Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel.
Clin Infect Dis. 2011 Jul 1;53(1):33-41. doi: 10.1093/cid/cir272.
Antibiotic overuse is of great public health concern. This study assessed whether intervention among physicians and their treated population could achieve a sustained reduction in antibiotic use, specifically in classes known to promote antibiotic resistance among children in a community setting.
We performed a cluster randomized controlled multifaceted trial among 52 primary care pediatricians and the 88,000 children registered in their practices. The intervention was led by local leaders and engaged the participating physicians. It included physician focus group meetings, workshops, seminars, and practice campaigns. These activities focused on self-developed guidelines, improving parent and physician knowledge, diagnostic skills, and parent-physician communication skills that promoted awareness of antibiotic resistance. The main outcome measure was the change in annual antibiotic prescription rates (APRs) of children treated by the intervention group physicians as compared with rates among those treated by control group physicians. The study comprised a 2-year pre-intervention period, a 3-year intervention period, and a 1-year follow-up period. Mixed-effect models were used to assess risk ratios to account for the clustered study design.
A decrease in the total APR among children treated by the intervention physicians compared with those treated by the control physicians was observed in the first intervention year (APR decrease among control physicians, 40%; APR decrease among intervention physicians, 22%; relative risk [RR], .76; 95% confidence interval [CI], .75-.78). This reduction crossed over all antibiotic classes but was most prominent for macrolides (macrolide prescription rate among control physicians, 58%; macrolide prescription rate among intervention physicians, 27%; RR, .58; 95% CI, .55-.62). The effect was sustained during the 4 following years. CONCLUSIONS. Multifaceted intervention that engages the physicians in an educational process is effective in reducing APRs and can be sustained.
NCT01187758.
抗生素滥用对公众健康构成了极大的威胁。本研究评估了针对医生及其治疗人群的干预措施是否能够实现抗生素使用的持续减少，特别是在社区环境中针对儿童的抗生素耐药性促进类抗生素。
我们在 52 名儿科初级保健医生及其所在实践中的 88000 名儿童中进行了一项集群随机对照多方面试验。干预措施由当地领导牵头，并让参与的医生参与其中。它包括医生焦点小组会议、研讨会、研讨会和实践活动。这些活动侧重于自我制定的指南，提高家长和医生的知识、诊断技能和医患沟通技巧，以提高对抗生素耐药性的认识。主要观察指标是干预组医生治疗的儿童与对照组医生治疗的儿童的年抗生素处方率（APR）变化。该研究包括 2 年的干预前阶段、3 年的干预阶段和 1 年的随访阶段。使用混合效应模型评估风险比，以考虑到聚类研究设计。
与对照组医生治疗的儿童相比，干预组医生治疗的儿童的总 APR 在干预的第一年有所下降（对照组医生的 APR 下降 40%；干预组医生的 APR 下降 22%；相对风险[RR]，.76；95%置信区间[CI]，.75-.78）。这种减少跨越了所有抗生素类别，但最显著的是大环内酯类（对照组医生的大环内酯类处方率为 58%；干预组医生的大环内酯类处方率为 27%；RR，.58；95%CI，.55-.62）。这种效果在接下来的 4 年中持续存在。
多方面的干预措施，使医生参与教育过程，可有效降低 APR，并可持续实施。
NCT01187758。
