喉の痛みのある子供の抗生物質治療
Jeffrey A Linder1, David W Bates, Grace M Lee
1Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. jlinder@partners.org
JAMA
|November 10, 2005
まとめ
喉の痛みを持つ子供に対する抗生物質の処方量は依然として高く,A群ベータ血分解性ストレプトコックスの (GABHS) 流行を上回っています. GABHS検査は特定のケースで抗生物質の使用を減らすことができますが,小児科のケアでは十分に活用されていません.
科学分野:
- 小児科は小児科です.
- 感染症 感染症は感染症です.
- クリニカル・プラクティスのガイドライン
背景:
- グループAベータ溶解性ストレプトコック (GABHS) は,小児の喉の痛みの15-36%の原因となります.
- 抗生物質の処方前のGABHS検査は,喉の痛みのある子供に推奨されます.
- GABHSに対する推奨抗生物質には,ペニシリン,アモキシシリン,エリトロマイシン,第1世代のセファロスポリンが含まれます.
研究 の 目的:
- 喉の痛みのある子供の抗生物質の処方とGABSテストの割合を測定する.
- GABHS検査と抗生物質治療決定の関連性を評価する.
主な方法:
- 全国 ambulatory medical care調査と全国病院 ambulatory medical care調査 (1995-2003) のデータを分析した.
- 喉の痛みのある3歳から17歳の子供による訪問も含まれています.
- 抗生物質の処方,推奨/非推奨の抗生物質使用,およびGABHS検査の調査された全国的な割合.
主要な成果:
- 抗生物質は,年間730万件の喉の痛み訪問のうち53%に処方されました.
- 推奨されていない抗生物質は,抗生物質を服用している子供の27%に投与されました.
- GABHS検査は53%の診察で実施され,特定の診断 (喉炎,炎, estreptococcal 喉の痛み) に対して抗生物質の処方量が低いとの関連がありました.
結論:
- 小児の喉の痛みに対する抗生物質の処方量は,GABHSの予想される罹患率を超えています.
- 1995年から2003年にかけての抗生物質の処方量の減少は,推奨薬の使用量の減少によるものです.
- GABHS検査は,特定の小児症例における抗生物質の処方量の減少と関連しているにもかかわらず,未充分に利用されています.
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