Cassir N, Di Marco J-N, Poujol A, Lagier J-C
Service de maladies infectieuses et tropicales, hôpital Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France.
Arch Pediatr. 2012 Jun;19(6):579-84. doi: 10.1016/j.arcped.2012.03.012. Epub 2012 May 1.
The judicious prescription of antibiotics has become a central focus of professional and public-health measures to combat the spread of resistant organisms. It also seems important to consider the other impacts and determinants of antibiotic misuse.
Evaluating the ambulatory antibiotic prescription for common infections in patients secondarily hospitalized as well as the consequences and determinants of this prescription.
Study conducted over a period of 6 months between May and November 2008, during which 52 children aged between 3 months and 15 years, hospitalized in the pediatric hospital of Aix-en-Provence, were recruited. The reason for the pediatric emergency department visit was persistent symptoms or new symptoms over 48 h of ambulatory antibiotic prescription. The ambulatory antibiotic prescription was compared with current practice guidelines, and clinical progression after hospitalization was also analyzed. Afterwards, the determinants of this overprescription in ambulatory practice were investigated through a telephone questionnaire.
Seventy-five percent of the antibiotic prescriptions were inappropriate, 60 % of which could potentially have been avoided with had an adequate and recommended practices been followed. Only 25 % of the children were prescribed ambulatory diagnostic exams, whereas these exams confirmed the diagnosis at the hospital for 71 % of them. In addition, 15 % of the children presented secondary effects of the antibiotics at their admission. Among practitioners, 84 % recognized having difficulties on reevaluation of the antibiotic prescription at 48 h. A high proportion of them (71 %) believe that antibiotics should be initiated precociously in patients with underlying conditions such as diabetes. Furthermore, 33 % recognized that the perceived parents' expectation could be a determinant of prescription. Otherwise, 22 % of them had attended an antibiotic prescription educational program during the past year.
Antibiotic prescription for children's common infections remains a difficult decision for practitioners. This could partly be explained by atypical clinical symptoms and the risk of rapid progression in pediatric medicine. However, the rate of inappropriate prescription of antibiotics is high in this population. Among the main consequences of this practice, one may note the appearance of antibiotic resistance, the occurrence of side effects, and delayed diagnoses as well as preventable hospitalizations. Although certain considerations, such as the problems re-evaluating the patient after 48 h, must be taken into account, better use of paraclinical examinations in general practice could help to reduce inappropriate antibiotic prescriptions. Further large-scale, prospective studies should be conducted on the existing practices and beliefs concerning ambulatory antibiotic prescription in order to adjust prevention strategies.
合理使用抗生素已成为对抗耐药菌传播的专业和公共卫生措施的核心关注点。考虑抗生素滥用的其他影响因素和决定因素似乎也很重要。
评估再次住院患者常见感染的门诊抗生素处方情况以及该处方的后果和决定因素。
在2008年5月至11月期间进行了为期6个月的研究，招募了52名年龄在3个月至15岁之间、在普罗旺斯地区艾克斯儿童医院住院的儿童。儿科急诊科就诊的原因是在门诊抗生素处方48小时后仍有持续症状或出现新症状。将门诊抗生素处方与现行实践指南进行比较，并分析住院后的临床进展。之后，通过电话问卷调查门诊实践中这种过度处方的决定因素。
75%的抗生素处方不恰当，其中60%若遵循适当且推荐的做法本可避免。只有25%的儿童接受了门诊诊断检查，而这些检查在医院确诊了其中71%儿童的病情。此外，15%的儿童在入院时出现了抗生素的副作用。在从业者中，84%的人承认在48小时后重新评估抗生素处方有困难。他们中很大一部分人（71%）认为对于患有糖尿病等基础疾病的患者应过早使用抗生素。此外，33%的人认识到家长的预期可能是处方的一个决定因素。另外，22%的人在过去一年参加过抗生素处方教育项目。
对于从业者来说，为儿童常见感染开抗生素处方仍然是一个艰难的决定。这部分可以由非典型临床症状以及儿科学中病情快速进展的风险来解释。然而，该人群中抗生素不恰当处方的比例很高。这种做法的主要后果包括抗生素耐药性的出现、副作用的发生、诊断延迟以及可避免的住院治疗。尽管必须考虑某些因素，如48小时后重新评估患者的问题，但在全科医疗中更好地使用辅助检查有助于减少不恰当的抗生素处方。应该针对门诊抗生素处方的现有做法和观念开展进一步的大规模前瞻性研究，以调整预防策略。
