Department of Public Health, Laboratory for Mother and Child Health, Mario Negri Institute for Pharmacological Research, Via Giuseppe La Masa 19, Milan, Italy.
Eur J Clin Pharmacol. 2012 Jun;68(6):997-1005. doi: 10.1007/s00228-011-1204-3. Epub 2012 Jan 21.
To evaluate paediatric antibiotic prescription patterns in Italy in an extra-hospital setting at the national, regional, and Local Health Unit (LHU) level.
Data sources were regional prescription databases. Eight Italian regions participated in the study providing data for the year 2008, with two exceptions (where the data for 2009 and 2006 were provided instead). A total of 4,828,569 children were included: 58% of the Italian population under 15 years old. Antibiotic prevalence rates, prescription rates and prescriptions distribution by class were evaluated at the regional and LHU levels. The correlation among mean latitude, Human Development Index (HDI), hospitalisation rate, satisfaction index for the National Health Service, number of paediatricians per 1,000 resident children and prevalence rate was evaluated by regions.
The estimated pooled average prevalence rate was 50.5% (95%CI 45.7-55.3). Between-regions prevalence rates ranged from 42.6% to 62.1% and at the LHU level they ranged from 35.6% to 68.5%. There was a trend indicating that in southern regions antibiotics are more frequently prescribed than in the northern and central regions (Cochrane-Armitage test Z = -187.5 p < 0.0001). Overall, penicillin covered 53.1% of antibiotic prescriptions, with differences between regions ranging from 39.2% to 62.5%. A direct correlation was found between the prevalence rate and HDI (p = 0.031), while an inverse correlation was found with paediatricians per 1,000 resident children (p = 0.038).
We found that relevant differences exist between the northern and the southern part of the country, and the heterogeneity among LHUs is higher. The greater use of antibiotics in the southern regions is related to lower HDI and does not seems to be justified by the higher prevalence of infectious diseases.
评估意大利在医院外环境下的儿科抗生素处方模式，在国家、地区和地方卫生单位（LHU）层面进行评估。
数据来源是区域处方数据库。有 8 个意大利地区参与了这项研究，提供了 2008 年的数据，有两个地区（提供了 2009 年和 2006 年的数据）除外。共纳入 4828569 名儿童：占意大利 15 岁以下人口的 58%。在区域和 LHU 层面评估抗生素流行率、处方率和按类别分布的处方。通过地区评估平均纬度、人类发展指数（HDI）、住院率、对国家卫生服务的满意度指数、每千名居民儿童的儿科医生数量和流行率之间的相关性。
估计的平均流行率为 50.5%（95%CI 45.7-55.3）。地区间流行率范围为 42.6%至 62.1%，LHU 水平范围为 35.6%至 68.5%。有一个趋势表明，在南部地区抗生素的使用频率高于北部和中部地区（Cochrane-Armitage 检验 Z=-187.5，p<0.0001）。总体而言，青霉素覆盖了 53.1%的抗生素处方，地区之间的差异范围为 39.2%至 62.5%。流行率与 HDI 呈正相关（p=0.031），与每千名居民儿童的儿科医生数量呈负相关（p=0.038）。
我们发现该国北部和南部之间存在显著差异，LHU 之间的异质性更高。南部地区抗生素使用量较大与 HDI 较低有关，而且似乎并不能由传染病的较高流行率来解释。
