Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings
Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings
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DOI：
10.1001/jama.2009.1163
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发表时间：
2009-08-19
影响因子：
120.7
通讯作者：
Griffin, Marie R.
中科院分区：
文献类型：
--
作者：
Grijalva, Carlos G.;Nuorti, J. Pekka;Griffin, Marie R.
背景在20世纪90年代，美国急性呼吸道感染（阿尔蒂）的抗生素处方减少。这些变化的可持续性是unknowed.Objective评估趋势抗生素处方阿尔蒂.Design，Setting，and Participants国家门诊医疗调查和国家医院门诊医疗调查数据（1995-2006）被用来研究抗生素处方率的趋势抗生素适应症和类。每年的调查数据和人口普查数据以2年为间隔进行合并，以计算比率。主要结果测量全国每年的阿尔蒂就诊率和抗生素处方率，包括中耳炎（OM）和非阿尔蒂。结果在5岁以下儿童中，每年的阿尔蒂就诊率下降了17（95%置信区间[CI]，9%-24%），从1995-1996年的每1000人1883例到2005-2006年的每1000人1560例，主要是由于33%的（95% CI，22%-43%）OM访视率降低（分别为950 - 634/1000人群）。这种减少伴随着ART相关抗生素处方减少36%（95% CI，26%-45%）（每1000人中1216至779）。在5岁或5岁以上人群中，阿尔蒂就诊率保持稳定，但相关抗生素处方率下降了18%（95% CI，6%-29%），从每1000人178例降至146例。在5岁以下和5岁或以上人群中，很少使用抗生素的非OM阿尔蒂的抗生素处方率分别下降了41%（95% CI，22%-55%）和24%（95% CI，10%-37%）。总体而言，青霉素、头孢菌素和磺胺/四环素的ART相关处方率下降。阿奇霉素的处方率增加，成为阿尔蒂和OM最常用的大环内酯类处方药（占OM访视的10%）。在成年人中，喹诺酮类药物处方增加。结论：总体抗生素处方率为阿尔蒂下降，与更少的OM访问小于5岁的儿童和更少的处方阿尔蒂的抗生素很少指示。然而，广谱抗生素的处方率大幅增加。美国医学会杂志2009;302（7）：758-766
Context During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown.Objective To assess trends in antibiotic prescriptions for ARTI.Design, Setting, and Participants The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations.Main Outcome Measures National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI.Results Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased.Conclusions Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly. JAMA. 2009;302(7):758-766