Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study.
Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study.
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DOI：
10.1186/s12879-021-05997-w
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发表时间：
2021-04-12
影响因子：
3.7
通讯作者：
Shen K
中科院分区：
文献类型：
--
作者：
Xue F;Xu B;Shen A;Shen K
在中国，很少有研究估计在全国范围内上呼吸道感染儿童的抗生素使用情况。本研究的目的是利用全国索赔数据库描述5岁以下上呼吸道感染（uri）儿童的抗生素处方实践。这是一项回顾性横断面研究，使用来自中国健康保险研究会（CHIRA）的样本数据库。研究对象包括2015年门诊诊断为上呼吸道感染的5岁以下儿童。我们计算了使用抗生素的就诊比例、注射配方的比例、联合使用抗生素的比例以及每种抗生素类别的比例。按医疗机构类型、城市级别和地理区域描述了抗菌药物的处方格局。在92,821次就诊中，27.1%获得抗生素处方，其中27.0%获得注射制剂。抗生素处方率因年龄组而异（P < 0.001），婴儿最低（16.0%），3至4岁以下患者最高（29.9%），4至5岁以下患者最高（32.5%）。中西部地区、欠发达城市和基层医院的抗生素处方率相对较高（P < 0.001），注射剂型比例相对较高（P < 0.001）。在所有就诊的抗生素处方中，最常见的3种抗生素是第三代头孢菌素（34.9%）、大环内酯类（24.3%）和第二代头孢菌素（23.3%）。在中国大陆地区，5岁以下尿路感染儿童抗菌药物处方总体使用率和注射制剂处方比例处于较低水平，但在欠发达地区和城市仍较高。此外，第二代和第三代头孢菌素大环内酯类药物的过度使用仍然是一个严重的问题。进一步的努力应集中在减少非一线抗生素处方和缩小区域和城市之间的差距。
In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database. This was a retrospective cross-sectional study using a sampled database from the China Health Insurance Research Association (CHIRA). Study subjects included children younger than 5 years with outpatient visits in 2015 that resulted in a diagnosis of a upper respiratory infection. We calculated the percentage of visits who received antibiotics, the proportion of injection formulations, the percentage of combined antibiotics and the proportion of each antibiotic class. The patterns of antibiotic prescription were also described by medical institution type, city level and geographical region. Among the 92,821 visits, 27.1% were prescribed antibiotics, of which 27.0% received injection formulations. The rate of antibiotic prescribing varied by age group (P < 0.001), with the lowest (16.0%) in infants and the highest in patients at age 3 to < 4 years (29.9%) and age 4 to < 5 years (32.5%). The Midwestern region, underdeveloped cities and low-level hospitals represented relatively higher rates of prescribing antibiotics (P < 0.001) and higher proportions of injection dosage forms (P < 0.001). The most 3 common antibiotic classes prescribed of all visits with antibiotic prescriptions were the third-generation cephalosporins (34.9%), macrolides (24.3%), and the second-generation cephalosporins (23.3%). In mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with URIs were at a low level, but still higher in underdeveloped regions and cities. Moreover, the overuse of the second and third generation cephalosporins, macrolides, remains a serious issue. Further efforts should be focused on reducing those non-first-line antibiotic prescribing and narrowing the gaps among regions and cities.
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