Gonzales R, Barrett P H, Crane L A, Steiner J F
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA.
J Gen Intern Med. 1998 Aug;13(8):541-8. doi: 10.1046/j.1525-1497.1998.00165.x.
To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis.
Prospective, cohort study.
Primary care office practices at a group-model HMO in the Denver metropolitan area.
PATIENTS/PARTICIPANTS: Patients were adults seeking care for acute respiratory illnesses. Participating clinicians included internists, family medicine physicians, nurse practitioners, physician assistants, and registered nurses.
Clinicians voluntarily completed encounter forms for patients presenting with acute respiratory illnesses between February and May, 1996. Acute bronchitis was the primary diagnosis in 16% of acute respiratory illness visits (n = 1,525). The most frequent symptoms of acute bronchitis were cough (92%), phlegm production (63%), "runny nose" (50%), and throat pain (50%). The most frequent physical examination findings were pharyngeal erythema (45%), cervical lymphadenopathy (19%), wheezes (18%), and rhonchi (17%). Antibiotics were prescribed to 85% of patients diagnosed with acute bronchitis. Purulent nasal discharge by patient report, and sinus tenderness on physical examination were moderately associated with antibiotic treatment (p = .06 and .08, respectively). Antibiotic prescription rates did not vary by patient age or gender, duration of illness, days of work lost due to illness, or clinician type.
Acute bronchitis is frequently treated with antibiotics in ambulatory practice. The clinical factors we identified to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics for this condition. These findings suggest that clinicians use the diagnosis of acute bronchitis as an indication for antibiotic treatment, despite clinical trials and expert recommendations to the contrary.
描述被诊断为急性支气管炎的成年人的临床特征，并确定与急性支气管炎抗生素治疗相关的临床变量。
前瞻性队列研究。
丹佛大都市地区一家集团模式健康维护组织（HMO）的初级保健诊所。
患者/参与者：患者为寻求急性呼吸道疾病治疗的成年人。参与的临床医生包括内科医生、家庭医学医生、执业护士、医师助理和注册护士。
临床医生自愿为1996年2月至5月间出现急性呼吸道疾病的患者填写会诊表格。急性支气管炎是16%的急性呼吸道疾病就诊病例（n = 1525）的主要诊断。急性支气管炎最常见的症状是咳嗽（92%）、咳痰（63%）、“流鼻涕”（50%）和咽痛（50%）。最常见的体格检查发现是咽部红斑（45%）、颈部淋巴结病（19%）、哮鸣音（18%）和粗湿啰音（17%）。85%被诊断为急性支气管炎的患者接受了抗生素治疗。患者自述有脓性鼻涕以及体格检查时有鼻窦压痛与抗生素治疗中度相关（分别为p = 0.06和0.08）。抗生素处方率不因患者年龄、性别、病程、因病缺勤天数或临床医生类型而有所不同。
在门诊实践中，急性支气管炎经常使用抗生素治疗。我们确定的与急性支气管炎抗生素使用相关的临床因素，在解释这种疾病抗生素的过度使用方面似乎只起了很小的作用。这些发现表明，尽管有临床试验和专家建议相反，但临床医生仍将急性支气管炎的诊断作为抗生素治疗的指征。
