외래 호흡기계 질환에서 항생제 사용에 대한 의사 태도 조사
Survey on Physician Attitude of Antibiotic Prescription for Upper Respiratory Tract Infections
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배경: 본 연구의 목적은 바이러스성 감염이 대부분인 호흡기계 질환에서 항생제 사용에 대한 의사의 인식을 파악하고자 하였다. 방법: 서울, 경기, 인천 지역에 소재한 의사를 무작위 층화추출하여 조사표를 발송하였고, 353명이 응답하였고, 최종 344명이 응답을 완료하였다(응답률 34.4%). 결과: 시나리오 환자에 대한 답변은, ‘항생제를 처방한다’가 39.2%, ‘기다렸다가 증상이 악화되면 항생제를 처방한다’가 30.5%, ‘항생제를 처방하지 않겠다’가 30.2%였다. 또한 급성 부비동염에 항생제 사용이 도움이 된다는 의사는 83.7%, 급성 인두염은 36%, 급성 편도염은 86.3%, 급성 기관지염은 64%, 하기도질환은 66.9%였다. 다중 로지스틱 회귀분석 결과 경기, 인천 지역에 소재하는 의사일수록, 편도염과 화농성 중이염에 항생제 처방이 도움이 된다고 생각하는 의사일수록 시나리오 환자에 대해 항생제를처방하는 것으로 나타났다. 결론: 호흡기계 질환의 항생제 처방에 대한 태도는 급성호흡기계 질환에서 항생제 처방에 유의한 영향을 미치는것으로 나타나므로, 적정한 항생제 사용을 유도하기 위해지침, 교육 등 각종 정책을 수행하는 것이 필요하겠다.
Abstract
Background: There are significant concerns about emerging antibiotic resistance that are largely due to the inappropriate use of antibacterial agents for viral respiratory infections. We explored clinicians' attitude on antibiotic prescription for patients with respiratory tract infections (RTIs) using survey. Methods: A random, stratified sample of physicians in Seoul, Gyeonggi, and Incheon was surveyed with a mailed questionnaire, and 353 clinicians completed information. A total of 344 were included in the final dataset after excluding incomplete data with missing information (response rate 34.4%). Results: Among 344 physicians, those who would prescribe antibiotics in scenario patient were 39.2%, wait and prescribe 30.5% and not prescribe antibiotics 30.2%. Those who believed antibiotics would help treatment of acute sinusitis were 83.7%, acute pharyngitis 36%, acute tonsillitis 86.3%, acute bronchitis 64% and acute lower respiratory diseases 66.9%. In logistic regression analysis, those who were located in Gyeonggi region and those who believed antibiotics help treatment of tonsillitis and suppurative otitis media would prescribe antibiotics in scenario patient significantly more, whereas those who believe antibiotics help treatment of acute pharyngitis and lower respiratory disease prescribe antibiotics less. Conclusions: Physicians’ attitude to antibiotics in respiratory disease has a significant effect on antibiotic prescription for RTIs. Interventions such as practice guidelines and patient education to optimize antibiotic prescription should take this effect into account.
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