社区范围内开展活动后儿童抗生素处方的变化。

Changes in antibiotic prescribing for children after a community-wide campaign.

作者信息

Perz Joseph F, Craig Allen S, Coffey Christopher S, Jorgensen Daniel M, Mitchel Edward, Hall Stephanie, Schaffner William, Griffin Marie R

机构信息

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.

出版信息

JAMA. 2002 Jun 19;287(23):3103-9. doi: 10.1001/jama.287.23.3103.

DOI:10.1001/jama.287.23.3103

PMID:12069673

Abstract

CONTEXT

Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee.

OBJECTIVE

To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children.

DESIGN, SETTING, AND PARTICIPANTS: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed).

INTERVENTION

Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials).

MAIN OUTCOME MEASURE

The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties.

RESULTS

Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001). The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% [P<.001]; among black children, 18% [P<.001]).

CONCLUSIONS

A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County.

摘要

背景

抗生素的过度使用导致了微生物耐药性，影响了细菌感染的治疗。田纳西州诺克斯县已记录到侵袭性肺炎链球菌的抗生素耐药率非常高（>50%）。

目的

确定一项旨在减少儿童不适当抗生素使用的全社区干预措施的效果。

设计、地点和参与者：诺克斯县卫生部门开展了为期一年的多方面活动（1997年5月至1998年4月），旨在减少儿童不必要的抗生素使用。田纳西州其他3个主要城市县（谢尔比、汉密尔顿和戴维森）未开展类似活动，作为对照。评估对象包括4个研究县参加田纳西州医疗补助管理式医疗计划的15岁以下白人和黑人儿童，占研究县儿童的36%（观察到464200人年）。