吸烟者出现急性咳嗽的初始治疗是否应包括抗生素治疗？——一项13个欧洲国家的观察研究
2010/08/20
很少学者关注吸烟者、既往吸烟者和不吸烟者在发生急性咳嗽时的初始治疗，是否降低抗生素的使用门槛使吸烟者获益？为了回答这一问题，Stanton等在13个欧洲国家进行了一项多中心的前瞻性、观察研究，比较临床医师对28天内患有急性咳嗽的正常免疫患者所进行的治疗。
在3402位参与研究的患者中，2549例有吸烟史。其中现在吸烟者占28%，既往吸烟者占24%，不吸烟者占48%。吸烟者和既往吸烟者患慢性呼吸系统症状的比例分别为18.5%和20.5%，均明显高于不吸烟者（12.5%)，但三者的中位症状严重度评分相当。吸烟者的抗生素使用率(60%)比既往吸烟者(51%)和不吸烟者(53%)更高。经过校正临床表现和患者特征，吸烟和不吸烟者被处方抗生素的优势比为1.44(95% CI 1.12–1.86; p = 0.005)，但在病情恢复方面二者无统计学差异。
根据研究结果，作者认为，患者的吸烟状态是医生确定是否给予抗生素治疗的独立因素之一，但使用抗生素并不能促进吸烟者的恢复。
（韩伟 青岛大学附属青岛市立医院东院 266071 摘译）
（Eur Respir J 2010; 35:761-767）
Are smokers with acute cough in primary care prescribed antibiotics more often, and to what benefit? An observational study in 13 European countries
N. Stanton1, K. Hood2, M. J. Kelly2, et al. Dept of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Belgium.
Little is known about actual clinical practice regarding management of smokers compared with ex-smokers and nonsmokers presenting with acute cough in primary care, and whether a lower threshold for prescribing antibiotics benefits smokers.
This was a multicentre 13-country European prospective observational study of primary care clinician management of acute cough in consecutive immunocompetent adults presenting with an acute cough of 28 days duration.
There was complete smoking status data for 2,549 out of 3,402 participants. 28% were smokers, 24% ex-smokers and 48% nonsmokers. Smokers and ex-smokers had more chronic respiratory conditions (18.5% and 20.5% versus 12.5%). Median symptom severity scores were similar. Smokers were prescribed antibiotics more frequently (60%) than ex-smokers (51%) and nonsmokers (53%). After adjusting for clinical presentation and patient characteristics, the odds ratio of being prescribed antibiotics for smokers compared with nonsmokers was 1.44 (95% CI 1.12–1.86; p = 0.005). Patient recovery was not significantly different for smokers and nonsmokers, after adjusting for clinical presentation and patient characteristics.
Smoking status was used as an independent factor to determine whether or not to prescribe an antibiotic. Being prescribed an antibiotic was not associated with recovery in smokers.
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