Hu Yanhong, Walley John, Chou Roger, Tucker Joseph D, Harwell Joseph I, Wu Xinyin, Yin Jia, Zou Guanyang, Wei Xiaolin
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong (CUHK), Hong Kong, China.
Nuffield Centre for International Health, LIHS, University of Leeds, Leeds, UK.
J Epidemiol Community Health. 2016 Dec;70(12):1162-1170. doi: 10.1136/jech-2015-206543. Epub 2016 Jun 20.
Antibiotics are overprescribed for children with upper respiratory infections (URIs), leading to unnecessary expenditures, adverse events and antibiotic resistance. This study assesses whether interventions antibiotic prescription rates (APR) for childhood URIs can be reduced and what factors impact intervention effectiveness.
MEDLINE, Embase, Google Scholar, Web of Science, Global Health, WHO website, United States CDC website and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched by December 2015. Cluster or individual-patient randomised controlled trials (RCTs) and non-RCTs that examined interventions to change APR for children with URIs were selected for meta-analysis. Educational interventions for clinicians and/or parents were compared with usual care.
Of 6074 studies identified, 13 were included. All were conducted in high-income countries. Interventions were associated with lower APR versus usual care (OR 0.63 (95% CI 0.50 to 0.81, p<0.001). A patient-clinician communication approach was the most effective type of intervention, with a pooled OR 0.41 (95% CI 0.20 to 0.83; p<0.001) for clinicians and 0.26 (95% CI 0.08 to 0.91; p=0.04) for parents. Interventions that targeted clinicians and parents were significant, with a pooled OR of 0.52 (95% CI 0.35 to 0.78; p=0.002). Insignificant effects were observed for targeting clinicians and parents alone, with a pooled OR of 0.88 (95% CI 0.67 to 1.16; p=0.37) and 0.50 (95% CI 0.10 to 2.51, p=0.40), respectively.
Educational interventions are effective in reducing antibiotic prescribing for childhood URIs. Interventions targeting clinicians and parents are more effective than those for either group alone. The most effective interventions address patient-clinician communication. Studies in low-income to middle-income countries are needed.
抗生素在治疗儿童上呼吸道感染（URI）时存在过度处方的情况，这导致了不必要的支出、不良事件以及抗生素耐药性。本研究评估针对儿童URI的干预措施能否降低抗生素处方率（APR），以及哪些因素会影响干预效果。
截至2015年12月，检索了MEDLINE、Embase、谷歌学术、科学网、全球健康、世界卫生组织网站、美国疾病控制与预防中心网站以及Cochrane系统评价中心注册库（CENTRAL）。选取了对改变儿童URI抗生素处方率的干预措施进行研究的整群或个体患者随机对照试验（RCT）及非随机对照试验，进行荟萃分析。将针对临床医生和/或家长的教育干预措施与常规治疗进行比较。
在检索到的6074项研究中，纳入了13项。所有研究均在高收入国家开展。与常规治疗相比，干预措施与较低的抗生素处方率相关（比值比[OR]0.63，95%置信区间[CI]0.50至0.81，p<0.001）。患者与临床医生的沟通方式是最有效的干预类型，针对临床医生的合并OR为0.41（95%CI0.20至0.83；p<0.001），针对家长的为0.26（95%CI0.08至0.91；p=0.04）。针对临床医生和家长的干预措施具有显著效果，合并OR为0.52（95%CI0.35至0.78；p=0.002）。单独针对临床医生和家长的干预措施效果不显著，合并OR分别为0.88（95%CI0.67至1.16；p=0.37）和0.50（95%CI0.10至2.51，p=0.40）。
教育干预措施在降低儿童URI抗生素处方方面是有效的。针对临床医生和家长的干预措施比单独针对任何一组的措施更有效。最有效的干预措施涉及患者与临床医生的沟通。需要在低收入至中等收入国家开展相关研究。
