Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study
Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study
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DOI：
10.1016/s1473-3099(19)30324-x
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发表时间：
2019-12-01
影响因子：
56.3
通讯作者：
Ross-Degnan, Dennis
中科院分区：
文献类型：
--
作者：
Chang, Jie;Xu, Sen;Ross-Degnan, Dennis
社区药房的非处方抗生素分发是抗生素耐药性的主要驱动因素。中国已将遏制社区药店非处方销售抗生素视为应对抗生素耐药性的重要任务，并计划在2020年前在全国范围内消除这种做法。我们的目的是量化的非处方抗生素配药在中国的社区药房横截面在2017年，纵向（2011年至2017年）在一个省。方法采用模拟客户端的方法来衡量非处方抗生素配药的基础上的情况下，有关儿童腹泻和成人急性上呼吸道感染（URTI），这是在每个药店。我们收集了2017年中国不同地区六个省221个县或区的2423家社区药店的横断面数据。我们还对陕西省213家社区药店进行了评估，2011年进行了基线调查，随后每两年进行一次随访调查，直到2017年。在横断面分析中，采用随机截取的多变量二元logistic回归分析来评估与非处方抗生素分配相关的因素。我们还估计未调整期的影响，非处方抗生素配药使用广义估计equations.Findings排除无效的相互作用后，在12个社区药店，该研究包括4822模拟2411社区药店内的相互作用。在2411例腹泻相互作用中的1169例（48.5% [95% CI 46.5-50.5]）和2411例成人URTI相互作用中的1690例（70.1% [68.2-71.9]）中观察到非处方抗生素分配。非处方抗生素配药在农村地区和中西部省份更为普遍，与现场药师的存在呈负相关（比值比0.66 [0.56-0.78]，p
Background Non-prescription dispensing of antibiotics at community pharmacies is a major driver of antimicrobial resistance. China has regarded curbing non-prescription sales of antibiotics at community pharmacies as an important task for tackling antibiotics resistance and planned to eliminate this practice nationwide before 2020. We aimed to quantify non-prescription dispensing of antibiotics cross-sectionally at community pharmacies in China in 2017, and longitudinally (2011-17) in a single province.Methods A simulated client method was used to measure non-prescription antibiotic dispensing based on scenarios about paediatric diarrhoea and adult acute upper respiratory tract infection (URTI), which were presented at each pharmacy. We collected cross-sectional data for 2423 community pharmacies from 221 counties or districts in six provinces in different regions of China, in 2017. We also assessed 213 community pharmacies in Shaanxi province with a baseline survey in 2011 and subsequent follow-up surveys every 2 years until 2017. In the cross-sectional analysis, multivariate binary logistic regression with random-intercepts was used to evaluate the factors associated with non-prescription dispensing of antibiotics. We also estimated unadjusted period effects of non-prescription antibiotic dispensing using generalised estimated equations.Findings After excluding invalid interactions within 12 community pharmacies, the study included 4822 simulated interactions within 2411 community pharmacies. Non-prescription antibiotic dispensing was observed during 1169 (48.5% [95% CI 46.5-50.5]) of 2411 diarrhoea interactions and 1690 (70.1% [68.2-71.9]) of 2411 adult URTI interactions. Non-prescription antibiotic dispensing was more prevalent in rural areas and the central and western provinces, and was negatively associated with the presence of a pharmacist on-site (odds ratio 0.66 [0.56-0.78], p