Phase I Clinical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Pharmacy, Civil Aviation General Hospital, Beijing, China.
JAMA Intern Med. 2014 Dec;174(12):1914-20. doi: 10.1001/jamainternmed.2014.5214.
Appropriate antibiotic use is a key strategy to control antibacterial resistance. The first step in achieving this is to identify the major problems in antibiotic prescription in health care facilities, especially in primary health care settings, which is where most patients receive medical care.
To identify current patterns of antibiotic use and explore the reasons for inappropriate prescription in primary health care settings in China.
DESIGN, SETTING, AND PARTICIPANTS: A total of 48 primary health care facilities in China were randomly selected from 6 provinces at various levels of economic development. Data for the years 2009 through 2011 from 39 qualifying facilities (23 city and 16 rural primary health care centers) were analyzed retrospectively. The study sample consisted of prescription records for 7311 outpatient visits and 2888 inpatient hospitalizations.
General health center information, drug usage, disease diagnoses, and antibiotic use by outpatients and inpatients were surveyed. Cases of inappropriate antibiotic prescription were identified.
Most staff in the primary health care facilities had less than a college degree, and the medical staff consisted primarily of physician assistants, assistant pharmacists, nurses, and nursing assistants. The median (range) governmental contribution to each facility was 34.0% (3.6%-92.5%) of total revenue. The facilities prescribed a median (range) of 28 (8-111) types of antibiotics, including 34 (10-115) individual agents. Antibiotics were included in 52.9% of the outpatient visit prescription records: of these, only 39.4% were prescribed properly. Of the inpatients, 77.5% received antibiotic therapy: of these, only 24.6% were prescribed properly. Antibiotics were prescribed for 78.0% of colds and 93.5% of cases of acute bronchitis. Of the antibiotic prescriptions, 28.0% contained cephalosporins and 15.7% fluoroquinolones. A total of 55.0% of the antibiotic prescriptions were for antibiotic combination therapy with 2 or more agents. In nonsurgical inpatients in cities, the mean (SD) duration of antibiotic therapy was 10.1 (7.8) days. Of the surgical patients, 98.0% received antibiotics, with 63.8% of these prescriptions for prophylaxis.
Antibiotics are frequently prescribed in Chinese primary health care facilities, and a large proportion of these prescriptions are inappropriate. Frequent and inappropriate use of antibiotics in primary health care settings in China is a serious problem that likely contributes to antimicrobial resistance worldwide.
适当使用抗生素是控制抗菌耐药性的关键策略。实现这一目标的第一步是确定医疗机构，特别是初级保健机构中抗生素处方的主要问题，因为大多数患者都在这些地方接受医疗服务。
确定中国初级保健机构中抗生素使用的现状，并探讨不合理处方的原因。
设计、地点和参与者：从经济发展水平不同的 6 个省随机抽取了 48 家初级保健机构。对 39 家合格机构（23 家城市和 16 家农村初级保健中心）的 2009 年至 2011 年的数据进行了回顾性分析。研究样本包括 7311 次门诊就诊和 2888 例住院患者的处方记录。
调查了一般保健中心信息、药物使用情况、疾病诊断以及门诊和住院患者的抗生素使用情况。确定了不合理抗生素处方的病例。
初级保健机构的工作人员大多学历低于大学，医务人员主要由助理医师、助理药剂师、护士和护理助理组成。各机构政府拨款中位数（范围）占总收入的 34.0%（3.6%-92.5%）。这些机构开的抗生素中位数（范围）为 28 种（8-111 种），包括 34 种（10-115 种）单药。52.9%的门诊处方记录中包含抗生素：其中只有 39.4%是合理处方。住院患者中，77.5%接受了抗生素治疗：其中只有 24.6%是合理处方。感冒患者中有 78.0%和急性支气管炎患者中有 93.5%接受了抗生素治疗。在抗生素处方中，28.0%含有头孢菌素，15.7%含有氟喹诺酮类药物。共有 55.0%的抗生素处方是用 2 种或以上药物联合治疗。在城市非手术住院患者中，抗生素治疗的平均（SD）持续时间为 10.1（7.8）天。手术患者中，98.0%接受了抗生素治疗，其中 63.8%是预防用药。
中国初级保健机构经常开抗生素，其中很大一部分处方不合理。中国初级保健机构中抗生素的频繁和不合理使用是一个严重的问题，可能导致全球抗菌耐药性的产生。
