English J A, Bauman K A
Department of Family Practice, University of Hawaii, Mililani, USA.
Fam Med. 1997 Jan;29(1):38-41.
Management of upper respiratory infection (URI) was examined in a family practice clinic to determine evidence-based practices, specifically for medication choice. Scientific evidence supports the use of decongestants and perhaps decongestant/antihistamine combinations in adolescents and adults and antipyretics in all age groups. The use of cold preparations for children younger than age 5 is not evidence based.
Data on demographics, medications prescribed, and over-the-counter medications recommended were collected from patient charts for 293 URI visits over a 6-month period. The cost of evidence-based URI treatment was compared with the cost of nonevidence-based treatment.
Thirty-three percent of patients younger than age 5 were given a prescription; 96% of the prescription cost in this age group was nonevidence based. Twenty-six percent of all patients seen were given unnecessary and potentially harmful medication. These unnecessary medications accounted for almost 60% of the total prescription cost. Various combinations of antihistamines, decongestants, and antitussives were most commonly prescribed.
Few medications have been shown to effectively alleviate the symptoms of the generally self-limited, benign common cold. Medications are often overprescribed, escalating health care costs and, in some cases, exposing the patient to dangerous side effects. Family physicians and educators are encouraged to reexamine their treatment and teaching practices for the common cold.
在一家家庭医疗诊所对治疗上呼吸道感染（URI）的方法进行研究，以确定循证医疗方法，尤其是药物选择方面。科学证据支持在青少年和成年人中使用减充血剂以及可能使用减充血剂/抗组胺药组合，在所有年龄组中使用退热药。对于5岁以下儿童使用感冒制剂并无循证依据。
在6个月期间，从293例URI就诊患者的病历中收集人口统计学数据、所开处方药物以及推荐的非处方药物信息。将循证URI治疗的费用与非循证治疗的费用进行比较。
5岁以下患者中有33%接受了处方治疗；该年龄组96%的处方费用是没有循证依据的。所有就诊患者中有26%接受了不必要且可能有害的药物治疗。这些不必要的药物几乎占总处方费用的60%。最常开具的是抗组胺药、减充血剂和镇咳药的各种组合。
很少有药物被证明能有效缓解通常具有自限性的良性普通感冒的症状。药物常常被过度开具，增加了医疗保健成本，并且在某些情况下，会使患者面临危险的副作用。鼓励家庭医生和教育工作者重新审视他们对普通感冒的治疗和教学方法。
