Trends in antibiotic use among outpatients in New Delhi, India.
Trends in antibiotic use among outpatients in New Delhi, India.
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DOI：
10.1186/1471-2334-11-99
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发表时间：
2011-04-20
影响因子：
3.7
通讯作者：
Holloway K
中科院分区：
文献类型：
--
作者：
Kotwani A;Holloway K
社区中的抗生素消费总量是造成抗菌素耐药性的主要原因之一。关于抗生素的不当使用、非处方药的可获得性和剂量不足等问题，有很多特别的信息，但很少有社区实践的实际证据。这项研究调查了社区(2007年12月至2008年11月)的抗生素使用情况，使用了在三种类型的设施中进行的患者出口访谈的既定方法：20家私人零售药店、10家公共部门设施和20家私人诊所，以获得一年来社区抗生素使用的完整情况。将解剖治疗化学物质(ATC)分类和限定日剂量(DDD)测量单位分配给数据。抗生素使用的衡量标准是每1000名就诊患者的DDD，以及接受抗生素治疗的患者的百分比。在数据收集期间，17995名、9,205名和5,922名前往私人零售药店、公共设施和私人诊所的患者被纳入我们的研究。39%到私人零售药店和公共设施就诊的患者和43%到私人诊所就诊的患者至少开了一种抗生素。私营零售药房和私人诊所的抗生素消费模式相似，其中氟喹诺酮类、头孢菌素类和超广谱青霉素类是最常开出的三类抗生素。在公共设施中，所有主要抗生素类包括青霉素、氟喹诺酮类、大环内酯类、头孢菌素类、四环素类和复方新诺明的使用更加均匀。每一类抗生素的新成员都被开了处方。虽然冬季某些抗生素的使用量略高，雨季氟喹诺酮类药物的使用量略高，但季节性变化不大。在公立和私营部门的门诊病人中，抗生素的使用量都很高。社区中大量使用广谱和较新的抗生素。应采取适当和可持续的干预措施，促进合理使用抗生素，这将有助于减少抗生素耐药性的威胁。
The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. There is much ad-hoc information about the inappropriate consumption of antibiotics, over-the-counter availability, and inadequate dosage but there is very little actual evidence of community practices. This study surveyed antibiotic use in the community (December 2007-November 2008) using the established methodology of patient exit interviews at three types of facilities: 20 private retail pharmacies, 10 public sector facilities, and 20 private clinics to obtain a complete picture of community antibiotic use over a year. The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose (DDD) measurement units were assigned to the data. Antibiotic use was measured as DDD/1000 patients visiting the facility and also as percent of patients receiving an antibiotic. During the data collection period, 17995, 9205, and 5922 patients visiting private retail pharmacies, public facilities and private clinics, respectively, were included in our study. 39% of the patients attending private retail pharmacies and public facilities and 43% of patients visiting private clinics were prescribed at least one antibiotic. Consumption patterns of antibiotics were similar at private retail pharmacies and private clinics where fluoroquinolones, cephalosporins, and extended spectrum penicillins were the three most commonly prescribed groups of antibiotics. At public facilities, there was a more even use of all the major antibiotic groups including penicillins, fluoroquinolones, macrolides, cephalosporins, tetracyclines, and cotrimoxazole. Newer members from each class of antibiotics were prescribed. Not much seasonal variation was seen although slightly higher consumption of some antibiotics in winter and slightly higher consumption of fluoroquinolones during the rainy season were observed. A very high consumption of antibiotics was observed in both public and private sector outpatients. There was a high use of broad spectrum and newer antibiotics in the community. Suitable and sustainable interventions should be implemented to promote rational use of antibiotics that will help in decreasing the menace of antibiotic resistance.