存在痰液变色的急性咳嗽/下呼吸道感染患者采用抗生素治疗
2011/05/12
摘要
在13个国家的3402名急性咳嗽/下呼吸道感染的成人患者中，前瞻性研究抗生素治疗是否与痰液变色和感觉不适有关，是否能对这些患者起到有效治疗作用。双水平模型用于研究痰液变色或感觉不适与抗生素处方的关系。三水平模型用于研究抗生素治疗与症状缓解间的关系。与无痰患者相比，出现痰液变色的患者更常给予抗生素治疗(OR: 3.2, 95% CI: [2.1, 5.0])，而且与正常/白色痰液患者也不一样(OR: 0.95, 95% CI: [0.61,1.48])。此外，症状评分缓解（患者每天完成13个项目的量表检测）的程度和比例与抗生素治疗无关：黄痰 (相关系数: 0.00, p: 0.68)、绿痰(相关系数: -0.01, p: 0.11)与主诉感觉舒适的3个分类无相关；与出现痰液变色和感觉不适无关(相关系数: -0.01, p: 0.19)。与那些无痰的患者相比，初级医疗机构中有痰液变色的咳嗽/下呼吸道感染成人患者更常采用抗生素治疗。痰液颜色单独，或与全身感觉不适一起，均与抗生素治疗后的恢复无相关性。
（陈欣 审校）
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
Antibiotic prescribing for discoloured sputum in acute cough/LRTI.
Butler CC, Kelly MJ, Hood K, Schaberg T, Melbye H, Serra-Prat M, Blasi F, Little P, Verheij T, Mölstad S, Godycki-Cwirko M, Edwards P, Almirall J, Torres A, Rautakorpi UM, Nuttall J, Goossens H, Coenen S.
School of Medicine, Cardiff University.
Abstract
We investigated whether discoloured sputum and feeling unwell is associated with antibiotic prescribing and benefit from antibiotic treatment for acute cough/lower respiratory tract infection in a prospective study of 3402 adults. in 13 countries. A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution. Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR: 3.2, 95% CI: [2.1, 5.0]), unlike those producing clear/white sputum (OR: 0.95, 95% CI: [0.61,1.48]). Antibiotic prescribing was not associated with greater rate or magnitude of symptoms score resolution (as measured by 13 item scale completed by patients each day) among those who: produced yellow (Coefficient: 0.00, p-value: 0.68) or green sputum (Coefficient: -0.01, p-value: 0.11); reported any of three categories of feeling unwell; produced discoloured sputum and felt generally unwell (Coefficient: -0.01, p-value: 0.19). Adults with acute cough/LRTI presenting in primary care with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell was not associated with recovery or benefit from antibiotic treatment.
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
在13个国家的3402名急性咳嗽/下呼吸道感染的成人患者中，前瞻性研究抗生素治疗是否与痰液变色和感觉不适有关，是否能对这些患者起到有效治疗作用。双水平模型用于研究痰液变色或感觉不适与抗生素处方的关系。三水平模型用于研究抗生素治疗与症状缓解间的关系。与无痰患者相比，出现痰液变色的患者更常给予抗生素治疗(OR: 3.2, 95% CI: [2.1, 5.0])，而且与正常/白色痰液患者也不一样(OR: 0.95, 95% CI: [0.61,1.48])。此外，症状评分缓解（患者每天完成13个项目的量表检测）的程度和比例与抗生素治疗无关：黄痰 (相关系数: 0.00, p: 0.68)、绿痰(相关系数: -0.01, p: 0.11)与主诉感觉舒适的3个分类无相关；与出现痰液变色和感觉不适无关(相关系数: -0.01, p: 0.19)。与那些无痰的患者相比，初级医疗机构中有痰液变色的咳嗽/下呼吸道感染成人患者更常采用抗生素治疗。痰液颜色单独，或与全身感觉不适一起，均与抗生素治疗后的恢复无相关性。
（陈欣 审校）
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
Antibiotic prescribing for discoloured sputum in acute cough/LRTI.
Butler CC, Kelly MJ, Hood K, Schaberg T, Melbye H, Serra-Prat M, Blasi F, Little P, Verheij T, Mölstad S, Godycki-Cwirko M, Edwards P, Almirall J, Torres A, Rautakorpi UM, Nuttall J, Goossens H, Coenen S.
School of Medicine, Cardiff University.
Abstract
We investigated whether discoloured sputum and feeling unwell is associated with antibiotic prescribing and benefit from antibiotic treatment for acute cough/lower respiratory tract infection in a prospective study of 3402 adults. in 13 countries. A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution. Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR: 3.2, 95% CI: [2.1, 5.0]), unlike those producing clear/white sputum (OR: 0.95, 95% CI: [0.61,1.48]). Antibiotic prescribing was not associated with greater rate or magnitude of symptoms score resolution (as measured by 13 item scale completed by patients each day) among those who: produced yellow (Coefficient: 0.00, p-value: 0.68) or green sputum (Coefficient: -0.01, p-value: 0.11); reported any of three categories of feeling unwell; produced discoloured sputum and felt generally unwell (Coefficient: -0.01, p-value: 0.19). Adults with acute cough/LRTI presenting in primary care with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell was not associated with recovery or benefit from antibiotic treatment.
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
