抗生素PPT课件（英文精品）_2.ppt

URTI Dr Bruce Davies www.bradfordvts.co.uk Scope Throats. Noses. Coughs. Sinuses. Otitis media. Otitis externa. Points to Consider Frequency. Alterable? Manageable? Why? Costs. To patients. To NHS. To GPs. Treatment. Abx or not. Other treatments. Research. Uncertainties. Empiricism. Opportunities Education. Future consultations. Self management. Empowerment. Other stuff (opportunistically). Role of Investigation Swabs. X-rays. Examination findings. PCR. Temperature. Inequality Different doctors. Different patients. Different standards. Expectations. The doctors state of mind. The doctors experiences. Research Heaps and heaps. A lot still leaves questions un-answered. What follows is a personal selection. Research: Sore Throats Satisfaction with the consultation was independent predictor of illness duration. 700 patients: randomised to no Abx, Abx immediately, delayed Abx. Consultation satisfaction better predictor of patient satisfaction than prescribing decision. Psychosocial factors better predictor of duration than physical findings. BMJ 1999; 319: 736-7. Research: Sore Throats and Nephritis ANTIBIOTICS, SORE THROATS AND ACUTE NEPHRITIS No effect JL Taylor and JGR Howie JRCGP 1983; 33: 783-6 Research: Sore throats You can’t tell from appearances. Remains a clinical decision. Pen V or erythromycin remain drugs of choice if anything is used. Drug and Therapeutics Bulletin 33; 2: 9-12 Research: Sore Throats 716 patients aged 4years or more with a sore throat and an abnormal physical sign in the throat were randomised to receive a prescription for 10 days of antibiotics, no prescription or a prescription for antibiotics to be obtained in a further three days if symptoms were not beginning to settle by that time. Prescribing antibiotics only marginally affects the resolution of symptoms but enhances belief in antibiotics and intention to consult in future. Psychosocial factors are important in the decision to see a general practitioner and in predicti