Annals of internal medicine · 2003
Changing use of antibiotics in community-based outpatient practice, 1991-1999.
СтатьяПоддержка исследования: вне правительства СШАПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Steinman Michael A, Gonzales Ralph, Linder Jeffrey A, Landefeld C Seth
Аннотация
BACKGROUND: Judicious use of antibiotics can slow the spread of antimicrobial resistance. However, overall patterns of antibiotic use among ambulatory patients are not well understood.
OBJECTIVE: To study patterns of outpatient antibiotic use in the United States, focusing on broad-spectrum antibiotics.
DESIGN: Cross-sectional survey in three 2-year periods (1991-1992, 1994-1995, and 1998-1999).
SETTING: The National Ambulatory Medical Care Survey, a nationally representative sample of community-based outpatient visits.
PATIENTS: Patients visiting community-based outpatient clinics.
MEASUREMENTS: Rates of overall antibiotic use and use of broad-spectrum antibiotics (azithromycin and clarithromycin, quinolones, amoxicillin-clavulanate, and second- and third-generation cephalosporins). All comparisons were made between the first study period (1991-1992) and the final study period (1998-1999).
RESULTS: Between 1991-1992 and 1998-1999, antibiotics were used less frequently to treat acute respiratory tract infections, such as the common cold and pharyngitis. However, use of broad-spectrum agents increased from 24% to 48% of antibiotic prescriptions in adults (P < 0.001) and from 23% to 40% in children (P < 0.001). Use of broad-spectrum antibiotics increased across many conditions, increasing two- to threefold as a percentage of total antibiotic use for a variety of diagnoses in both adults and children. By 1998-1999, 22% of adult and 14% of pediatric prescriptions for broad-spectrum antibiotics were for the common cold, unspecified upper respiratory tract infections, and acute bronchitis, conditions that are primarily viral.
CONCLUSIONS: Antibiotic use in ambulatory patients is decreasing in the United States. However, physicians are increasingly turning to expensive, broad-spectrum agents, even when there is little clinical rationale for their use.
OBJECTIVE: To study patterns of outpatient antibiotic use in the United States, focusing on broad-spectrum antibiotics.
DESIGN: Cross-sectional survey in three 2-year periods (1991-1992, 1994-1995, and 1998-1999).
SETTING: The National Ambulatory Medical Care Survey, a nationally representative sample of community-based outpatient visits.
PATIENTS: Patients visiting community-based outpatient clinics.
MEASUREMENTS: Rates of overall antibiotic use and use of broad-spectrum antibiotics (azithromycin and clarithromycin, quinolones, amoxicillin-clavulanate, and second- and third-generation cephalosporins). All comparisons were made between the first study period (1991-1992) and the final study period (1998-1999).
RESULTS: Between 1991-1992 and 1998-1999, antibiotics were used less frequently to treat acute respiratory tract infections, such as the common cold and pharyngitis. However, use of broad-spectrum agents increased from 24% to 48% of antibiotic prescriptions in adults (P < 0.001) and from 23% to 40% in children (P < 0.001). Use of broad-spectrum antibiotics increased across many conditions, increasing two- to threefold as a percentage of total antibiotic use for a variety of diagnoses in both adults and children. By 1998-1999, 22% of adult and 14% of pediatric prescriptions for broad-spectrum antibiotics were for the common cold, unspecified upper respiratory tract infections, and acute bronchitis, conditions that are primarily viral.
CONCLUSIONS: Antibiotic use in ambulatory patients is decreasing in the United States. However, physicians are increasingly turning to expensive, broad-spectrum agents, even when there is little clinical rationale for their use.