Lee Grace C, Reveles Kelly R, Attridge Russell T, Lawson Kenneth A, Mansi Ishak A, Lewis James S, Frei Christopher R
College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
BMC Med. 2014 Jun 11;12:96. doi: 10.1186/1741-7015-12-96.
The use of antibiotics is the single most important driver in antibiotic resistance. Nevertheless, antibiotic overuse remains common. Decline in antibiotic prescribing in the United States coincided with the launch of national educational campaigns in the 1990s and other interventions, including the introduction of routine infant immunizations with the pneumococcal conjugate vaccine (PCV-7); however, it is unknown if these trends have been sustained through recent measurements.
We performed an analysis of nationally representative data from the Medical Expenditure Panel Surveys from 2000 to 2010. Trends in population-based prescribing were examined for overall antibiotics, broad-spectrum antibiotics, antibiotics for acute respiratory tract infections (ARTIs) and antibiotics prescribed during ARTI visits. Rates were reported for three age groups: children and adolescents (<18 years), adults (18 to 64 years), and older adults (≥65 years).
An estimated 1.4 billion antibiotics were dispensed over the study period. Overall antibiotic prescribing decreased 18% (risk ratio (RR) 0.82, 95% confidence interval (95% CI) 0.72 to 0.94) among children and adolescents, remained unchanged for adults, and increased 30% (1.30, 1.14 to 1.49) among older adults. Rates of broad-spectrum antibiotic prescriptions doubled from 2000 to 2010 (2.11, 1.81 to 2.47). Proportions of broad-spectrum antibiotic prescribing increased across all age groups: 79% (1.79, 1.52 to 2.11) for children and adolescents, 143% (2.43, 2.07 to 2.86) for adults and 68% (1.68, 1.45 to 1.94) for older adults. ARTI antibiotic prescribing decreased 57% (0.43, 0.35 to 0.52) among children and adolescents and 38% (0.62, 0.48 to 0.80) among adults; however, it remained unchanged among older adults. While the number of ARTI visits declined by 19%, patients with ARTI visits were more likely to receive an antibiotic (73% versus 64%; P <0.001) in 2010 than in 2000.
Antibiotic use has decreased among children and adolescents, but has increased for older adults. Broad-spectrum antibiotic prescribing continues to be on the rise. Public policy initiatives to promote the judicious use of antibiotics should continue and programs targeting older adults should be developed.
抗生素的使用是抗生素耐药性的最重要单一驱动因素。然而，抗生素过度使用现象仍然普遍。美国抗生素处方量的下降与20世纪90年代开展的全国性教育活动以及其他干预措施同时出现，包括引入肺炎球菌结合疫苗（PCV - 7）进行常规婴儿免疫；然而，目前尚不清楚这些趋势是否通过近期的测量得以持续。
我们对2000年至2010年医疗支出小组调查的全国代表性数据进行了分析。研究了基于人群的总体抗生素、广谱抗生素、急性呼吸道感染（ARTI）用抗生素以及ARTI就诊期间开具的抗生素的处方趋势。报告了三个年龄组的比率：儿童和青少年（<18岁）、成年人（18至64岁）和老年人（≥65岁）。
在研究期间估计分发了14亿剂抗生素。儿童和青少年中总体抗生素处方量下降了18%（风险比（RR）0.82，95%置信区间（95%CI）0.72至0.94），成年人中保持不变，老年人中增加了30%（1.30，1.14至1.49）。从2000年到2010年，广谱抗生素处方率翻了一番（2.11，1.81至2.47）。所有年龄组中广谱抗生素处方的比例均有所增加：儿童和青少年为79%（1.79，1.52至2.11），成年人中为143%（2.43，2.07至2.86），老年人中为68%（1.68，1.45至1.94）。儿童和青少年中ARTI抗生素处方量下降了57%（0.43，0.35至0.52），成年人中下降了38%（0.62，0.48至0.80）；然而，老年人中保持不变。虽然ARTI就诊次数下降了19%，但2010年ARTI就诊患者比2000年更有可能接受抗生素治疗（73%对64%；P<0.001）。
儿童和青少年的抗生素使用量有所下降，但老年人的使用量有所增加。广谱抗生素处方量持续上升。促进抗生素合理使用的公共政策举措应继续，并且应制定针对老年人的项目。
