Factors predicting amoxicillin prescribing in primary care among children: a cohort study.
Factors predicting amoxicillin prescribing in primary care among children: a cohort study.
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DOI：
10.3399/bjgp.2021.0639
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发表时间：
2022-04-04
影响因子：
5.9
通讯作者：
Hardelid, Pia
中科院分区：
文献类型：
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作者：
Miller, Faith;Zylbersztejn, Ania;Favarato, Graziella;Adamestam, Imad;Pembrey, Lucy;Shallcross, Laura;Mason, Dan;Wright, John;Hardelid, Pia
关键词：
儿童时期的抗生素处方，最常见的是呼吸道感染（RTI），会导致抗生素耐药性，这是一个主要的公共卫生问题。确定与阿莫西林处方和RTI咨询出席初级保健幼儿的相关因素。布拉德福德的队列研究，从怀孕到24个月，收集了2007-2013年，与电子初级保健和空气污染数据有关。计算阿莫西林处方和RTI咨询率/1000儿童年。以全科（GP）手术作为随机效应，拟合混合效应logistic回归模型。2493例儿童中，第1年阿莫西林处方率为710/1000儿童年（95%置信区间[CI] = 677 - 744），第2年为780/1000（95% CI = 745 - 816）。在第一年，阿莫西林处方的几率对男孩来说更高（调整后比值比[aOR] 1.36，95% CI = 1.14 - 1.61），来自社会经济贫困家庭的婴儿（aOR 1.36，95%CI = 1.00至1.86），以及巴基斯坦种族背景的婴儿（母亲出生在英国[aOR 1.44，95% CI = 1.06 - 1.94]和国外[aOR 1.42，95% CI = 1.07 - 1.90]）。在第2年，巴基斯坦种族背景的婴儿使用阿莫西林的几率更高（母亲出生在英国[aOR 1.46，95% CI = 1.10 - 1.94]和英国以外[aOR 1.56，95% CI = 1.19 - 2.04]）和出生于妊娠<39周的患者（aOR 1.20，95% CI = 1.00 - 1.45）。其他风险因素包括剖腹产，先天性异常，过度拥挤，出生季节和儿童保育，GP手术解释了7%-9%的变化。社会经济地位和种族背景与儿童时期的阿莫西林处方相关。努力减少RTI在家庭和儿童保育环境中的传播可能会减少初级保健中的抗生素处方。
Antibiotic prescribing during childhood, most commonly for respiratory tract infections (RTIs), contributes to antimicrobial resistance, which is a major public health concern. To identify factors associated with amoxicillin prescribing and RTI consultation attendance in young children in primary care. Cohort study in Bradford spanning pregnancy to age 24 months, collected 2007–2013, linked to electronic primary care and air pollution data. Amoxicillin prescribing and RTI consultation rates/1000 child–years were calculated. Mixed-effects logistic regression models were fitted with general practice (GP) surgery as the random effect. The amoxicillin prescribing rate among 2493 children was 710/1000 child–years during year 1 (95% confidence interval [CI] = 677 to 744) and 780/1000 (95% CI = 745 to 816) during year 2. During year 1, odds of amoxicillin prescribing were higher for boys (adjusted odds ratio [aOR] 1.36, 95% CI = 1.14 to 1.61), infants from socioeconomically deprived households (aOR 1.36, 95% CI = 1.00 to 1.86), and infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.44, 95% CI = 1.06 to 1.94] and outside [aOR 1.42, 95% CI = 1.07 to 1.90]). During year 2, odds of amoxicillin prescribing were higher for infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.46, 95% CI = 1.10 to 1.94] and outside [aOR 1.56, 95% CI = 1.19 to 2.04]) and those born <39 weeks gestation (aOR 1.20, 95% CI = 1.00 to 1.45). Additional risk factors included caesarean delivery, congenital anomalies, overcrowding, birth season, and childcare attendance, with GP surgery explaining 7%–9% of variation. Socioeconomic status and ethnic background were associated with amoxicillin prescribing during childhood. Efforts to reduce RTI spread in household and childcare settings may reduce antibiotic prescribing in primary care.