Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
J Antimicrob Chemother. 2013 Jan;68(1):229-36. doi: 10.1093/jac/dks355. Epub 2012 Sep 3.
There is considerable evidence linking antibiotic usage to bacterial resistance. Intervention strategies are needed to contain antibiotic use and thereby resistance. To plan appropriate strategies, it is imperative to undertake surveillance in the community to monitor antibiotic encounters and drivers of specific antibiotic misuse. Such surveillance is rarely in place in lower-middle-income countries (LMICs). This study describes antibiotic patterns and challenges faced while developing such surveillance systems in an LMIC.
Surveillance of antibiotic encounters (prescriptions and dispensations) was carried out using a repeated cross-sectional design for 2 years in Vellore, south India. Every month, patients attending 30 health facilities (small hospitals, general practitioner clinics and pharmacy shops) were observed until 30 antibiotic encounters were attained in each. Antibiotic use was expressed as the percentage of encounters containing specific antibiotics and defined daily doses (DDDs)/100 patients. Bulk antibiotic sales data were also collected.
Over 2 years, a total of 52,788 patients were observed and 21,600 antibiotic encounters (40.9%) were accrued. Fluoroquinolones and penicillins were widely used. Rural hospitals used co-trimoxazole more often and urban private hospitals used cephalosporins more often; 41.1% of antibiotic prescriptions were for respiratory infections. The main challenges in surveillance included issues regarding sampling, data collection, denominator calculation and sustainability.
Patterns of antibiotic use varied across health facilities, suggesting that interventions should involve all types of health facilities. Although challenges were encountered, our study shows that it is possible to develop surveillance systems in LMICs and the data generated may be used to plan feasible interventions, assess impact and thereby contain resistance.
有大量证据表明抗生素的使用与细菌耐药性有关。需要采取干预策略来控制抗生素的使用，从而遏制耐药性。为了制定适当的策略，必须在社区开展监测，以监测抗生素的使用情况和特定抗生素滥用的驱动因素。在中低收入国家（LMICs），这种监测很少进行。本研究描述了在 LMIC 中开发这种监测系统时的抗生素模式和面临的挑战。
在印度南部的维洛尔，使用重复横断面设计进行了为期两年的抗生素接触（处方和配药）监测。每月观察在 30 家卫生机构（小医院、全科医生诊所和药店）就诊的患者，直到每个机构获得 30 次抗生素接触。抗生素的使用以含有特定抗生素的接触百分比和定义日剂量（DDD）/100 名患者表示。还收集了大量抗生素销售数据。
在两年期间，共观察了 52788 名患者，共获得了 21600 次抗生素接触（40.9%）。氟喹诺酮类和青霉素类药物广泛使用。农村医院更常使用复方磺胺甲噁唑，城市私立医院更常使用头孢菌素；41.1%的抗生素处方用于治疗呼吸道感染。监测面临的主要挑战包括抽样、数据收集、分母计算和可持续性问题。
抗生素使用模式在不同的卫生机构之间存在差异，这表明干预措施应涵盖所有类型的卫生机构。尽管面临挑战，但我们的研究表明，在 LMICs 中开发监测系统是可行的，所产生的数据可用于规划可行的干预措施、评估影响，从而遏制耐药性。
