Outpatient antibiotic prescribing in the United States: 2000 to 2010
Outpatient antibiotic prescribing in the United States: 2000 to 2010
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DOI：
10.1186/1741-7015-12-96
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发表时间：
2014-06-11
期刊：
影响因子：
9.3
通讯作者：
Frei, Christopher R.
中科院分区：
文献类型：
--
作者：
Lee, Grace C.;Reveles, Kelly R.;Frei, Christopher R.
背景：抗生素的使用是抗生素耐药性最重要的驱动因素。然而，抗生素的过度使用仍然很普遍。在美国，抗生素处方的减少与20世纪90年代启动的全国教育运动和其他干预措施同时进行，包括采用肺炎球菌结合疫苗（PCV-7）进行常规婴儿免疫接种；然而，目前尚不清楚这些趋势是否通过最近的测量得以维持。方法：对2000 - 2010年医疗费用小组调查中具有全国代表性的数据进行分析。对以人群为基础的处方趋势进行了总体抗生素、广谱抗生素、急性呼吸道感染（ARTIs）抗生素和ARTI就诊期间处方的抗生素的检查。报告了三个年龄组的发病率：儿童和青少年（= 65岁）。结果：在研究期间，估计有14亿抗生素被分发。总的抗生素处方在儿童和青少年中减少了18%（风险比（RR） 0.82, 95%可信区间（95% CI） 0.72至0.94），在成人中保持不变，在老年人中增加了30%（1.30,1.14至1.49）。广谱抗生素处方率从2000年到2010年翻了一番（2.11,1.81到2.47）。所有年龄组的广谱抗生素处方比例均有所增加：儿童和青少年占79%(1.79,1.52至2.11)，成人占143%(2.43,2.07至2.86)，老年人占68%（1.68,1.45至1.94）。儿童和青少年ARTI抗生素处方减少57%(0.43,0.35 ~ 0.52)，成人减少38% (0.62,0.48 ~ 0.80)；然而，这在老年人中保持不变。虽然ARTI就诊次数下降了19%，但与2000年相比，2010年ARTI就诊的患者更有可能接受抗生素治疗（73%对64%；P < 0.001）。结论：抗生素的使用在儿童和青少年中有所减少，但在老年人中有所增加。广谱抗生素处方继续呈上升趋势。促进明智使用抗生素的公共政策倡议应继续下去，并应制定针对老年人的规划。
Background: The use of antibiotics is the single most important driver in antibiotic resistance. Nevertheless, antibiotic overuse remains common. Decline in antibiotic prescribing in the United States coincided with the launch of national educational campaigns in the 1990s and other interventions, including the introduction of routine infant immunizations with the pneumococcal conjugate vaccine (PCV-7); however, it is unknown if these trends have been sustained through recent measurements.Methods: We performed an analysis of nationally representative data from the Medical Expenditure Panel Surveys from 2000 to 2010. Trends in population-based prescribing were examined for overall antibiotics, broad-spectrum antibiotics, antibiotics for acute respiratory tract infections (ARTIs) and antibiotics prescribed during ARTI visits. Rates were reported for three age groups: children and adolescents (= 65 years).Results: An estimated 1.4 billion antibiotics were dispensed over the study period. Overall antibiotic prescribing decreased 18% (risk ratio (RR) 0.82, 95% confidence interval (95% CI) 0.72 to 0.94) among children and adolescents, remained unchanged for adults, and increased 30% (1.30, 1.14 to 1.49) among older adults. Rates of broad-spectrum antibiotic prescriptions doubled from 2000 to 2010 (2.11, 1.81 to 2.47). Proportions of broad-spectrum antibiotic prescribing increased across all age groups: 79% (1.79, 1.52 to 2.11) for children and adolescents, 143% (2.43, 2.07 to 2.86) for adults and 68% (1.68, 1.45 to 1.94) for older adults. ARTI antibiotic prescribing decreased 57% (0.43, 0.35 to 0.52) among children and adolescents and 38% (0.62, 0.48 to 0.80) among adults; however, it remained unchanged among older adults. While the number of ARTI visits declined by 19%, patients with ARTI visits were more likely to receive an antibiotic (73% versus 64%; P < 0.001) in 2010 than in 2000.Conclusions: Antibiotic use has decreased among children and adolescents, but has increased for older adults. Broad-spectrum antibiotic prescribing continues to be on the rise. Public policy initiatives to promote the judicious use of antibiotics should continue and programs targeting older adults should be developed.