Grijalva Carlos G, Nuorti J Pekka, Griffin Marie R
Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Ave, Ste 2600, The Village at Vanderbilt, Nashville, TN 37232-2637, USA.
JAMA. 2009 Aug 19;302(7):758-66. doi: 10.1001/jama.2009.1163.
During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown.
To assess trends in antibiotic prescriptions for ARTI.
DESIGN, SETTING, AND PARTICIPANTS: The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations.
National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI.
Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased.
Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.
在20世纪90年代，美国急性呼吸道感染（ARTI）的抗生素处方量有所下降。这些变化的可持续性尚不清楚。
评估ARTI抗生素处方的趋势。
设计、设置和参与者：使用国家门诊医疗调查和国家医院门诊医疗调查数据（1995 - 2006年），按抗生素适应症和类别检查抗生素处方率的趋势。年度调查数据和人口普查分母每两年合并一次用于率的计算。
ARTI的全国年度就诊率和抗生素处方率，包括中耳炎（OM）和非ARTI。
在5岁以下儿童中，年度ARTI就诊率下降了17%（95%置信区间[CI]，9% - 24%），从1995 - 1996年的每1000人口1883次降至2005 - 2006年的每1000人口1560次，主要原因是OM就诊率下降了33%（95%CI，22% - 43%）（分别从每1000人口950次降至634次）。这种下降伴随着ARTI相关抗生素处方下降了36%（95%CI，26% - 45%）（从每1000人口1216次降至779次）。在5岁及以上人群中，ARTI就诊率保持稳定，但相关抗生素处方率下降了18%（95%CI，6% - 29%），从每1000人口178次降至146次。在5岁以下和5岁及以上人群中，很少使用抗生素的非OM ARTI的抗生素处方率分别下降了4l%（95%CI，22% - 55%）和24%（95%CI，10% - 37%）。总体而言，与ARTI相关的青霉素、头孢菌素和磺胺/四环素的处方率下降。阿奇霉素的处方率上升，它成为ARTI和OM最常用的大环内酯类药物（占OM就诊的10%）。在成年人中，喹诺酮类处方增加。
ARTI的总体抗生素处方率下降，这与5岁以下儿童OM就诊减少以及很少使用抗生素的ARTI处方减少有关。然而，广谱抗生素的处方率显著上升。
