Division of Health Economics and Health Policy, Helsana, Zurich, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
Clin Microbiol Infect. 2011 Jun;17(6):855-61. doi: 10.1111/j.1469-0691.2010.03348.x. Epub 2010 Oct 20.
The use of antibiotics is highest in primary care and directly associated with antibiotic resistance in the community. We assessed regional variations in antibiotic use in primary care in Switzerland and explored prescription patterns in relation to the use of point of care tests. Defined daily doses of antibiotics per 1000 inhabitants (DDD(1000pd) ) were calculated for the year 2007 from reimbursement data of the largest Swiss health insurer, based on the anatomic therapeutic chemical classification and the DDD methodology recommended by WHO. We present ecological associations by use of descriptive and regression analysis. We analysed data from 1 067 934 adults, representing 17.1% of the Swiss population. The rate of outpatient antibiotic prescriptions in the entire population was 8.5 DDD(1000pd) , and varied between 7.28 and 11.33 DDD(1000pd) for northwest Switzerland and the Lake Geneva region. DDD(1000pd) for the three most prescribed antibiotics were 2.90 for amoxicillin and amoxicillin-clavulanate, 1.77 for fluoroquinolones, and 1.34 for macrolides. Regions with higher DDD(1000pd) showed higher seasonal variability in antibiotic use and lower use of all point of care tests. In regression analysis for each class of antibiotics, the use of any point of care test was consistently associated with fewer antibiotic prescriptions. Prescription rates of primary care physicians showed variations between Swiss regions and were lower in northwest Switzerland and in physicians using point of care tests. Ecological studies are prone to bias and whether point of care tests reduce antibiotic use has to be investigated in pragmatic primary care trials.
抗生素的使用在初级保健中最高，并且与社区中的抗生素耐药性直接相关。我们评估了瑞士初级保健中抗生素使用的区域差异，并探讨了与即时检测使用相关的处方模式。根据世界卫生组织推荐的解剖治疗化学分类和 DDD 方法，从瑞士最大的健康保险公司的报销数据中计算了 2007 年每 1000 名居民的抗生素定义日剂量（DDD(1000pd) ）。我们通过描述性和回归分析呈现了生态关联。我们分析了来自 1067934 名成年人的数据，占瑞士人口的 17.1%。整个人群的门诊抗生素处方率为 8.5 DDD(1000pd) ，从瑞士西北部和日内瓦湖地区的 7.28 到 11.33 DDD(1000pd)不等。三种最常开的抗生素的 DDD(1000pd) 分别为阿莫西林和阿莫西林克拉维酸 2.90、氟喹诺酮 1.77 和大环内酯类 1.34。DDD(1000pd)较高的地区抗生素使用的季节性变化更大，即时检测的使用也更低。在每类抗生素的回归分析中，任何即时检测的使用都与抗生素处方的减少有关。初级保健医生的处方率在瑞士各地区存在差异，在瑞士西北部和使用即时检测的医生中较低。生态研究容易存在偏倚，即时检测是否能减少抗生素的使用，需要在实用的初级保健试验中进行调查。
