To investigate the prevalence of self-administered antibacterial agents use prior to medical consultation among patients in enteric disease clinic, and then take action to improve the education on appropriate antibacterial agents use and promote rational use of antibacterial agents.

Total of 1 349 patients who attended enteric disease clinic of Peking University First Hospital from 1st April to 31st October, 2021 were selected. General data such as demographic characteristics, disease course, clinical manifestations, use of antibacterial agents, and laboratory test results were collected. All patients were grouped according to whether they had used antibacterial agents before consultation to analyze the clinical characteristics of the population using antimicrobials drugs before consultation and assess the rationality of their use of antibacterial agents. The measurement data were analyzed by t test or non-parametric test, and the counting data was analyzed by χ² test.

Total of 1 349 patients were enrolled, including 681 males (50.5%) and 668 females (49.5%). The average age was (44.5 ± 19.09) years old. There were 220 patients (16.31%) who had used antibacterial agents before treatment, and quinolones (110 cases, 50%) was the most, followed by cephalosporins (49 cases, 22.3%) and penicillins (17 cases, 7.7%). Among 220 cases who had used antibacterial agents before consultation, 119 cases (54.1%) were not recommended to use antibacterial agents. Compared with patients who did not use antibacterial agents before treatment, patients who had used antibacterial agents before treatment had higher proportion of college education or above (77.6% vs. 67.0%: χ² = 9.592, P = 0.002), longer course of disease [34 (16, 55) h vs. 24 (10, 50) h: Z =-3.935, P < 0.001], higher maximum body temperature [36.9 (36.5, 38.0) ℃ vs. 36.7 (36.5, 37.2) ℃: Z =-3.563, P < 0.001], and increased frequency of diarrhea [7 (5, 10) vs. 5 (4, 8): Z =-4.464, P < 0.001]. Among patients who had used antibacterial agents before consultation, compared with cases who were not recommended to use antibacterial drugs, cases who recommended to use antibacterial drugs had shorter course of disease [29 (12.5, 44.5) h vs. 44 (18, 74) h: Z =-2.945, P = 0.003], higher maximum body temperature [37.4 (36.7, 38.5) ℃ vs. 36.7 (36.4, 37.0) ℃: Z =-4.572, P < 0.001], elevated fecal white blood cell count [3 (0, 15)/HP vs. 0 (0, 0)/HP: Z =-6.658, P < 0.001], higher percentage of vomiting (28.7% vs. 16.8%: χ² = 4.473, P = 0.034) and higher percentage of fever (55.4% vs. 22.7%: χ² = 24.951, P < 0.001). Among patients who did not use antibacterial agents before consultation, compared with cases who were not recommended to use antibacterial drugs, cases who were recommended to use antibacterial drugs had shorter course of disease [19 (8, 37) h vs. 26 (11, 56) h: Z =-4.331, P < 0.001], higher maximum body temperature [36.9 (36.5, 37.9) ℃ vs. 36.6 (36.5, 37.0) ℃: Z =-6.723, P < 0.001], increased incidence of diarrhea [6 (4, 10) vs. 5 (4, 8): Z =-3.512, P = 0.001], elevated fecal white blood cell count [1 (0, 15)/HP vs. 0 (0, 0)/HP: Z =-12 .237, P < 0.001], higher percentage of abdominal pain (70.4% vs. 58.3%: χ² = 14.601, P < 0.001), nausea (48.4% vs. 39.3%: χ² = 7.871, P = 0.005), fever (37.7% vs. 16.5%: χ² = 58.642, P < 0.001) and tenesmus (25.8% vs. 19.9%: χ² = 4.685, P = 0.030). Compared with cases with course from onset to consultation > 24 hours, patients with course from onset to consultation < 24 hours had higher maximum body temperature [36.8 (36.5, 37.5) ℃ vs. 36.6 (36.4, 37.0) ℃: Z =-4.756, P < 0.001], higher proportion of abdominal pain (66.2% vs. 58.2%: χ² = 7.120, P = 0.008), nausea (50.8% vs. 33.9%: χ² = 31.025, P < 0.001), vomiting (33.11% vs. 13.9%: χ² = 54.867, P < 0.001) and fever (28.6% vs. 18.2%: χ² = 16.122, P < 0.001). Compared with cases with course from onset to consultation > 48 hours, patient with course from onset to consultation < 48 hours had higher maximum body temperature [36.8 (36.5, 37.4) ℃ vs. 36.6 (36.4, 36.9) ℃: Z =-4.847, P < 0.001], with higher proportion of abdominal pain (64.4% vs. 56.4%: χ² = 5.660, P = 0.017), nausea (46.2% vs. 31.8%: χ² = 17.820, P < 0.001), vomiting (28.3% vs. 10.4%: χ² = 37.737, P < 0.001), and fever (27.5% vs. 12.1%: χ² = 28.019, P < 0.001).

At present, pre-hospital antimicrobial drug abuse is still a serious phenomenon among patients in enteric disease clinic, and it is necessary to strengthen the management of antibiotics. The highly educated, middle-aged and young people can be taken as the key education targets, emphasizing that the frequency of diarrhea and high body temperature are not indications of antibacterial agents, and the long course of disease cannot be used as the standard to guide the application of antibiotics.