Dowell S F, Schwartz B, Phillips W R
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Am Fam Physician. 1998 Oct 15;58(6):1335-42, 1345.
This article summarizes the principles of judicious antimicrobial therapy for three of the five conditions--cough, pharyngitis, the common cold--that account for most of the outpatient use of these drugs in the United States. The principles governing the other two conditions, otitis media and acute sinusitis, were presented in the previous issue. This article summarizes evidence against the use of antibiotic treatment for illness with cough or bronchitis in children, unless the cough is prolonged. Although empiric treatment may be started in patients with pharyngitis when streptococcal infection is suspected, the authors recommend withholding antibiotic treatment until antigen testing or culture is positive. There is never any indication for antibiotic treatment of the common cold; it is important to understand the natural history of colds, because symptoms such as mucopurulent rhinitis or cough, even when they persist for up to two weeks, do not necessarily indicate bacterial infection.
本文总结了在美国门诊中最常使用这些药物治疗的五种病症中的三种——咳嗽、咽炎、普通感冒——的合理抗菌治疗原则。关于另外两种病症——中耳炎和急性鼻窦炎——的治疗原则已在上一期介绍过。本文总结了反对在儿童咳嗽或支气管炎时使用抗生素治疗的证据，除非咳嗽持续时间较长。虽然怀疑有链球菌感染的咽炎患者可开始经验性治疗，但作者建议在抗原检测或培养结果呈阳性之前暂不使用抗生素治疗。普通感冒绝对没有使用抗生素治疗的指征；了解感冒的自然病程很重要，因为诸如脓性鼻炎或咳嗽等症状，即使持续长达两周，也不一定表明存在细菌感染。
