Birkett D J, Mitchell A S, Godeck A, Grigson T, Cully R, Lee C
Department of Clinical Pharmacology, Flinders Medical Centre, Bedford Park, SA.
Med J Aust. 1991 Sep 16;155(6):410-5.
To survey the use by Australian pensioners of orally administered antimicrobial agents supplied through the Pharmaceutical Benefits Scheme over the years 1987-1989.
Australian Pharmaceutical Benefits Scheme pensioner data for 1987-1989 and market research data from a private company.
The data were initially available as the number of prescriptions dispensed and were aggregated on a quarter year basis. These were converted to defined daily doses (DDDs) per 1000 pensioners per day (DDD/1000 per day). This conversion of the data allows comparisons across drug groups, and with prescribing patterns in other countries. The DDD/1000 per day also gives an indication of the proportion of individuals in the community receiving a drug at a particular time.
There was a 26% increase in antibacterial drug use over this period. Comparison of prescribing profiles for particular indications with peer consensus guidelines revealed marked discrepancies, particularly for upper respiratory tract infections, urinary tract infections, otitis media and sinusitis. Upper respiratory tract infections accounted for 31% of instances of antibiotic prescribing. Dispensing of amoxycillin/potassium clavulanate relative to amoxycillin as a single agent, showed a marked increase in 1989 to the point where it represented 25% of all amoxycillin used. This could be considered excessive given the lack of evidence that amoxycillin resistance has substantially increased in infections presenting to general practice. The data presented here confirm previous suggestions that Australian antibiotic prescribing is heavily concentrated on the use of broad spectrum agents. By comparison with Norway or Sweden, there is a greater relative use of broad spectrum penicillins and tetracyclines and a lower relative use of phenoxymethylpenicillin and trimethoprim.
Antibiotic prescribing practices in Australia continue to be often inappropriate and expensive, being directed too heavily towards the use of broad spectrum agents and newer more expensive drugs. Correction of such antibacterial drug use will require coordination of educational and regulatory activities that are sensitive to the context of general practice.
调查1987年至1989年间澳大利亚养老金领取者通过药品福利计划使用口服抗菌药物的情况。
1987年至1989年澳大利亚药品福利计划养老金领取者数据以及一家私人公司的市场研究数据。
数据最初以配药处方数量的形式提供，并按季度进行汇总。这些数据被转换为每1000名养老金领取者每天的限定日剂量（DDD/1000每天）。数据的这种转换使得能够在不同药物组之间进行比较，并与其他国家的处方模式进行比较。DDD/1000每天还能表明在特定时间社区中接受某种药物治疗的个体比例。
在此期间抗菌药物的使用增加了26%。将特定适应症的处方概况与同行共识指南进行比较发现存在明显差异，尤其是在上呼吸道感染、尿路感染、中耳炎和鼻窦炎方面。上呼吸道感染占抗生素处方病例的31%。与单一制剂阿莫西林相比，阿莫西林/克拉维酸钾的配药量在1989年显著增加，占所有使用的阿莫西林的25%。鉴于缺乏证据表明在全科医疗中出现的感染中阿莫西林耐药性已大幅增加，这可能被认为是过度的。此处呈现的数据证实了之前的观点，即澳大利亚的抗生素处方严重集中在使用广谱药物上。与挪威或瑞典相比，广谱青霉素和四环素的相对使用量更大，而苯氧甲基青霉素和甲氧苄啶的相对使用量更低。
澳大利亚的抗生素处方做法仍然常常不恰当且昂贵，过于侧重于使用广谱药物和更新的、更昂贵的药物。纠正这种抗菌药物的使用需要协调对全科医疗背景敏感的教育和监管活动。
