感冒开具抗生素的费用为3750万美元。
大多数因普通感冒接受医疗护理的人都被开具了不必要的抗生素处方。这种做法若不加以控制，可能会导致更大的抗生素耐药性以及医疗资源的不必要使用。未来的研究应聚焦于在封闭系统（如管理式医疗）和开放系统（如普通医生群体）中促使治疗普通感冒行为发生改变的能力。
