Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis.
Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis.
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DOI：
10.1136/bmjopen-2021-056348
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发表时间：
2022-03-25
期刊：
影响因子：
2.9
通讯作者：
Cabral C
中科院分区：
文献类型：
--
作者：
Coope C;Schneider A;Zhang T;Kadetz P;Feng R;Lambert H;Wang D;Oliver I;Michie S;Cabral C
抗生素的不适当使用是抗生素耐药性的关键驱动因素。在中国，抗生素处方和消费量超过了推荐水平，在国际上相对较高。了解对抗生素使用的影响对于提供有效的循证干预措施至关重要。我们进行了一项范围审查，以获得关于中国抗生素使用的关键行为，文化，经济和社会影响的实证研究概述。在Econlit、Medline、PsycINFO、社会科学引文索引和科克伦系统评价数据库中进行了2003年至2018年初的检索。所有研究类型均符合条件，包括基于社区和临床环境的观察性和干预性、定性和定量设计。两位作者独立筛选了纳入研究。开发了数据提取表，其中包含研究设计、与抗生素使用相关的行为、对行为的影响和效果信息（仅限干预研究）的详细信息。自2014年以来，干预性研究显著增加，主要集中在国家政策和实践指令对中国二级和三级医疗环境中抗生素使用的影响。大多数研究使用了语用设计，如前后比较。对抗生素使用的影响集中在四个主题下：抗生素处方;坚持使用抗生素;自我用药行为和抗生素的非处方销售。许多研究强调了在没有处方的情况下使用抗生素治疗常见感染的情况，这是由于有剩余的药物和从当地药店购买。旨在改变抗生素处方行为的干预措施显示出积极影响的证据，但需要使用更稳健的研究设计（如随机试验）进行进一步研究，并纳入过程评估，以更好地评估结果。需要评估国家政策在初级卫生保健层面的影响，并进一步探索对抗生素自我用药的影响，以制定应对这种行为的干预措施。
The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
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影响因子：
168.9
作者：
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通讯作者：
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DOI：
10.6224/jn.62.1.58
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期刊：
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