Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia Clinical Pharmacology Unit, University Children's Hospital, Belgrade, Serbia.
Arch Dis Child. 2015 Oct;100(10):966-9. doi: 10.1136/archdischild-2015-308274. Epub 2015 May 20.
The aim of the study was to compare the quality of antibiotic use among children in primary settings with the internationally developed disease-specific quality indicators and with National Guidelines.
Prescriptions of systemic antibiotics to the paediatric population (<18 years) at the primary level of healthcare for the period between 2011 and 2013 were analysed by using the National Health Insurance Fund's outpatient reimbursement database.
The mean annual number of antibiotic prescriptions was 1.887.615, while the mean annual number of children receiving antibiotics was 728.285. The prescription rate slightly decreased by 10% from 1.516 antibiotic prescriptions per 1000 persons per year in 2011 to 1.365 in 2013. The highest percentage of prescribed antibiotics was observed in the group of children aged 2-23 months. The mean annual prevalence of antibiotic prescriptions was 54%. The percentage of patients prescribed an antibiotic for acute upper respiratory tract infections, acute tonsillitis and acute otitis media (AOM) was above the proposed range (≤ 20), 87% -96%. These three diagnoses represent more than 69% of all indications for prescribing antibiotics. The percentage of patients prescribed a recommended antibiotic was below the proposed range (≥ 80%), 1% -17%, while the adherence rate to National Guidelines was low, 19%-28%. The percentage of patients prescribed quinolones was above the proposed range for AOM (≤ 5%), 7%. There were no significant differences in indicators value at the regional level in Serbia.
Antibiotic use among children in Serbia is extremely high compared with that in most other European countries. Major problems are frequent use of antibiotics for indications that usually receive no benefit from this treatment and the use of broad-spectrum antibiotics.
本研究旨在比较初级医疗机构儿童抗生素使用的质量与国际制定的疾病特异性质量指标和国家指南。
利用国家健康保险基金的门诊报销数据库，分析了 2011 年至 2013 年期间初级医疗保健中儿科人群（<18 岁）使用全身抗生素的处方。
平均每年开具的抗生素处方为 1887615 份，而接受抗生素治疗的儿童平均每年为 728285 人。抗生素处方率从 2011 年的每人每年 1516 份抗生素下降了 10%，至 2013 年的 1365 份。在 2-23 个月的儿童组中，开具抗生素的比例最高。每年抗生素处方的平均流行率为 54%。急性上呼吸道感染、急性扁桃体炎和急性中耳炎（AOM）患者中开具抗生素的比例超过了建议范围（≤20%），为 87%-96%。这三种诊断占所有开具抗生素指征的 69%以上。推荐使用抗生素的患者比例低于建议范围（≥80%），为 1%-17%，而国家指南的依从率较低，为 19%-28%。用于 AOM 的喹诺酮类药物的处方比例超过了建议范围（≤5%），为 7%。在塞尔维亚，区域水平的指标值没有显著差异。
与大多数其他欧洲国家相比，塞尔维亚儿童抗生素的使用极其高。主要问题是频繁使用抗生素治疗通常不能从中获益的指征和使用广谱抗生素。
