欧洲抗菌药物消耗监测（ESAC）：欧洲地区（1997-2009 年）的门诊喹诺酮类药物使用情况。
European Surveillance of Antimicrobial Consumption (ESAC): outpatient quinolone use in Europe (1997-2009).
机构信息
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
出版信息
J Antimicrob Chemother. 2011 Dec;66 Suppl 6:vi47-56. doi: 10.1093/jac/dkr457.
BACKGROUND
Data on more than a decade of outpatient quinolone use were collected from 33 European countries within the European Surveillance of Antimicrobial Consumption (ESAC) project, funded by the European Centre for Disease Prevention and Control (ECDC).
METHODS
For the period 1997-2009, data on outpatient use of systemic quinolones aggregated at the level of the active substance were collected using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) method (WHO, version 2011), and expressed in DDD and packages per 1000 inhabitants per day (DID and PID, respectively). Using a classification based on pharmacokinetic and in vitro potency profiles, quinolone use was analysed with regard to trends over time, seasonal variation and composition.
RESULTS
Total outpatient quinolone use in 2009 varied by a factor of 7.5 between the country with the highest (Italy, 3.61 DID) and the country with the lowest (the UK, 0.48 DID) quinolone use. The second-generation quinolones accounted for >50% of quinolone use (mainly ciprofloxacin), except for Croatia, where first-generation quinolones (mainly norfloxacin) were mostly used. A significant increase in outpatient quinolone use was found for Europe, as well as a large seasonal variation, which increased significantly over time from 1997 to 2009. Relative use of third-generation quinolones significantly increased over time with respect to the use of second-generation quinolones, while the relative use of both significantly increased with respect to the first-generation quinolones. Levofloxacin and moxifloxacin (respiratory quinolones) represented >10% of quinolone outpatient use in 17 countries, with extreme seasonal variation in all countries.
CONCLUSIONS
There was a substantial increase and change in the pattern of quinolone use between 1997 and 2009, a period during which quinolones that are effective for the treatment of respiratory tract infections were introduced. These quinolones are not the first-line antibiotics for this indication and their use should generally be limited, and quinolones should ideally show no substantial seasonal variation in terms of their use.
背景
在欧洲疾病预防控制中心（ECDC）的资助下，欧洲监测抗生素消费（ESAC）项目从 33 个欧洲国家收集了超过 10 年的门诊喹诺酮类药物使用数据。
方法
在 1997 年至 2009 年期间，使用解剖治疗化学（ATC）/定义日剂量（DDD）方法（世界卫生组织，2011 年版），对系统使用喹诺酮类药物的汇总数据进行了收集，这些数据以活性物质为基础，并以 DDD 和每 1000 居民每天的包装数（DID 和 PID）表示。根据药代动力学和体外效力谱进行分类，分析了喹诺酮类药物的使用趋势、季节性变化和组成。
结果
2009 年，各国门诊喹诺酮类药物的总使用量相差 7.5 倍，使用量最高的国家（意大利，3.61 DID）和使用量最低的国家（英国，0.48 DID）之间存在显著差异。第二代喹诺酮类药物占喹诺酮类药物使用量的 50%以上（主要是环丙沙星），除克罗地亚外，第一代喹诺酮类药物（主要是诺氟沙星）的使用量最大。欧洲门诊喹诺酮类药物的使用量显著增加，季节性变化也很大，从 1997 年到 2009 年，这种变化显著增加。第三代喹诺酮类药物的相对使用量随着第二代喹诺酮类药物的使用而显著增加，而两者的相对使用量都随着第一代喹诺酮类药物的使用而显著增加。在 17 个国家中，左氧氟沙星和莫西沙星（呼吸喹诺酮类药物）占门诊喹诺酮类药物使用量的 10%以上，所有国家的季节性变化都非常极端。
结论
在 1997 年至 2009 年间，喹诺酮类药物的使用模式发生了实质性的增加和变化，在此期间，治疗呼吸道感染有效的喹诺酮类药物被引入。这些喹诺酮类药物不是该适应症的一线抗生素，其使用应受到限制，并且理想情况下，它们的使用不应有明显的季节性变化。
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