Li Jing, Song Xingyue, Yang Tingting, Chen Yawen, Gong Yanhong, Yin Xiaoxv, Lu Zuxun
From the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Medicine (Baltimore). 2016 May;95(19):e3587. doi: 10.1097/MD.0000000000003587.
Overuse of antibiotics among patients with upper respiratory tract infection (URTI) is a worldwide problem, and the problem is especially serious in developing countries, such as China. This systematic review is aimed at summarizing previous findings on outpatient prescriptions of antibiotics associated with URTI in China in order to help policymakers and the public understand and tackle the problem.We systematically searched and reviewed studies of antibiotic prescribing patterns for outpatients with URTI in China that were published in Chinese or English before December 31, 2014. The study quality was assessed, and the overall rates of URTI cases prescribed antibiotics were calculated by using random-effects model. Subgroup analyses were performed to explore the potential sources of heterogeneity among studies.We included 45 eligible studies with a total of 52,072 URTI outpatients. The overall percentage of URTI outpatients prescribed antibiotics was 83.7% (95% confidence interval [CI]: 80.6%-86.4%). Of the URTI outpatients prescribed antibiotics, 79.7% (95% CI: 72.8%-85.2%) were prescribed 1 antibiotic, 18.4% (95% CI: 13.6%-24.5%) prescribed 2 antibiotics, and 1.1% (95% CI: 0.7%-1.6%) prescribed 3 or more antibiotics. The rates of antibiotic prescription varied greatly across hospitals and showed a downward trend over time.An extremely high percentage of URTI patients in China were prescribed antibiotics and, the overuse is especially problematic in lower-level hospitals. Although there appears a downward trend, likely attributable to China's recent efforts in curbing antibiotic abuse, greater efforts are needed to promote the rational use of antibiotics.
上呼吸道感染（URTI）患者中抗生素的过度使用是一个全球性问题，在中国等发展中国家，这个问题尤为严重。本系统综述旨在总结此前关于中国URTI门诊抗生素处方的研究结果，以帮助政策制定者和公众理解并解决该问题。我们系统检索并回顾了2014年12月31日前发表的关于中国URTI门诊患者抗生素处方模式的中英文研究。评估了研究质量，并使用随机效应模型计算了URTI病例使用抗生素的总体比例。进行亚组分析以探索研究间异质性的潜在来源。我们纳入了45项符合条件的研究，共涉及52,072名URTI门诊患者。URTI门诊患者中使用抗生素的总体比例为83.7%（95%置信区间[CI]：80.6%-86.4%）。在使用抗生素的URTI门诊患者中，79.7%（95%CI：72.8%-85.2%）使用了1种抗生素，18.4%（95%CI：13.6%-24.5%）使用了2种抗生素，1.1%（95%CI：0.7%-1.6%）使用了3种或更多种抗生素。不同医院的抗生素处方率差异很大，且随时间呈下降趋势。中国极高比例的URTI患者被开具了抗生素，且这种过度使用在基层医院尤其成问题。尽管似乎有下降趋势，这可能归因于中国近期在遏制抗生素滥用方面所做的努力，但仍需要做出更大努力来促进抗生素的合理使用。
