抗生素曾经被视为神奇的药丸，节省了数百万。但不幸的是，抗生素耐药性正在侵蚀其功效。这种抗药性的主要驱动因素之一是在初级保健中极高地使用了抗生素。

To understand part of the problem, consider this: have you ever taken an antibiotic for an acute respiratory infection such as a sore throat, acute cough or middle ear infection? You likely said yes: more than half of patients with an acute respiratory infection receive an antibiotic prescription.

Yet the main benefit of taking antibiotics for these conditions is small; the decrease in the duration of sore throat is about 16 hours compared to not taking antibiotics. You could be one of the people who will have problems from taking antibiotics, like vomiting, diarrhea, thrush or rash. Other downsides include cost, remembering to take them, and the risk of antibiotic resistance, which could threaten successful treatment of any really serious future infection (such as meningitis, community acquired pneumonia).

There are many reasons for the high rate of antibiotic use for acute respiratory infections. One can be the imperative for clinicians wanting to support their patients with acute respiratory infections and ‘do something’, perhaps in the belief that any benefit from antibiotics (however minimal) is better than none.

Another reason might be that clinicians, believing their patients want antibiotics, prescribed them to maintain a good therapeutic relationship. Some patients may even ask for antibiotics (often because they over-estimate their benefits, and do not realize they have harms).

Shared decision making

改善对此类感染的抗生素使用的适当性的一部分是改善医生与患者之间关于抗生素及其益处和危害的沟通。更好的是，使临床医生和患者能够共同参与决定使用抗生素的决定，是否在讨论了选择，福利和危害以及患者的价值观和偏好之后。

这是一个称为共同的决策. We know this can help with reducing unnecessary antibiotic prescribing, the question is: how much does it currently occur within consultations between doctors and patients with acute respiratory infections?

Our study在常规临床咨询期间讨论了这个问题，以及如何在决策辅助工具（旨在鼓励共同决策制定的工具）中讨论抗生素的益处和危害，包括抗生素耐药性，并包括使用或不使用使用或不使用的危害使用抗生素）。

这项研究是澳大利亚昆士兰州东南部的一项大型研究的一部分 - 针对最常见的急性呼吸道感染（喉咙痛，中耳感染，急性咳嗽）的决策辅助试验，该试验是抗生素的处方，以查看是否提供决策决策这有助于减少抗生素处方。

How common is shared decision making?

当使用患者决策援助的临床医生使用它时，关于抗生素益处和危害的讨论（包括谈论抗生素耐药性）会更好。

我们对患有急性呼吸道感染的患者进行了36次咨询，随后询问患者他们参与治疗决策和对决定的信心。理想情况下，我们本可以在随机试验中记录所有咨询，但是这样做会非常昂贵且困难。

We found that the extent to which shared decision making occurred in consultations was quite low. Even simple communication about antibiotic benefits and harms was not common: it was rare in consultations when decision aids were not used, and antibiotic resistance was never mentioned as a harm. However, when clinicians who had been provided with a patient decision aid used it, the discussion about antibiotic benefits and harms, including talking about antibiotic resistance, was better.

令人惊讶的是，患者认为即使没有做到这一决定，他们也高度参与了决定。也许这来自期望的低期：从未经历过共同决策的患者不知道这是什么样的。

Our current study suggests that using decision aids might improve the way primary care doctors communicate antibiotic benefits and harms in routine consultations for acute respiratory infection – and this is important so that patients can make an informed health decision. The next time you visit your primary care doctor with one of these infections, ask some questions such as: what will happen if you wait and watch? How much benefit is there from antibiotics? And how much harm is there?