1차 의료기관에서 코감기에 처방한 항균제
Antibiotic Prescription by Primary Care Physicians for Upper Respiratory Infections
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목 적 : 상기도 감염은 매우 흔한 질환으로 개개인으로 보면 중요하지 않은 병이나 국가 전체로 보면 비용, 부작용, 항균제 내성에 미치는 영향이 더 문제가 되는 병이다. 이런 영향에 대한 연구가 주로 3차 병원에서만 되므로, 3차 병원에 도착하기 전까지 받은 치료 내역이 연구 결과에 큰 영향을 미칠 수 있지만, 국내에서는 의약분업 후로는 의원에서 감기 처방에 대한 조사가 없어 현재 진료 상황을 알 수가 없다. 이에 의약분업 이후, 1차 의료에 종사하는 의원들을 대상으로 코감기에 관련된 진단의 다양성, 주사제의 사용, 항균제 사용에 대해 조사를 하였다. 재료 및 방법 : 2006년 7월과 8월에 걸쳐 서울, 경기, 인천에 개업하고 있는 일반의, 내과의, 이비인후과의, 가정의를 대상으로 122개 의원을 조사 하였다. 23명의 의과대학생들이 코감기 환자로 모의를 하여 개원의들의 진찰을 받은 후, 진단과 처방을 분석하였다. 코감기 증상은, 3일간 지속한 콧물과 코막힘을 주소로 했고, 발열과 오한은 없었으며, 목아픔과 기침은 약간 있는 정도로 하였다. 결 과 : 조사한 의원에서 코감기에 사용한 경구 약제 수는 평균 4.71 (SD±0.951), 과별 차이는 없었다(P=0.99 by chi-square test). 부신피질호르몬은 10개(8.2%) 의원에서 처방하였다. 항균제는 50개(41.0%) 의원에서 처방하였으며, 세팔로스포린 17건, Augmentin 16건, amoxicillin (7) 또는 bacampicillin (1) 8건, 퀴놀론 5건, macrolide 3건, trimethoprim-sulfamethoxazole 1건이었다. 과별로는 내과 34.9%, 이비인후과 52.5%, 가정의학과 33.3%, 일반외과 39.1%, 소아과 0%였고 통계적 의미는 없었다(P=0.41 by chi-square test). 주사를 권한 경우는 32 (26.4%)예였다. X-선 검사를 권유받은 1건 외에는 검사를 권유받지 않았다. 결 론 : 이전 보고보다는 감기에서 항균제 사용률은 낮았으며, 진단을 하기 위한 검사가 적어 진단의 불분명을 극복하기 위한 것도 항균제 남용의 한 원인으로 생각된다. 주사제 처방률도 높은 듯하며 이는 빨리 증상이 호전되지 않을 때 병원을 바꾸는 환자들의 행위에 대한 반응일 가능성이 있으며, 항균제 사용 역시 빠른 증상 호전을 위한 것이어서, 환자의 행동 양상에 대한 조사가 필요하다.
Abstract
Background : Upper respiratory infections (URIs) are common benign illnesses that are associated with significant economic burden, adverse effects of medications, and antimicrobial resistance. These effects have been evaluated chiefly at the tertiary health care centers. The purpose of this study was to investigate the prescribing habits, including antibiotic use, for the management of URIs among the primary care physicians. Methods : Between July and August 2006, 23 medical students visited 122 clinics of primary care physicians for the management of simulated common cold. They were instructed to present symptoms that simulated common cold; clear rhinorrhea and nasal stuffiness that lasted for 3 days, and neither was accompanied with fever nor myalgia. Results : The physicians' specialties were as follows: 43 were general internists; 40, otolaryngologists; 23, general practitioners; 15, family practitioners; and 1, pediatrician. The mean number of prescribed oral medications was 4.71 (S.D.±0.951). Glucocorticoids were prescribed in 10 (8.2%) clinics. Antibiotics were prescribed in 50 (41.0%) clinics - cephalosporins in 17, amoxicillin-clavulanate in 16, amoxicillin in 8, fluoroquinolones in 5, macrolides in 3, and trimethoprim-sulfamethoxazole in 1 clinic. There was no difference in the rates of antibiotic prescription among the specialties. Injections were recommended in 32 (26.4%) clinics. With the exception of chest X-ray recommended in 1 clinic, no laboratory or radiologic evaluation was performed. Conclusion : The antibiotic prescription rate observed in this study is lower than those of the previous studies. Since diagnostic tests are seldom performed, diagnostic ambiguity might be a key cause for the overuse of antibiotics in the management of URI. The reasons for the high rates of prescription of parenteral medications need to be evaluated.
참고문헌 (28)
- Lee YS, "Private practitioners' antimicrobial prescription patterns for acute respiratory infections in children. J Korean Public Health Assoc 17", pp.3~19 (1991)
- Lee YS, "Evaluation of acute respiratory infections control programme in a Korean rural community. Korean J Rural Med 18", pp.105~20 (1993)
- Eo KS, "Antibiotics prescription pattern of family practitioners for respiratory tract infections.", 21, pp.901~913 (2000)
- Cho HJ, "Comparison of prescription behaviors between practicing physicians and pharmacists by simulated patients with common cold.", 22, pp.1394~1399 (2001)
- Jang SN, "Understanding the culture of antibiotics prescribing of primary physicians for acute upper respiratory infection.", 25, pp.901~907 (2004)
- Kim NS, "Factors Influencing antibiotics prescribing of primary health physicians in acute upper respiratory infections.", 38, pp.1~8 (2005)
- Yoon JL, "Antibiotics in the medications prescribed by pharmacists for the management of upper respiratory infections.", 16, pp.33~42 (1998)
- Ha KC, "Medications dispensed by pharmacies for the management of common cold in 2005.", 39, pp.1~8 (2007)
- Fagnani F, "Antibiotic prescribing patterns of French GPs for upper respiratory tract infections impact of fusafungine on rates of prescription of systemic antibiotics.", 2, pp.491~498 (2003)
- Watson RL, "Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs", 104, pp.1251~1257 (1999)
- Gonzales R, "Antibiotic prescribing for adults with colds and bronchitis by ambulatory care physicians.", 278, pp.901~904 (1997)
- Gill JM, "Use of antibiotics for adult upper respiratory infections in outpatient settings: a national ambulatory network study", 38, pp.349~354 (2006)
- Yankaskas JR, "Bronchitis, bronchiectasis and cystic fibrosis. In Infectious Diseases", pp.359~367 (2004), Mosby
- Health Insurance Review Agency, "Current status of antibiotic prescription for upper respiratory infections", Health Insurance Review Agency
- Kaiser L, "Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions", 347, pp.1507~1510 (1996)
- Arroll B, "Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials", 333(279) (2006)
- Arroll B, "Antibiotics for the common cold and acute purulent rhinitis" (2005), Cochrane Database Syst Rev (3) CD000247
- Morris P, "Antibiotics for persistent nasal discharge (rhinosinusitis) in children" (2002), Cochrane Database Syst Rev (4):CD001094
- Bhattacharyya N, "Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis.", 116, pp.1~22 (2006)
- Sun C, "Osteopathic physicians in the United States antibiotic prescribing practices for patients with nonspecific upper respiratory tract infections.", 106, pp.450~455 (2006)
- Ho M, "Changes before and after a policy to restrict antimicrobial usage in upper respiratory infections in Taiwan.", 23, pp.438~445 (2004)
- Vincent JM, "Prolonged afebrile nonproductive cough illnesses in American soldiers in Korea a serological search for causation.", 30, pp.534~539 (2000)
- Park WB, "Pertussis in adults with persistent cough in South Korea.", 24, pp.156~158 (2005)
- Hogberg L, "Reduction in outpatient antibiotic sales for pre-school children interrupted time series analysis of weekly antibiotic sales data in Sweden 1992-2002.", 56, pp.208~215 (2005)
- Lee EK, "Analysis of antibiotic consumption using the DDD (the Defined Daily Dose) methodology and antibiotic expenditure", 8, pp.28~43 (2000)
- Chung MH, "Antimicrobial resistance rates in Korea - fact or fiction?", 38, pp.S89~S92 (2006)
- Chuc NT, "Management of childhood acute respiratory infections at private pharmacies in Vietnam.", 35, pp.1283~1288 (2001)
- Song JH, "High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study).", 48, pp.2101~2107 (2004)