Minimal use of antibiotics for acute respiratory tract infections: validity and patient satisfaction.
BACKGROUND
Antibiotics have been overused for acute respiratory tract infections (ARTIs) and the recent guidelines have emphasized limiting their use.


OBJECTIVE
To clarify the exact rate of antibiotic use and patient outcomes and satisfaction, under strict adherence to the guideline proposed by the American College of Physicians.


METHODS
Prospective cohort observational study.


METHODS
Primary care clinics in Japan.


METHODS
783 patients diagnosed with ARTIs from October 2004 to April 2005, aged 15-64 and without any underlying disease.


METHODS
Scores of symptoms and patient satisfaction at the 5th, 8th and 15th day of their initial visit, when treatment had been initiated according to that strategy.


RESULTS
In 691 non-influenza patients, comprising 554 (80%) cases of nonspecific upper respiratory tract infection (A), 11 (2%) of acute rhinosinusitis (B), 90 (13%) of acute pharyngitis (C) and 36 (5%) of acute bronchitis (D); the rates of antibiotic use were 5% [0.2%; (A), 9%; (B), 36%; (C), 3%; (D)] initially and 2% [2%; (A), 0%; (B), 1%; (C), 3%; (D)] subsequently. For the remaining 92 influenza patients, no antibiotics were prescribed, though oseltamivir was prescribed in 89 (97%). Within 7 days, more than 90% of all patients felt improved and expressed their satisfaction with the treatment. Furthermore, no patients needed emergency room visits or hospital admission.


CONCLUSIONS
Only patients who gave informed consent were enrolled.


CONCLUSIONS
Adhering to the guideline, antibiotic use could be limited to only 5-7% of non-influenza ARTIs-mainly acute pharyngitis-without any problems and with a high degree of patient satisfaction.
Tomii
Keisuke
K
Department of Pulmonary Medicine, Kobe City General Hospital. ktomii@kcgh.gr.jp
Matsumura
Yoshihisa
Y
Maeda
Kenji
K
Kobayashi
Yuki
Y
Takano
Yoshihisa
Y
Tasaka
Yoshikazu
Y
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000628:therapy; D007564:Japan; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents