Prevalence of inappropriate antibiotic prescriptions after the great east Japan earthquake, 2011.
Prevalence of inappropriate antibiotic prescriptions after the great east Japan earthquake, 2011.
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DOI：
10.1097/md.0000000000006625
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发表时间：
2017-04
期刊：
影响因子：
1.6
通讯作者：
Kanatani Y
中科院分区：
文献类型：
--
作者：
Iwata K;Fukuchi T;Hirai M;Yoshimura K;Kanatani Y
很少有研究调查了灾后环境中抗生素使用的适宜性。我们回顾性地评估了2011年东日本大地震后建立的避难所附近诊所提供的医疗保健的临床数据库。通过应用和采用先例研究和临床指南，我们定义了每个诊断类别的适当、可接受和不适当的抗生素使用。2011年3月至7月，98个庇护所共有7934名居民进行了23,704次门诊就诊。口服抗生素处方共计2253次。患者年龄中位数为48.5岁（0 ~ 97岁），男性占43.7%。在2253张抗生素处方中，有1944张被判定为不合适（86.3%,95% CI 84.8%-87.7%）。使用最多的抗生素是克拉霉素（646次，28.7%），其次是头孢capene pivoxil（644次，28.6%）、左氧氟沙星（380次，16.9%）、头孢地尼（194次，8.6%）和头孢地仑pivoxil（98次，4.4%）。使用抗生素最多的是上呼吸道感染（URI， 1040次，46.2%），其次是急性支气管炎（369次，16.4%）、咽炎（298次，13.2%）、外伤（194次，8.6%）、急性胃肠炎（136次，6.0%）、尿路感染（uti， 123次，5.5%）和变应性鼻炎（5.1%）。东日本大地震后，诊所开出的大多数抗生素都是不合适的。日本应立即寻求在灾后环境中显著改善抗生素的使用。
Few studies have investigated the appropriateness of antibiotic use in postdisaster settings. We retrospectively evaluated clinical databases on health care delivered at clinics near shelters set up after the Great East Japan Earthquake, 2011. We defined appropriate, acceptable, and inappropriate antibiotic use for each diagnostic category, by applying and adopting precedent studies and clinical guidelines. From March to July, 2011, a total of 23,704 clinic visits occurred at 98 shelters with 7934 residents. Oral antibiotics were prescribed a total of 2253 times. The median age of the patients was 48.5 years old (range 0–97), and 43.7% were male. Of 2253 antibiotic prescriptions, 1944 were judged to be inappropriate (86.3% 95% CI 84.8%–87.7%). The most prescribed antibiotic was clarithromycin (646 times, 28.7%), followed by cefcapene pivoxil (644 times, 28.6%), levofloxacin (380, 16.9%), cefdinir (194, 8.6%), and cefditren pivoxil (98, 4.4%). The most frequent diagnosis for which antibiotics were prescribed was upper respiratory infection (URI, 1040 visits, 46.2%), followed by acute bronchitis (369, 16.4%), pharyngitis (298, 13.2%), traumatic injuries (194, 8.6%), acute gastroenteritis (136, 6.0%), urinary tract infections (UTIs, 123, 5.5%), and allergic rhinitis (5.1%). The majority of antibiotics prescribed at clinics after the Great East Japan Earthquake was inappropriate. Significant improvement of the use of antibiotics in postdisaster settings should be sought immediately in Japan.