Berni Ellen, Butler Chris C, Jenkins-Jones Sara, de Voogd Hanka, Ouwens Mario, Morgan Christopher Ll, Currie Craig J
a Global Epidemiology and Medical Statistics, Pharmatelligence , Cardiff , UK ;
b Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK ;
Curr Med Res Opin. 2016 Jun;32(6):1023-32. doi: 10.1185/03007995.2016.1157459. Epub 2016 Mar 11.
Purpose To compare the estimated effectiveness of seven frequently prescribed antibiotic classes as initial and secondary treatments of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs) 1991-2012. The main outcome measure was a surrogate for estimated antibiotic effectiveness. Methods Routine, primary care data from the UK Clinical Practice Research Datalink (CPRD) were used. Having established standardized criteria representing antibiotic treatment failure, estimated treatment effectiveness rates were calculated as one minus the treatment failure rate. For each year from 1991 to 2012, estimated effectiveness rates by treatment line, indication, and sub-indication were calculated. These were presented by antibiotic class, with a sub-analysis for the macrolide clarithromycin. Findings From approximately 58 million antibiotic prescriptions in CPRD, we analyzed 8,654,734 courses of antibiotic monotherapy: 4,825,422 courses (56%) were associated with URTI; 3,829,312 (44%) were associated with LRTI. Amino-penicillins (4,148,729 [56%]), penicillins (1,304,561 [18%]), and macrolides (944,622 [13%]) predominated as initial treatments; macrolides (375,903 [32%]), aminopenicillins (275,866 [23%]), and cephalosporins (159,954 [14%]) as secondary treatments. Macrolides and aminopenicillins had estimated effectiveness rates ≥80% across the study period as initial treatments of URTI and LRTI. In secondary use, only macrolides maintained these rates: 80.7% vs. 79.8% in LRTI, 85.1% vs. 84.5% in throat infections, 80.7% vs. 82.3% in nasal infections, 83.5% vs. 83.8% in unspecified URTI in 1991 and 2012, respectively. Implications After more than two decades, macrolides remained amongst the most effective antibiotic classes for both URTI and LRTI in initial and secondary antibiotic treatment when a further antibiotic course was prescribed. Limitations Antibiotic treatments were classified as intention to treat. It is unknown whether the prescription was redeemed or taken correctly. We do not know the etiology of these infections, therefore evidence of antibiotic non-response may relate to sub-optimal diagnosis and inappropriate treatment rather than antibiotic effectiveness for true bacterial infections.
目的 比较1991年至2012年期间七种常用抗生素类别作为上呼吸道感染（URTIs）和下呼吸道感染（LRTIs）初始治疗和二线治疗的估计有效性。主要结局指标是估计抗生素有效性的替代指标。方法 使用来自英国临床实践研究数据链（CPRD）的常规初级保健数据。在确定了代表抗生素治疗失败的标准化标准后，估计治疗有效率计算为1减去治疗失败率。对于1991年至2012年的每一年，计算按治疗线、适应症和亚适应症划分的估计有效率。这些按抗生素类别呈现，并对大环内酯类药物克拉霉素进行亚分析。结果 在CPRD中约5800万份抗生素处方中，我们分析了8654734个抗生素单药治疗疗程：4825422个疗程（56%）与URTI相关；3829312个疗程（44%）与LRTI相关。氨基青霉素（4148729 [56%]）、青霉素（1304561 [18%]）和大环内酯类药物（944622 [13%]）作为初始治疗占主导地位；大环内酯类药物（375903 [32%]）、氨基青霉素（275866 [23%]）和头孢菌素（159954 [14%]）作为二线治疗。在整个研究期间，大环内酯类药物和氨基青霉素作为URTI和LRTI的初始治疗，估计有效率≥80%。在二线使用中，只有大环内酯类药物保持了这些比率：在LRTI中分别为80.7%对79.8%，在咽喉感染中为85.1%对84.5%，在鼻感染中为80.7%对82.3%，在1991年和2012年未明确的URTI中为83.5%对83.8%。启示 二十多年后，当开具进一步的抗生素疗程时，大环内酯类药物仍然是URTI和LRTI初始和二线抗生素治疗中最有效的抗生素类别之一。局限性 抗生素治疗按意向性治疗分类。未知处方是否被兑现或正确服用。我们不知道这些感染的病因，因此抗生素无反应的证据可能与诊断欠佳和治疗不当有关，而不是与真正细菌感染的抗生素有效性有关。
