Malo Sara, Bjerrum Lars, Feja Cristina, Lallana María-Jesús, Moliner Javier, Rabanaque María-José
Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.
Basic Clin Pharmacol Toxicol. 2015 Apr;116(4):337-42. doi: 10.1111/bcpt.12316. Epub 2014 Sep 25.
Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bacterial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evaluating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and antibiotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifaceted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.
基层医疗中不恰当使用抗生素，如在呼吸道感染（RTIs）中，是细菌耐药性的一个重要原因。本研究旨在描述西班牙急性呼吸道感染门诊抗生素使用的现状模式，并评估对国家建议的遵循情况。进行了一项回顾性观察研究，纳入了西班牙东北部一个地区1年内登记的所有呼吸道感染病例。从该地区的电子病历数据库中收集了与患者人口统计学、诊断和抗生素处方相关的数据，并评估了抗生素处方对建议的遵循情况。三分之一的呼吸道感染患者被开具了抗生素，其中年轻人（15 - 64岁）接受治疗的比例最高。急性中耳炎、鼻窦炎和急性扁桃体炎患者的处方率较高（约70%），而急性支气管炎（50%）和非特异性上呼吸道感染（24%）病例的处方率较低。观察到广谱药物和不推荐作为首选的抗生素的高处方率。根据西班牙指南，在所研究的所有诊断中，尤其是在成年人群中，存在抗生素潜在过度处方的情况。此外，抗生素的选择通常基于具有增加抗菌耐药性高风险的药物。应实施多方面策略以提高基层医疗中抗生素处方的质量。
