Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions?
Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions?
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DOI：
10.1093/jac/dkx504
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发表时间：
2018-02-01
影响因子：
5.2
通讯作者：
Smieszek, Timo
中科院分区：
文献类型：
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作者：
Dolk, F. Christiaan K.;Pouwels, Koen B.;Smieszek, Timo
为了分析英国初级保健中的抗生素处方行为，特别是关于哪些抗生素处方和哪些条件。对健康改善网络（THIN）数据库中记录的2013-15年初级保健数据进行了分析。提取全身性抗生素处方的记录，并将其链接到共现诊断代码，用于将处方归因于临床状况。我们进一步评估了哪些抗生素类处方，哪些条件导致处方的最大份额。处方率在参与实践中差异很大，中位数为626处方/1000例患者（IQR 543-699）。总体而言，69%的抗生素处方（n = 3aEuro 156 aEuro 507）可能与身体系统和/或临床状况有关。在这些处方中，46%与呼吸道疾病有关，包括耳鼻喉（RT/ENT）;该组中的主要疾病是咳嗽症状（22.7%）、下呼吸道感染（RTI）（17.9%）、咽喉痛（16.7%）和上呼吸道感染（14.5%）。RT/ENT感染后，泌尿生殖道感染（22.7%的处方与疾病有关）和皮肤/伤口感染（16.4%）占处方的最大份额。青霉素类占所有处方的50%，其次是大环内酯类（13%），四环素类（12%）和甲氧苄啶（11%）。英国初级保健中的大多数抗生素处方用于呼吸道和泌尿道感染。然而，在几乎三分之一的处方中，没有记录临床依据。抗生素处方率在不同实践之间差异很大，这表明至少在某些实践中有可能减少处方。
To analyse antibiotic prescribing behaviour in English primary care with particular regard to which antibiotics are prescribed and for which conditions.Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were analysed. Records with a prescription for systemic antibiotics were extracted and linked to co-occurring diagnostic codes, which were used to attribute prescriptions to clinical conditions. We further assessed which antibiotic classes were prescribed and which conditions resulted in the greatest share of prescribing.The prescribing rate varied considerably among participating practices, with a median of 626 prescriptions/1000 patients (IQR 543-699). In total, 69% of antibiotic prescriptions (n = 3aEuro156aEuro507) could be linked to a body system and/or clinical condition. Of these prescriptions, 46% were linked to conditions of the respiratory tract, including ear, nose and throat (RT/ENT); leading conditions within this group were cough symptoms (22.7%), lower respiratory tract infection (RTI) (17.9%), sore throat (16.7%) and upper RTI (14.5%). After RT/ENT infections, infections of the urogenital tract (22.7% of prescriptions linked to a condition) and skin/wounds (16.4%) accounted for the greatest share of prescribing. Penicillins accounted for 50% of all prescriptions, followed by macrolides (13%), tetracyclines (12%) and trimethoprim (11%).The majority of antibiotic prescriptions in English primary care were for infections of the respiratory and urinary tracts. However, in almost one-third of all prescriptions no clinical justification was documented. Antibiotic prescribing rates varied substantially between practices, suggesting that there is potential to reduce prescribing in at least some practices.