Estimating changes in antibiotic consumption in the USA with the introduction of doxycycline post-exposure prophylaxis.
Estimating changes in antibiotic consumption in the USA with the introduction of doxycycline post-exposure prophylaxis.
复制标题
随着强力霉素暴露后预防的引入，估计美国抗生素消耗量的变化。
DOI：
10.1016/s2666-5247(23)00314-2
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Grad,YonatanH
中科院分区：
文献类型：
--
作者：
Roster,KirstinIOliveira;Grad,YonatanH
在一项随机对照试验中，多西环素作为暴露后预防（doxy-PEP）降低了与服用HIV暴露前预防（PrEP）的男性发生性关系的男性，服用HIV PrEP的变性女性和HIV感染者的细菌性传播感染（STI）风险。1人们担心，增加多西环素的消费可能会增加抗菌药物的耐药性，包括耐多西环素的淋病奈瑟菌，金黄色葡萄球菌和肺炎链球菌。2-4抗生素的使用可能会随着doxy-PEP的引入而改变;估计这种变化可以为考虑抗生素耐药性的风险和预防性传播感染的益处提供信息。我们估计了美国在几种强力PEP处方情况下抗生素消费的一阶预期增长（附录第1-2页）。我们解释了定义的每日剂量，以下简称剂量，由于Doxy-PEP预防衣原体（多西环素），淋病（头孢曲松）和梅毒（青霉素）感染而可以避免的抗生素，以及DoxyPEP试验中报告的消耗率（即每人每月4剂）和相对风险估计（附录第5页）。1我们估计，根据DoxyPEP试验的入组标准，美国有86万人可能有资格接受DoxyPEP（即，估计高达53万艾滋病毒感染者和估计高达33万目前正在接受艾滋病毒PrEP的人;附录p 5）;但是，我们没有包括他们要求的
Doxycycline as a post-exposure prophylaxis (doxy-PEP) reduced the risk of bacterial sexually transmitted infections (STIs) in a randomised controlled trial of men who have sex with men taking HIV pre-exposure prophylaxis (PrEP), transgender women taking HIV PrEP, and people living with HIV. 1 There is concern that increased consumption of doxycycline might increase antimicrobial resistance, including doxycycline-resistant Neisseria gonorrhoeae, Staphylococcus aureus, and Streptococcus pneumoniae. 2–4 Antibiotic use might change with the introduction of doxy-PEP; estimating this change could inform considerations of the risks of antimicrobial resistance and the benefits of STI prevention. We estimated the first-order expected increase in antibiotic consumption in the USA under several doxy-PEP prescribing scenarios (appendix pp 1–2). We accounted for defined daily doses, hereafter referred to as doses, of antibiotics that could be averted due to the prevention of chlamydia (doxycycline), gonorrhoea (ceftriaxone), and syphilis (penicillin) infections by doxy-PEP, with rates of consumption (ie, four doses per personmonth) and relative risk estimates as reported in the DoxyPEP trial (appendix p 5). 1We estimated that 0· 86 million people in the USA might be eligible for doxy-PEP under the enrolment criteria of the DoxyPEP trial (ie, up to an estimated 0· 53 million people living with HIV and up to an estimated 0· 33 million people currently taking HIV PrEP; appendix p 5); however, we did not include their requirement of an