Office-related antibiotic prescribing for persons aged ≤ 14 years--United States, 1993-1994 to 2007-2008

In 2003, the Institute of Medicine identified antibiotic resistance as a key microbial threat to health in the United States and recommended promoting appropriate antibiotic use as an important strategy to address this threat. Antibiotic use contributes to development of antibiotic resistance on both the individual and country level. To examine trends in pediatric antibiotic prescribing in physician offices, CDC analyzed data from the National Ambulatory Medical Care Survey (NAMCS) for the period 1993-1994 to 2007-2008. This report summarizes the results of that analysis, which found that antibiotic prescribing rates for persons aged ≤ 14 years who had visited physician offices decreased 24% from 300 antibiotic courses per 1,000 office visits in 1993-1994 to 229 antibiotic courses per 1,000 office visits in 2007-2008. Among the five acute respiratory infections (ARIs) examined, antibiotic prescribing rates decreased 26% for pharyngitis and 19% for nonspecific upper respiratory infection (common cold); prescribing rates for otitis media, bronchitis, and sinusitis did not change significantly. Although the overall antibiotic prescribing rate for persons aged ≤ 14 years has decreased, the rate remains inappropriately high. Further efforts are needed to decrease inappropriate antibiotic prescribing for persons aged ≤ 14 years.     

郑州市流感和呼吸道合胞病毒感染住院病例的抗生素使用及合理性评估

目的 描述河南省郑州市流感和呼吸道合胞病毒(respiratory syncytial virus, RSV)感染住院病例的抗生素使用情况,评估抗生素使用的合理性。方法 采用前瞻性病例系列研究,2018年11月—2019年11月在河南省儿童医院与郑州市中心医院分别纳入儿童和成人急性呼吸道感染住院病例,收集人口学和临床资料,采集呼吸道标本,使用Real-time PCR法检测流感病毒和RSV,分析流感和RSV感染病例合并细菌感染、抗生素使用及其合理性。结果 共检出669例流感和RSV感染住院病例,38.4%(252/656)合并细菌感染,13例无法判断细菌感染情况。97.9%的病例住院期间使用抗生素,第三代头孢菌素(77.0%)、大环内酯类(20.3%)、青霉素和β-内酰胺酶抑制剂复合制剂(15.5%)、喹诺酮类(9.9%)和碳青霉烯类(7.9%)为常用的种类。从入院到使用抗生素的时间间隔为1.0(1.0,1.0)d,抗生素使用持续时间为6.0(5.0,8.0)d。抗生素用药频度和总费用分别为2.4(1.3,6.0)DDDs和369.7(210.6,1 154.0)元/人。在655例使用...     

5岁以下上呼吸道感染儿童合理用药研究

目的 分析5岁以下上呼吸道感染儿童合理用药情况.方法 采用世界卫生组织推荐的方法随机抽取1 200份上呼吸道感染儿童门诊处方,对其平均用药个数、注射剂使用比例、抗生素使用比例、抗生素联用比例、激素使用比例进行分析.结果 单张处方平均用药个数为2.72,注射剂使用比例为48.00%,抗生素使用比例为56.83%,抗生素联用比例为4.50%,激素使用比例为14.00%.不同职称医务人员处方指标存在差异性.结论 5岁以下上呼吸道感染儿童不合理用药情况较为严重,有必要采取更有效的干预措施促进医生的处方行为.     

Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?

BACKGROUND: Guidelines on acute lower respiratory tract infections recommend restrictive use of antibiotics, however, in patients with relevant co-morbid conditions treatment with antibiotics should be considered. Presently, it is unknown whether GPs adhere to these guidelines and target antibiotic treatment more often at patients with risk-elevating conditions. OBJECTIVES: We assessed whether in elderly primary care patients with acute bronchitis or exacerbations of chronic pulmonary disease (COPD), antibiotics are more often prescribed to patients with risk-elevating co-morbid conditions. METHODS: Using the Utrecht GP research database, we analysed 2643 episodes in patients of 65 years of age or older with a GP-diagnosed acute bronchitis or exacerbation of COPD. Multivariable logistic regression analysis was applied to determine independent determinants of antibiotic use. RESULTS: Antibiotic prescribing rates were high in both acute bronchitis (84%) and in exacerbations of COPD (53%). In acute bronchitis, only age was an independent determinant of antibiotic use [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.003-1.048], whereas in exacerbations of COPD antibiotics were more often prescribed to male patients (OR 1.3, 95% CI 1.0-1.5), patients with diabetes (OR 1.7, 95% CI 1.1-2.4) and heart failure (OR 1.3, 95% CI 1.0-1.7). CONCLUSION: Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD. Tailoring their antibiotic treatment according to the presence or absence of high-risk co-morbid conditions could help GPs in improving antibiotic use in patients with respiratory tract infections in primary care.