Metlay J P, Stafford R S, Singer D E
General Medicine Division, Massachusetts Division, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Arch Intern Med. 1998 Sep 14;158(16):1813-8. doi: 10.1001/archinte.158.16.1813.
Increased antibiotic use for outpatient illnesses has been identified as an important determinant of the recent rise in antibiotic resistance among common respiratory pathogens. Efforts to reduce the inappropriate use will need to be evaluated against current trends in the outpatient use of antibiotics.
To examine national trends in the use of antibiotics by primary care physicians in the care of adult patients with cough and identify patient factors that may influence antibiotic use for these patients.
This study was based on a serial analysis of results from all National Ambulatory Medical Care Surveys beginning in 1980 (when therapeutic drug use was first recorded) to 1994 (the most recent survey year available). These surveys are a random sampling of visits to US office-based physicians in 1980, 1981, 1985, and annually from 1989-1994. Eligible visits included those by adults presenting to general internists, family practitioners, or general practitioners with a chief complaint of cough. A total of 3416 visits for cough were identified over the survey years. Survey results were extrapolated, based on sampling weights in each year, to project national rates of antibiotic use for patients with cough. Additional analyses examined the rates of antibiotic use stratified by patient age, race, and clinical diagnosis.
Overall, an antibiotic was prescribed 66% of the time during office visits for patients with cough: 59% of patient visits in 1980 rising to 70% of visits in 1994 (P = .002 for trend). In every study year, white, non-Hispanic patients and patients younger than 65 years were more likely to receive antibiotics compared with nonwhite patients and patients 65 years or older, respectively.
The rate of antibiotic use by primary care physicians for patients with cough remained high from 1980 to 1994, and was influenced by nonclinical characteristics of patients.
门诊疾病抗生素使用增加已被确定为常见呼吸道病原体抗生素耐药性近期上升的一个重要决定因素。减少不当使用抗生素的努力需要根据当前门诊抗生素使用趋势进行评估。
研究初级保健医生在治疗成年咳嗽患者时使用抗生素的全国趋势，并确定可能影响这些患者抗生素使用的患者因素。
本研究基于对1980年（首次记录治疗药物使用情况）至1994年（可获得的最近调查年份）所有国家门诊医疗调查结果的系列分析。这些调查是对1980年、1981年、1985年以及1989 - 1994年每年美国门诊医生就诊情况的随机抽样。符合条件的就诊包括以咳嗽为主诉就诊于普通内科医生、家庭医生或全科医生的成年患者。在调查年份中总共确定了3416例咳嗽就诊病例。根据每年的抽样权重对调查结果进行外推，以推算全国咳嗽患者抗生素使用比例。进一步分析按患者年龄、种族和临床诊断对抗生素使用比例进行分层。
总体而言，咳嗽患者门诊就诊时66%的时间会开具抗生素：1980年为59%的患者就诊，到1994年升至70%的就诊（趋势P = 0.002）。在每个研究年份，与非白人患者和65岁及以上患者相比，白人、非西班牙裔患者以及65岁以下患者更有可能接受抗生素治疗。
1980年至1994年期间，初级保健医生对咳嗽患者使用抗生素的比例仍然很高，并且受到患者非临床特征的影响。
