Antimicrobial Medicines Consumption in Eastern Europe and Central Asia - An Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action
Antimicrobial Medicines Consumption in Eastern Europe and Central Asia - An Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action
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DOI：
10.3389/fphar.2018.01156
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发表时间：
2019-03-05
影响因子：
5.6
通讯作者：
Pedersen, Hanne Bak
中科院分区：
文献类型：
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作者：
Robertson, Jane;Iwamoto, Kotoji;Pedersen, Hanne Bak
引言：监测抗菌药物的消费对于改善其使用和降低耐药性率至关重要。关于东欧和中亚抗生素消费的已发表数据很少。为解决这一问题，18个非欧洲联盟（欧盟）国家和地区向世卫组织欧洲区域办事处提供捐款（WHO欧洲）抗菌药物消费（AMC）网络。目的：（i）分析2015年16个AMC网络成员全身使用的J 01类抗菌药物的消费量;（ii）将结果与2011年数据和2015年ESAC-Net估计值进行比较;（iii）根据建议的指标评估消费量;（iv）评估2019年某些常用抗生素限定日剂量（DDDs）计划变化的影响;（v）考虑消费量定量指标对政策行动的效用。使用解剖治疗化学（ATC）分类和DDD方法计算总消耗量（DDD/1000居民/天[DID]），相对使用量（百分比）、世卫组织观察和储备组抗生素的使用程度以及DDD变化的影响。2015年的J 01总消费量范围为8.0-41.5 DID（平均21.2 DID），普遍低于2011年（6.4-42.3 DID，平均23.6 DID）。β-内酰胺青霉素类、头孢菌素类和喹诺酮类分别占J 01总消耗量的16.2- 56.6%、9.4- 28.8%和7.5-24.6%。在一些国家，第三代头孢菌素占头孢菌素总消费量的90%。世卫组织储备抗生素的消费量非常低;观察抗生素占总消费量的17.3-49.5%（平均30.9%）。变异性与2015年ESAC-Net数据相似（11.7-38.3 DID;平均22.6 DID）。2019年的DDD变化影响了总消费量和相对消费量估计值：总DID平均下降了12.0%（7.3-35.5 DID），主要是由于常用青霉素的总DDD下降;对排名和相对使用估计值的影响不大。随着时间的推移，情况有所改善，这反映了各国开展的活动，但是，总量的变化可能掩盖了向不太理想的选择的转变。针对关注抗生素的相对使用措施可能更具信息性。包括世卫组织观察和储备分类在内的一些分类有助于制定得到准则和治疗方案支持的目标。
Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network.Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action.Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes.Findings: Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest.Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.