Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK Global Epidemiology, Pharmatelligence, Cardiff, UK
Global Epidemiology, Pharmatelligence, Cardiff, UK.
BMJ. 2014 Sep 23;349:g5493. doi: 10.1136/bmj.g5493.
To characterise failure of antibiotic treatment in primary care in the United Kingdom in four common infection classes from 1991 to 2012.
Longitudinal analysis of failure rates for first line antibiotic monotherapies associated with diagnoses for upper and lower respiratory tract infections, skin and soft tissue infections, and acute otitis media.
Routine primary care data from the UK Clinical Practice Research Datalink (CPRD).
Adjusted rates of treatment failure defined by standardised criteria and indexed to year 1 (1991=100).
From 58 million antibiotic prescriptions in CPRD, we analysed 10,967,607 monotherapy episodes for the four indications: 4,236,574 (38.6%) for upper respiratory tract infections; 3,148,947 (28.7%) for lower respiratory tract infections; 2,568,230 (23.4%) for skin and soft tissue infections; and 1,013,856 (9.2%) for acute otitis media. In 1991, the overall failure rate was 13.9% (12.0% for upper respiratory tract infections; 16.9% for lower respiratory tract infections; 12.8% for skin and soft tissue infections; and 13.9% for acute otitis media). By 2012, the overall failure rate was 15.4%, representing an increase of 12% compared with 1991 (adjusted value indexed to first year (1991) 112, 95% confidence interval 112 to 113). The highest rate was seen in lower respiratory tract infections (135, 134 to 136). While failure rates were below 20% for most commonly prescribed antibiotics (amoxicillin, phenoxymethylpenicillin (penicillin-V), and flucloxacillin), notable increases were seen for trimethoprim in the treatment of upper respiratory tract infections (from 29.2% in 1991-95 to 70.1% in 2008-12) and for ciprofloxacin (from 22.3% in 1991-95 to 30.8% in 2008-12) and cefalexin (from 22.0% in 1991-95 to 30.8% in 2008-12) in the treatment of lower respiratory tract infections. Failure rates for broad spectrum penicillins, macrolides, and flucloxacillin remained largely stable.
From 1991 to 2012, more than one in 10 first line antibiotic monotherapies for the selected infections were associated with treatment failure. Overall failure rates increased by 12% over this period, with most of the increase occurring in more recent years, when antibiotic prescribing in primary care plateaued and then increased.
描述英国初级保健中四类常见感染性疾病抗生素治疗失败的情况，时间跨度为 1991 年至 2012 年。
对一线抗生素单药治疗相关失败率进行纵向分析，这些治疗与上、下呼吸道感染、皮肤和软组织感染以及急性中耳炎的诊断相关联。
英国临床实践研究数据链（CPRD）中的常规初级保健数据。
根据标准化标准定义的治疗失败率，并以第一年（1991 年=100）为基准进行索引。
从 CPRD 中的 5800 万份抗生素处方中，我们分析了四类适应证的 10967607 例单药治疗病例：上呼吸道感染 4236574 例（38.6%）；下呼吸道感染 3148947 例（28.7%）；皮肤和软组织感染 2568230 例（23.4%）；急性中耳炎 1013856 例（9.2%）。1991 年，总体失败率为 13.9%（上呼吸道感染为 12.0%；下呼吸道感染为 16.9%；皮肤和软组织感染为 12.8%；急性中耳炎为 13.9%）。到 2012 年，总体失败率为 15.4%，与 1991 年相比增加了 12%（调整后第一年（1991 年）的指数为 112，95%置信区间为 112 至 113）。下呼吸道感染的失败率最高（135，134 至 136）。虽然最常开处方的抗生素（阿莫西林、苯氧甲基青霉素（青霉素-V）和氟氯西林）的失败率低于 20%，但在治疗上呼吸道感染时，甲氧苄啶的失败率显著上升（从 1991-95 年的 29.2%上升到 2008-12 年的 70.1%），环丙沙星（从 1991-95 年的 22.3%上升到 2008-12 年的 30.8%）和头孢氨苄（从 1991-95 年的 22.0%上升到 2008-12 年的 30.8%）在治疗下呼吸道感染时也有所上升。广谱青霉素、大环内酯类和氟氯西林的失败率基本保持稳定。
1991 年至 2012 年期间，四类选定感染性疾病中，超过十分之一的一线抗生素单药治疗与治疗失败有关。在此期间，总体失败率增加了 12%，其中大部分增加发生在最近几年，当时初级保健中的抗生素处方量达到了平台期，随后又有所增加。
