외래 급성 비부비동염 환자의 잠재적으로 부적절한 항생제 사용
Potentially Inappropriate Prescriptions of Antibiotics in Patients with Acute Rhinosinusitis in Ambulatory Settings in South Korea
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Acute rhinosinusitis (ARS) is a common condition encountered in ambulatory practice and is one of the most common reasons for antibiotic prescriptions. This study aimed to evaluate the potentially inappropriate antibiotic prescribing for ARS in South Korea and identify influencing factors. Methods: We analyzed Health Insurance Review and Assessment Service-National Patient Samples data. We selected outpatients aged 20 to 64 with ARS, prescribed antibiotics between February and November 2020. Potentially inappropriate antibiotic prescribing was categorized as: 1) inappropriate antibiotic selection and 2) inappropriate antibiotic dosage or duration. Multiple logistic regression was conducted to estimate the impact of various factors on inappropriate antibiotic prescribing. Results: Of 1,210 patients, 80.83% received potentially inappropriate ARS antibiotic prescriptions. Inappropriate antibiotic selection accounted for 43.55%, and inappropriate antibiotic dosage and duration contributed to 37.28%. Otolaryngologists had higher odds ratio (OR) of potentially inappropriate antibiotic prescribing compared to internal medicine practitioners, while dentists had lower OR. Patients aged 20 to 29 years had a higher OR than other age groups, and those who visited primary care clinics had a higher OR than those who visited hospitals. Conclusion: Potentially inappropriate antibiotic prescribing for ARS is prevalent in South Korea. This study identified physician specialty, patient age group, and the level of healthcare facility as factors influencing potentially inappropriate antibiotic prescriptions. Addressing this issue through targeted interventions, such as improved guidelines adherence and patient education, is imperative to mitigate the risks associated with antibiotic misuse and antibiotic resistance.
Abstract
Background: Acute rhinosinusitis (ARS) is a common condition encountered in ambulatory practice and is one of the most common reasons for antibiotic prescriptions. This study aimed to evaluate the potentially inappropriate antibiotic prescribing for ARS in South Korea and identify influencing factors. Methods: We analyzed Health Insurance Review and Assessment Service-National Patient Samples data. We selected outpatients aged 20 to 64 with ARS, prescribed antibiotics between February and November 2020. Potentially inappropriate antibiotic prescribing was categorized as: 1) inappropriate antibiotic selection and 2) inappropriate antibiotic dosage or duration. Multiple logistic regression was conducted to estimate the impact of various factors on inappropriate antibiotic prescribing. Results: Of 1,210 patients, 80.83% received potentially inappropriate ARS antibiotic prescriptions. Inappropriate antibiotic selection accounted for 43.55%, and inappropriate antibiotic dosage and duration contributed to 37.28%. Otolaryngologists had higher odds ratio (OR) of potentially inappropriate antibiotic prescribing compared to internal medicine practitioners, while dentists had lower OR. Patients aged 20 to 29 years had a higher OR than other age groups, and those who visited primary care clinics had a higher OR than those who visited hospitals. Conclusion: Potentially inappropriate antibiotic prescribing for ARS is prevalent in South Korea. This study identified physician specialty, patient age group, and the level of healthcare facility as factors influencing potentially inappropriate antibiotic prescriptions. Addressing this issue through targeted interventions, such as improved guidelines adherence and patient education, is imperative to mitigate the risks associated with antibiotic misuse and antibiotic resistance.
참고문헌 (27)
- DeGeorge KC, "Treatment of the common cold", Am Fam Physician, 100(5), pp.281~289 (2019)
- 김신우, "성인의 상기도 감염", 대한의사협회지, 53(1), pp.10~19 (2010), 대한의사협회
- Rosenfeld RM, "Clinical practice guideline(update) : Adult sinusitis", Otolaryngol Head Neck Surg, 152(2 Suppl), pp.S1~S39 (2015)
- Meltzer EO, "Rhinosinusitis : Establishing definitions for clinical research and patient care", J Allergy Clin Immunol, 114(6 Suppl), pp.155~212 (2004)
- "Health and medical big data opening system statistics on high frequency diseases in 2020"[URL]
- "Sinus And Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis", Otolaryngol Head Neck Surg, 130(1 Suppl), pp.1~45 (2004)
- Adams PF, "Summary health statistics for the U.S. Population: National Health Interview Survey, 2004", Vital Health Stat 10, 229, pp.1~104 (2006)
- Blackwell DL, "Summary health statistics for the U.S. Population: National Health Interview Survey, 2012", Vital Health Stat 10, 260, pp.1~161 (2014)
- "Treatment guidelines for rhinosinusitis" (2005)[URL]
- Gwaltney Jr JM, "Acute community acquired bacterial sinusitis : To treat or not to treat", Can Respir J, 6(Suppl A), pp.46A~50A (1999)
- Gwaltney Jr JM, "Acute communityacquired bacterial sinusitis : The value of antimicrobial treatment and the natural history", Clin Infect Dis, 38(2), pp.227~233 (2004)
- 윤영경, "Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections", Infection and Chemotherapy, 49(4), pp.326~352 (2017), 대한감염학회
- Rosenfeld RM, "Clinical practice. Acute sinusitis in adults", N Engl J Med, 375(10), pp.962~970 (2016)
- 정형준, "1차 의료기관에서 코감기에 처방한 항균제", Infection and Chemotherapy, 39(3), pp.125~132 (2007), 대한감염학회
- 최원정, "급성상기도감염 환자의 항생제 처방에 영향을 주는 요인", 보건행정학회지, 25(4), pp.256~263 (2015), 한국보건행정학회
- Chow AW, "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults", Clin Infect Dis, 54(8), pp.e72~e112 (2012)
- Orlandi RR, "International consensus statement on allergy and rhinology : Rhinosinusitis 2021", Int Forum Allergy Rhinol, 11(3), pp.213~739 (2021)
- Truitt KN, "Appropriateness of antibiotic prescribing for acute sinusitis in primary care : A crosssectional study", Clin Infect Dis, 72(2), pp.311~314 (2021)
- Sharma P, "Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013", PLoS One, 12(7), pp.e0181957~ (2017)
- Han SB, "Recent epidemiology of Streptococcus pneumoniae in nasopharynxes of Korean children with acute otitis media", J Infect Chemother, 23(3), pp.136~141 (2017)
- 유정순, "급성상기도감염 진료비 변이 및 관련 특성 분석: 의원급 요양기관 외래를 중심으로", 보건의료기술평가, 7(1), pp.82~87 (2019), 한국보건의료기술평가학회[DOI]
- 공미진, "1차 의료기관의 급성 상기도 감염 질환자 의약품 처방특성 - 가정의학과, 내과, 소아청소년과, 이비인후과, 일반의 중심으로 -", 보건의료산업학회지, 11(3), pp.37~49 (2017), 보건의료산업학회
- Martinez KA, "Coding bias in respiratory tract infections may obscure inappropriate antibiotic use", J Gen Intern Med, 34(6), pp.806~808 (2019)
- Gerber JS, "Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians : A randomized trial", JAMA, 309(22), pp.2345~2352 (2013)
- Gjelstad S, "Improving antibiotic prescribing in acute respiratory tract infections : Cluster randomised trial from norwegian general practice(prescription peer academic detailing(Rx-PAD)study)", BMJ, 347, pp.f4403~ (2013)
- Kim B, "Current status of antimicrobial stewardship programmes in Korean hospitals : Results of a 2018nationwide survey", J Hosp Infect, 104(2), pp.172~180 (2020)
- 최수미, "적절한 항균제 선택의 원칙", 대한의사협회지, 62(6), pp.335~344 (2019), 대한의사협회[DOI]