Frischer M, Heatlie H, Norwood J, Bashford J, Millson D, Chapman S
Department of Medicines Management, Keele University.
J Public Health Med. 2001 Mar;23(1):69-73. doi: 10.1093/pubmed/23.1.69.
Recent concerns that evidence on the appropriate use of antibiotics is not having an impact on prescribing trends are based on UK prescribing data relating to 1980-1991. The aim of this paper is to determine trends in antibiotic prescribing from 1993 to 1997 and link antibiotic prescriptions to diagnostic categories.
A retrospective analysis of antibiotic prescriptions linked to diagnostic codes was carried out using the West Midlands General Practice Research Database.
The prescribing rate for antibiotics fell from 963 prescriptions/1,000 patients in 1993 to 807 prescriptions/1,000 patients in 1997 (p < 0.001). The proportion of antibiotic prescribing for respiratory conditions fell from 65 per cent in 1993 to 59 per cent in 1997 (p < 0.001). The main decreases in antibiotic prescribing are accounted for by non-specific lower respiratory tract infections (-22 prescriptions/1,000 patients), non-specific upper respiratory tract infections (-21/1,000 patients) and throat infections (-20/1,000 patients). There was increased prescribing for non-respiratory miscellaneous conditions (+6 prescriptions/1,000 patients).
Overall antibiotic prescribing declined by 16 per cent between 1993 and 1997, primarily for respiratory conditions. These results of the current study are in marked contrast to an earlier review, which found an increase of 46 per cent between 1980 and 1991 in England. The level of antibiotic prescribing for conditions which may not be bacterial in origin is still high and there is scope for further reductions in antibiotic prescribing. This study highlights the need for regular epidemiological data to inform the debate on antibiotic prescribing.
近期有人担心关于抗生素合理使用的证据并未对处方趋势产生影响，这一担忧基于英国1980 - 1991年的处方数据。本文旨在确定1993年至1997年抗生素处方的趋势，并将抗生素处方与诊断类别相关联。
利用西米德兰兹郡全科医疗研究数据库，对与诊断代码相关联的抗生素处方进行回顾性分析。
抗生素处方率从1993年的每1000名患者963张处方降至1997年的每1000名患者807张处方（p < 0.001）。用于呼吸道疾病的抗生素处方比例从1993年的65%降至1997年的59%（p < 0.001）。抗生素处方的主要减少原因是非特异性下呼吸道感染（每1000名患者减少22张处方）、非特异性上呼吸道感染（每1000名患者减少21张处方）和咽喉感染（每1000名患者减少20张处方）。非呼吸道杂症的处方量有所增加（每1000名患者增加6张处方）。
1993年至1997年间，总体抗生素处方量下降了16%，主要是针对呼吸道疾病。本研究的结果与早期一项综述形成显著对比，该综述发现1980年至1991年期间英格兰的抗生素处方量增加了46%。对于可能并非细菌感染引起的疾病，抗生素处方水平仍然较高，抗生素处方仍有进一步降低的空间。本研究强调了需要定期的流行病学数据来为抗生素处方的讨论提供信息。
