加拿大各省 2000 年至 2010 年门诊口腔抗菌药物使用模式的变化。
Variation in outpatient oral antimicrobial use patterns among Canadian provinces, 2000 to 2010.
机构信息
Public Health Agency of Canada, Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Guelph, Ontario;
Division of Medical Microbiology, Island Medical Program, University of British Columbia;
出版信息
Can J Infect Dis Med Microbiol. 2014 Mar;25(2):95-8. doi: 10.1155/2014/703898.
BACKGROUND
The volume and patterns of antimicrobial drug use are key variables to consider when developing guidelines for prescribing, and programs to address stewardship and combat the increasing prevalence of antimicrobial resistant pathogens. Because drug programs are regulated at the provincial level, there is an expectation that antibiotic use may vary among provinces.
OBJECTIVE
To assess these potential differences according to province and time.
METHODS
Provincial antimicrobial prescribing data at the individual drug level were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance for 2000 to 2010. Data were used to calculate two yearly metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses per prescription. The proportion of liquid oral prescriptions of total prescriptions was also calculated as a proxy measure for the proportion of prescriptions given to children versus adults. To assess the significance of provincial antimicrobial use, linear mixed models were developed for each metric, accounting for repeated measurements over time.
RESULTS
Significant differences among provinces were found, as well as significant changes in use over time. Newfoundland and Labrador was found to have significantly higher prescribing rates than all other provinces (P<0.001) in 2010, as well as the mean of all other provinces (P<0.001). In contrast, Quebec exhibited significantly lower prescribing than all other provinces (P<0.001 for all provinces except British Columbia, where P=0.024) and the mean of all other provinces (P<0.001).
DISCUSSION/CONCLUSION: Reports of reductions in antimicrobial use at the Canadian level are promising, especially prescribing to children; however, care must be taken to avoid the pitfall of the ecological fallacy. Reductions are not consistent among the provinces or among the classes of antimicrobial drugs dispensed in Canada.
背景
在制定处方指南和管理计划以应对药物管理和日益增加的抗微生物药物耐药病原体流行时，抗菌药物使用的数量和模式是需要考虑的关键变量。由于药物计划是在省级层面进行监管的，因此预计各省之间的抗生素使用情况可能存在差异。
目的
根据省份和时间评估这些潜在差异。
方法
从加拿大抗菌药物耐药性监测综合计划获得 2000 年至 2010 年的省级个体抗菌药物处方数据。使用这些数据计算了两个年度指标：每 1000 居民日的处方数和每处方平均限定日剂量。总处方中液体口服处方的比例也被计算为儿童与成人处方比例的替代指标。为了评估省级抗菌药物使用的显著性，针对每个指标建立了线性混合模型，考虑了随时间重复测量的情况。
结果
发现各省之间存在显著差异，而且使用情况随时间发生了显著变化。2010 年，纽芬兰和拉布拉多的处方率明显高于所有其他省份（P<0.001），也明显高于所有其他省份的平均值（P<0.001）。相比之下，魁北克的处方率明显低于所有其他省份（除不列颠哥伦比亚省外，所有省份的 P<0.001，而不列颠哥伦比亚省的 P=0.024）和所有其他省份的平均值（P<0.001）。
讨论/结论：在加拿大层面报告的抗菌药物使用减少是令人鼓舞的，特别是对儿童的处方；然而，必须注意避免生态学谬误的陷阱。减少在各省之间或在加拿大分发的抗菌药物类别之间并不一致。
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