Use and Prescription of Antibiotics in Primary Health Care Settings in China
Use and Prescription of Antibiotics in Primary Health Care Settings in China
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DOI：
10.1001/jamainternmed.2014.5214
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发表时间：
2014-12-01
影响因子：
39
通讯作者：
Xiao, Yonghong
中科院分区：
文献类型：
--
作者：
Wang, Jin;Wang, Pan;Xiao, Yonghong
重要性适当使用抗生素是控制抗生素耐药性的关键策略。实现这一目标的第一步是确定卫生保健机构抗生素处方中存在的主要问题，特别是在初级卫生保健机构，这是大多数患者接受医疗护理的地方。研究对象从中国6个不同经济发展水平的省份随机抽取48家基层医疗机构。回顾性分析了39个符合条件的机构（23个城市和16个农村初级卫生保健中心）2009年至2011年的数据。研究样本包括处方记录7311门诊就诊和2888住院hospitalizations.Main结果和措施一般卫生中心的信息，药物使用，疾病诊断，门诊和住院患者的抗生素使用进行了调查。不适当的抗生素处方的情况下identified.Results大多数工作人员在初级卫生保健设施有不到大专学历，医务人员主要包括医师助理，助理药剂师，护士，护理助理。政府对每项设施的捐款中位数（范围）为总收入的34.0%（3.6%-92.5%）。这些机构规定了28种（8-111）抗生素的中位数（范围），包括34种（10-115）单独的药物。抗生素包括在52.9%的门诊处方记录中：其中，只有39.4%的处方是正确的。在住院患者中，77.5%接受了抗生素治疗，其中只有24.6%得到了适当的处方。78.0%的感冒和93.5%的急性支气管炎病例使用抗生素。抗生素处方中头孢菌素类占28.0%，氟喹诺酮类占15.7%。55.0%的抗生素处方为2种或2种以上药物的抗生素联合治疗。在城市非手术住院患者中，抗生素治疗的平均（SD）持续时间为10.1（7.8）天。在手术患者中，98.0%接受了抗生素，63.8%的处方用于preventions.CONCLUSIONS和RELEVANCE抗生素是经常规定在中国的初级卫生保健设施，这些处方中有很大一部分是不适当的。在中国的初级卫生保健环境中，抗生素的频繁和不适当使用是一个严重的问题，可能导致全球范围内的抗生素耐药性。
IMPORTANCE Appropriate antibiotic use is a key strategy to control antibacterial resistance. The first step in achieving this is to identify the major problems in antibiotic prescription in health care facilities, especially in primary health care settings, which is where most patients receive medical care.OBJECTIVE To identify current patterns of antibiotic use and explore the reasons for inappropriate prescription in primary health care settings in China.DESIGN, SETTING, AND PARTICIPANTS A total of 48 primary health care facilities in China were randomly selected from 6 provinces at various levels of economic development. Data for the years 2009 through 2011 from 39 qualifying facilities (23 city and 16 rural primary health care centers) were analyzed retrospectively. The study sample consisted of prescription records for 7311 outpatient visits and 2888 inpatient hospitalizations.MAIN OUTCOMES AND MEASURES General health center information, drug usage, disease diagnoses, and antibiotic use by outpatients and inpatients were surveyed. Cases of inappropriate antibiotic prescription were identified.RESULTS Most staff in the primary health care facilities had less than a college degree, and the medical staff consisted primarily of physician assistants, assistant pharmacists, nurses, and nursing assistants. The median (range) governmental contribution to each facility was 34.0% (3.6%-92.5%) of total revenue. The facilities prescribed a median (range) of 28 (8-111) types of antibiotics, including 34 (10-115) individual agents. Antibiotics were included in 52.9% of the outpatient visit prescription records: of these, only 39.4% were prescribed properly. Of the inpatients, 77.5% received antibiotic therapy: of these, only 24.6% were prescribed properly. Antibiotics were prescribed for 78.0% of colds and 93.5% of cases of acute bronchitis. Of the antibiotic prescriptions, 28.0% contained cephalosporins and 15.7% fluoroquinolones. A total of 55.0% of the antibiotic prescriptions were for antibiotic combination therapy with 2 or more agents. In nonsurgical inpatients in cities, the mean (SD) duration of antibiotic therapy was 10.1 (7.8) days. Of the surgical patients, 98.0% received antibiotics, with 63.8% of these prescriptions for prophylaxis.CONCLUSIONS AND RELEVANCE Antibiotics are frequently prescribed in Chinese primary health care facilities, and a large proportion of these prescriptions are inappropriate. Frequent and inappropriate use of antibiotics in primary health care settings in China is a serious problem that likely contributes to antimicrobial resistance worldwide.