抗生素治疗上呼吸道感染的作用（英文ＰＰＴ）The Role of Antibiotics in Treating URTI′sPPT.pptVIP

The Role of Antibiotics in Treating URTI’s Or A small battle in the war against “superbugs” Or Tools to aid the modification of health seeking behaviour Where’s The Evidence? SIGN Clinical Evidence Tayside Formulary Presentation Most Patients with sore throat never attend GP UK study (1975) of women 20-44 years found that only 1 in 18 consulted. Estimated consultation rates of 0.1 per capita per annum = ￡60 million “Illness behaviour”. Dutch Study 1994 Diagnosis “Clinical exam should not be relied upon to differentiate between bacterial and viral infection.” (B) “Throat swabs should not be carried out routinely in sore throat.” (B) Questions What about Glomerulonephritis and RF? Incidence in UK very low. Most info on prevention is post war “AB’s should not be used specifically to prevent GN and RF” (B) What about abscesses? “The prevention of suppurative complications is not an indication for AB’s” (C) To relieve symptoms? Is evidence that better than placebo but not superior to simple analgaesics “AB’s should not be used for this purpose” (A) What to Use Acute Otitis Media SIGN 66 Diagnosis Signs and symptoms associated with purulent middle ear effusion in association with signs of systemic illness. Earache is most important May resolve with perforation Effusion may persist after resolution of acute symptoms. Antibiotics 8 studies of acceptable standard in 30 years Large proportion of exclusions - ? Why.? Ignore more severe cases Variable inclusion criteria Only 1 trial looked at AB’s in under 2’s Meta-analysis AB’s v Placebo: No influence on pain in 24hrs At 2-7 days only 14% control still have pain Early use of AB’s ↓ risk of pain by 40% ↓ risk of contralateral AOM but not recurrence or deafness. ↑ risk of vomiting, diarrhoea and rash with AB’s Antibiotics 2 Study of predictors of poor outcome: In the absence of fever and vomiting AB’s had little benefit Lack of AB did not lead to a poor outcome Simplest method to target minority at ↑ risk