Department of Health Care Management, National Taipei College of Nursing, Taipei, Taiwan.
J Eval Clin Pract. 2011 Dec;17(6):1030-5. doi: 10.1111/j.1365-2753.2010.01469.x. Epub 2010 Aug 24.
Inappropriate use of antibiotics may increase antibiotic resistance and health care service load. Few studies have been conducted to investigate physician non-adherence to antibiotic prescription guidelines for treating urinary tract infections (UTIs) in child patients. This study aimed to examine the rates of and factors associated with non-adherence to antibiotic prescription guidelines for treating uncomplicated UTIs in child patients.
This is a cross-sectional study in which a random sample of 8921 children who received antibiotics prescription for UTIs (ICD-9-CM: 590.1, 595.0, 595.9 or 599.0) at age 17 years or less, between 2000 and 2007, were analysed. Data analysed were retrieved from Taiwan's National Health Insurance database. Non-adherence was determined by antibiotic prescription not recommended by the Infectious Disease Society of Taiwan. Multivariate logistic regression model was employed to assess the potential predictors for non-adherence, including various characteristics of patients, physicians and medical institutions.
The overall non-adherence rate was estimated at 20.05%. Older patients, older physicians and physicians from community clinics were associated with higher rates of non-adherence. Compared with pediatricians who had the lowest rate (13.15%) of non-adherence, certain specialties were found to have significantly elevated adjusted odds ratio (AOR) of non-adherence, with the highest one noted for gynecologists (35.11%, AOR = 2.29, 95% confidence interval: 1.89-2.77). We also observed that the most frequently prescribed antibiotics not recommended on guidelines varied with physician specialty.
Special attention should be concentrated on older physicians, gynecologists and physicians who practiced at community clinics to reduce non-adherence of antibiotic prescription for treating UTIs in child patients.
抗生素使用不当可能会增加抗生素耐药性和医疗服务负担。很少有研究调查医生在治疗儿童尿路感染（UTI）时是否遵守抗生素处方指南。本研究旨在调查治疗儿童单纯性尿路感染时不遵守抗生素处方指南的发生率和相关因素。
这是一项横断面研究，分析了 2000 年至 2007 年间年龄在 17 岁及以下、接受过抗生素处方治疗 UTI（ICD-9-CM：590.1、595.0、595.9 或 599.0）的 8921 名儿童的随机样本。分析数据来自台湾全民健康保险数据库。不遵守是指抗生素处方不符合台湾传染病学会的建议。采用多变量逻辑回归模型评估不遵守的潜在预测因素，包括患者、医生和医疗机构的各种特征。
总体不遵守率估计为 20.05%。年龄较大的患者、年龄较大的医生和来自社区诊所的医生与较高的不遵守率相关。与不遵守率最低的儿科医生（13.15%）相比，某些专科被发现具有显著升高的调整后比值比（AOR），其中妇科医生的 AOR 最高（35.11%，AOR=2.29，95%置信区间：1.89-2.77）。我们还观察到，最常开的不符合指南的抗生素也因医生的专业而异。
应特别关注老年医生、妇科医生和社区诊所的医生，以减少治疗儿童尿路感染时不遵守抗生素处方的情况。
