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临床滥用抗生素治疗腹泻现象非常普遍,但该方面报道很少。我们回顾性调查我院2008年4月至2009年10月成人肠道门诊4891例急性感染性腹泻患者的临床诊治情况,发现其中30.5%临床支持侵袭性细菌腹泻,48.1%应用了抗生素治疗,不合理应用抗生素为20.3%,其中19%为非适应症使用了抗生素,占总使用抗生素的39.4%。在不合理使用抗生素方面,上级医师(主治医师和副主任医师)与住院医师没有差别(P=1.0)。Logistic回归分析显示除了体温、腹痛、里急后重及便白细胞计数>10个/HPF与抗生素应用密切相关外,呕吐(OR 1.25,95%CI 1.06-1.48),排便次数5～10次/天(OR 1.21,95%CI 1.03-1.41),粘液便(OR 2.03,95%CI 1.40-2.94),便白细胞计数1～10个/HPF(OR 2.59,95%CI 2.05-3.28)也与抗生素应用密切相关,而这四种表现正常情况下不是抗生素应用的指症,可能临床医生误把这四种表现作为了侵袭性腹泻的特征,从而导致了抗生素的过度应用。
Clinical abuse of antibiotics to treat diarrhea is very common, but little has been reported in this area. We retrospectively investigated the clinical diagnosis and treatment of 4891 acute infectious diarrhea patients in our adult gut clinic from April 2008 to October 2009 and found that 30.5% of them were clinically supported by invasive bacterial diarrhea, 48.1% were treated with antibiotics, and no Rational use of antibiotics was 20.3%, of which 19% used antibiotics for non-indications, accounting for 39.4% of total antibiotics. There was no difference between senior physicians (attending physicians and associate chief physicians) and residents in terms of unreasonable use of antibiotics (P = 1.0). Logistic regression analysis showed that vomiting (OR 1.25, 95% CI 1.06-1.48) and defecation frequency 5 ~ 10 times a day (OR 1.21), except for body temperature, abdominal pain, tenesmus and white blood cell count> 10 / HPF were closely related to antibiotic application , 95% CI 1.03-1.41), mucus (OR 2.03, 95% CI 1.40-2.94) and leukocyte count 1-10 HPF (OR 2.59,95% CI 2.05-3.28) were also closely related to antibiotic use, While these four manifestations are not indications of antibiotic use under normal conditions, it is possible that clinicians incorrectly characterized these four manifestations as invasive diarrhea, leading to overuse of antibiotics.