最佳的儿科门诊抗生素处方
Brittany J Lehrer1, Glodi Mutamba2, Katie A Thure2
1Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA network open
|October 3, 2024
概括
在田纳西州,只有不到三分之一的儿科门诊抗生素处方在选择和持续时间方面是最佳的. 干预措施应侧重于减少对不太严重疾病的不必要处方,并改善对常见感染的指导方针的遵守.
科学领域:
- 儿科传染病儿童传染病
- 抗微生物药物管理管理
- 医疗服务研究 医疗服务研究
背景情况:
- 美国一半的儿科门诊抗生素处方是不必要的或不合适的.
- 关于在门诊环境中给儿童开抗生素处方的适当性存在有限的数据.
研究的目的:
- 确定符合国家一线抗生素选择和持续时间指南的儿科门诊抗生素处方的百分比.
- 确定与儿童群体最佳抗生素处方相关的因素.
主要方法:
- 一项横截面研究分析了2022年1月至12月在田纳西州20岁以下患者的抗生素处方.
- 处方按诊断级别 (1-3) 分类,并与选择和持续时间的既定国家指南进行比较.
- 使用多变量逻辑回归来评估最佳处方和患者/临床医生因素之间的关联.
主要成果:
- 在506,633份抗生素处方中,只有31.4%的选择和持续时间都是最佳的.
- 最佳处方率因诊断而异,急性中耳炎 (AOM) 和喉炎的比例更高 (最佳选择分别为67.3%和55.9%).
- 在社区获得的肺炎处方经常超过推的5天持续时间 (只有5.7%的最佳). 年龄较小和社会脆弱性较低与更优的抗生素选择有关.
结论:
- 在田纳西州,只有不到三分之一的儿科门诊抗生素处方符合最佳选择和持续时间的准则.
- 需要有针对性的管理干预措施,包括减少3级诊断的处方,改善AOM和炎的处方,教育肺炎治疗持续时间,并在服务不足的地区促进最佳处方.
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