Means Arianna Rubin, Weaver Marcia R, Burnett Sarah M, Mbonye Martin K, Naikoba Sarah, McClelland R Scott
Department of Global Health, University of Washington, Seattle, Washington, United States of America ; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2014 Feb 28;9(2):e90179. doi: 10.1371/journal.pone.0090179. eCollection 2014.
In many rural areas of Uganda, febrile patients presenting to health facilities are prescribed both antimalarials and antibiotics, contributing to the overuse of antibiotics. We identified the prevalence and correlates of inappropriate antibiotic management of patients with confirmed malaria.
We utilized individual outpatient data from 36 health centers from January to September 2011. We identified patients who were prescribed antibiotics without an appropriate clinical indication, as well as patients who were not prescribed antibiotics when treatment was clinically indicated. Multivariate logistic regression models were used to identify clinical and operational factors associated with inappropriate case management.
Of the 45,591 patients with parasitological diagnosis of malaria, 40,870 (90%) did not have a clinical indication for antibiotic treatment. Within this group, 17,152 (42%) were inappropriately prescribed antibiotics. The odds of inappropriate prescribing were higher if the patient was less than five years old (aOR 1.96, 95% CI 1.75-2.19) and if the health provider had the fewest years of training (aOR 1.86, 95% CI 1.05-3.29). The odds of inappropriate prescribing were lower if patients had emergency triage status (aOR 0.75, 95% CI 0.59-0.96) or were HIV positive (aOR 0.31, 95% CI 0.20-0.45). Of the 4,721 (10%) patients with clinical indications for antibiotic treatment, 521 (11%) were inappropriately not prescribed antibiotics. Clinical officers were less likely than medical officers to inappropriately withhold antibiotics (aOR 0.54, 95% CI 0.29-0.98).
Over 40% of the antibiotic treatment in malaria positive patients is prescribed despite a lack of documented clinical indication. In addition, over 10% of patients with malaria and a clinical indication for antibiotics do not receive them. These findings should inform facility-level trainings and interventions to optimize patient care and slow trends of rising antibiotic resistance.
在乌干达的许多农村地区，前往医疗机构就诊的发热患者会同时被开具抗疟药和抗生素，这导致了抗生素的过度使用。我们确定了确诊疟疾患者抗生素管理不当的患病率及其相关因素。
我们利用了2011年1月至9月期间36个医疗中心的个体门诊数据。我们确定了那些在没有适当临床指征的情况下被开具抗生素的患者，以及那些在临床上有治疗指征时却未被开具抗生素的患者。使用多变量逻辑回归模型来确定与不当病例管理相关的临床和操作因素。
在45591例经寄生虫学诊断为疟疾的患者中，40870例（90%）没有抗生素治疗的临床指征。在这组患者中，17152例（42%）被不恰当地开具了抗生素。如果患者年龄小于5岁（调整后比值比1.96，95%置信区间1.75 - 2.19）以及医疗服务提供者接受培训的年限最少（调整后比值比1.86，95%置信区间1.05 - 3.29），则不恰当开药的几率更高。如果患者具有急诊分诊状态（调整后比值比0.75，95%置信区间0.59 - 0.96）或为艾滋病毒阳性（调整后比值比0.31，95%置信区间0.20 - 0.45），则不恰当开药的几率较低。在4721例（10%）有抗生素治疗临床指征的患者中，521例（11%）被不恰当地未开具抗生素。临床干事比医务人员更不容易不恰当地停用抗生素（调整后比值比0.54，95%置信区间0.29 - 0.98）。
尽管缺乏记录在案的临床指征，但超过40%的疟疾阳性患者仍被开具抗生素治疗。此外，超过10%有疟疾且有抗生素治疗临床指征的患者未接受抗生素治疗。这些发现应为医疗机构层面的培训和干预提供依据，以优化患者护理并减缓抗生素耐药性上升的趋势。
