S Kumari Indira K, Chandy S J, Jeyaseelan L, Kumar Rashmi, Suresh Saradha
Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, India.
Indian J Med Res. 2008 Aug;128(2):165-71.
BACKGROUND & OBJECTIVES: Irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. This study was undertaken to determine the rate and pattern of antimicrobial prescribing in patients with uncomplicated acute respiratory infections, fever and diarrhoea attending a few rural and urban health settings.
The study was done in primary and secondary health care facilities of public/government and private settings at four sites in India. Patients with fever, cough, diarrhoea or ear, nose or throat infections of < 7 days were included. Pregnant women, lactating mothers, infants, seriously ill patients and patients with bloody diarrhoea or purulent nasal or ear discharge were excluded.
Overall antimicrobial prescription rate was 69.4 per cent (95% CI 67.1, 71.7). Wide variation was observed (Thiruvananthapuram 47.6%, Lucknow 81.8%, Chennai 73.1% and Vellore 76.5%). Physicians practicing in rural and public/government settings prescribed antimicrobials more frequently than those in urban and private settings (83.8, 81.9, 68.3 and 68.2% respectively). Antimicrobials were more frequently prescribed for patients presenting with fever. Highest rate was noticed for children aged between 6 and 18 yr. Patients of the high-income group received antimicrobials more frequently (72.7%). In both public/ government and private settings, for patients who purchased medicines, the rate was higher (82.4 and 68.9% respectively), vs. those receiving free medicines (70.2 and 46.2% respectively). Two third of all antimicrobials prescribed were penicillins and co-trimoxazole, and > 40 per cent of prescriptions from private sector were quinolones and cephalosporins.
INTERPRETATION & CONCLUSIONS: Our findings showed that prescription of antimicrobials for acute respiratory infections and diarrhoea was extremely common and warrants interventional strategies.
抗菌药物的不合理使用是微生物中抗菌药物耐药性迅速传播的关键因素。本研究旨在确定在一些农村和城市医疗机构就诊的单纯性急性呼吸道感染、发热和腹泻患者中抗菌药物的处方率及模式。
该研究在印度四个地点的公立/政府及私立机构的初级和二级卫生保健设施中进行。纳入发热、咳嗽、腹泻或小于7天的耳鼻喉感染患者。排除孕妇、哺乳期母亲、婴儿、重症患者以及血性腹泻或脓性鼻或耳分泌物患者。
总体抗菌药物处方率为69.4%（95%置信区间67.1，71.7）。观察到有很大差异（特里凡得琅47.6%，勒克瑙81.8%，金奈73.1%，韦洛尔76.5%）。在农村及公立/政府机构执业的医生比在城市及私立机构执业的医生更频繁地开具抗菌药物（分别为83.8%、81.9%、68.3%和68.2%）。发热患者更频繁地被开具抗菌药物。6至18岁儿童的开具率最高。高收入组患者更频繁地接受抗菌药物（72.7%）。在公立/政府及私立机构中，购药患者的开具率更高（分别为82.4%和68.9%），而接受免费药物的患者开具率分别为70.2%和46.2%。所有开具的抗菌药物中有三分之二是青霉素和复方新诺明，私立部门超过40%的处方是喹诺酮类和头孢菌素类。
我们的研究结果表明，急性呼吸道感染和腹泻患者使用抗菌药物的处方极为常见，需要采取干预策略。
