Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations
Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations
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DOI：
10.1093/jac/dku291
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发表时间：
2014-12-01
影响因子：
5.2
通讯作者：
Hayward, Andrew C.
中科院分区：
文献类型：
--
作者：
Hawker, Jeremy I.;Smith, Sue;Hayward, Andrew C.
衡量英国初级保健中抗生素处方的趋势与国家推荐的最佳实践。一项描述性研究将大型初级保健数据库中的诊断和处方个体患者数据联系起来，涵盖1995- 2011年期间537个英国全科实践。抗生素处方的咳嗽/感冒发作比例从1995年的47%下降到1999年的36%，2011年上升到51%。2011年，初级保健实践存在显著差异[第10 - 90百分位数范围（TNPR）32%-65%]。用于咽喉痛的抗生素处方从1995年的77%下降到1999年的62%，然后大致保持稳定（TNPR 45%-78%）。2011年，69%的病例使用了推荐的抗生素（1995年为64%）。在16-74岁的女性中使用推荐的短程甲氧苄啶治疗尿路感染（UTI）从1995年的8%增加到2011年的50%;然而，2011年有四分之一的实践以千分之一的货币符号16%的发作开了短程疗程。对于中耳炎，2011年85%的处方是推荐的抗生素，高于1995年的77%。所有这些年处方的变化在统计学上都非常显著（PaEuroS <aEuroS 0.001）。在英国初级保健中实施国家指南取得了好坏参半的成功，咳嗽/感冒的处方，无论是在总量上还是在咨询中的比例上，现在都比建议减少它之前要大。实践的广泛差异表明，改善处方的空间很大，特别是对于咳嗽/感冒和UTI。
To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice.A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995-2011.The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th-90th percentile range (TNPR) 32%-65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%-78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16-74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in a parts per thousand currency sign16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (PaEuroS < aEuroS0.001).The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.