Antibiotikaverbrauch bei Kindern mit akuten Atemwegs- oder Ohrinfekten: eine prospektive Beobachtungsstudie zum Vergleich zwischen anthroposophischer und konventioneller Behandlung in der hausärztlichen Routineversorgung

Harald J. Hamre, Anja Glockmann, Reinhard Schwarz, David Riley, Erik Baars, Helmut Kiene, Gunver S. Kienle
Artikel-ID: DMS-20637-DE
DOI: https://doi.org/10.14271/DMS-20637-DE

Kindern mit akuten Atemwegs- oder Ohrinfekten (AWO) werden oft unnötigerweise Antibiotika verordnet. Antibiotika-Resistenz ist ein zentrales Problem der Volksgesundheit und Antibiotika-Verordnungen für AWO sollten reduziert werden. Die anthroposophisch-medizinische Behandlung von AWO beinhaltet anthroposophische Arzneimittel, nicht-medikamentöse Therapien und, falls notwendig, auch Antibiotika. Diese Sekundäranalyse einer Beobachtungsstudie aus der hausärztlichen Versorgung umfasst 529 Kinder unter 18 Jahren aus Europa (AT, DE, NL und UK) oder den USA, deren Eltern einen Arzt für die Behandlung der AWO gewählt haben, der entweder anthroposophische Therapie (A-Arzt) oder konventionelle Therapie (K-Arzt) anbietet. Während des 28-Tage-Follow-ups wurden bei 5,5 % der A-Patienten und 25,6 % der K-Patienten (p < 0,001) Antibiotika verordnet; das unadjustierte Quotenverhältnis (engl. odds ratio) für die Nicht-Verordnung bei A- versus K-Patienten lag bei 6,58 (95 %-Konfidenzintervall 3,45–12,56); nach Adjustierung für demografische Daten und Komorbidität bei 6,33 (3,17–12,64). Antibiotika-Verordnungsraten in jüngeren Beobachtungsstudien mit ähnlichen Patienten in ähnlichen Settings lagen bei 31,0 % bis 84,1 %. Verglichen mit den K-Patienten hatten die A-Patienten einen erheblich geringeren Analgetikaverbrauch, ein etwas schnelleres Abklingen der Krankheitssymptomatik und eine höhere Zufriedenheit bei den Eltern. Nebenwirkungen durch Arzneimittel waren selten (2,3 % in beiden Gruppen) und nicht schwerwiegend. Eine Limitierung der Studie ist, dass die Ergebnisse nur auf die Eltern übertragen werden können, die sich dafür entscheiden, einen A-Arzt zu konsultieren. Es kann nicht gefolgert werden, zu welchem Ausmaß Antibiotika hätten vermieden werden können, wenn Kindern, die gewöhnlich von einem K-Arzt behandelt werden, eine anthroposophische medizinische Behandlung angeboten worden wäre.

Use of antibiotics to treat acute respiratory tract or ear infections in children – prospective observational study to compare anthroposophic and conventional treatment in routine home care medical practice

Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy, and if necessary also antibiotics. This secondary analysis from an observational primary care study comprised 529 children < 18 years from Europe (AT, DE, NL and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5 % of A-patients and 25.6 % of C-patients (p < 0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95 %-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings ranged from 31.0 % to 84.1 %. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3 % in both groups) and not serious. Limitation was that results apply to children of caregivers consulting A-physicians. One cannot infer to what extent antibiotics might be avoided, if children who usually receive C-treatment were offered A-treatment.

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