Antibiotic Prescribing in Ambulatory Pediatrics in the United States
Antibiotic Prescribing in Ambulatory Pediatrics in the United States
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DOI：
10.1542/peds.2011-1337
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发表时间：
2011-12-01
期刊：
影响因子：
8
通讯作者：
Shah, Samir S.
中科院分区：
文献类型：
--
作者：
Hersh, Adam L.;Shapiro, Daniel J.;Shah, Samir S.
背景技术背景：抗生素通常用于儿童，他们提供没有好处的条件，包括病毒性呼吸道感染。广谱抗生素的使用正在增加，这增加了不必要的成本，并促进抗生素耐药性的发展。目的：根据抗生素类别和诊断类别，提供一个全国性的抗生素处方分析，并确定与广谱抗生素处方相关的因素。我们使用了2006年至2008年的国家门诊和国家医院门诊医疗调查，这些调查是美国门诊医疗访问的全国代表性样本。我们根据抗生素类别、广谱抗生素和诊断类别估计了18岁以下患者接受抗生素治疗的比例。我们使用多变量logistic回归来确定与广谱抗生素处方独立相关的人口统计学和临床因素。结果：21%的儿科门诊就诊期间处方抗生素; 50%为广谱抗生素，最常见的是大环内酯类。呼吸系统疾病占抗生素和广谱抗生素处方就诊的70%以上。在开抗生素处方的就诊中，有23%是针对抗生素没有明确指示的呼吸系统疾病，每年有超过1000万人次就诊。与广谱抗生素处方独立相关的因素包括抗生素不适用的呼吸系统疾病，年轻患者，在南方的访问，和私人insurance.CONCLUSIONS：在门诊儿科广谱抗生素处方是非常常见的，经常不合适。这些发现可以为最重要的地理区域、诊断条件和患者人群的门诊护理中抗生素管理工作的发展和实施提供信息。儿科2011; 128：1053-1061
BACKGROUND: Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance.OBJECTIVE: To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing.PATIENTS AND METHODS: We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing.RESULTS: Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance.CONCLUSIONS: Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations. Pediatrics 2011; 128:1053-1061