Kliemann Breno S, Levin Anna S, Moura M Luísa, Boszczowski Icaro, Lewis James J
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Course of Medicine, Health Sciences Sector, Federal University of Paraná, Curitiba, Brazil.
PLoS One. 2016 Dec 12;11(12):e0167885. doi: 10.1371/journal.pone.0167885. eCollection 2016.
Improper antibiotic use is one of the main drivers of bacterial resistance to antibiotics, increasing infectious diseases morbidity and mortality and raising costs of healthcare. The level of antibiotic consumption has been shown to vary according to socioeconomic determinants (SED) such as income and access to education. In many Latin American countries, antibiotics could be easily purchased without a medical prescription in private pharmacies before enforcement of restrictions on over-the-counter (OTC) sales in recent years. Brazil issued a law abolishing OTC sales in October 2010. This study seeks to find SED of antibiotic consumption in the Brazilian state of São Paulo (SSP) and to estimate the impact of the 2010 law.
Data on all oral antibiotic sales having occurred in the private sector in SSP from 2008 to 2012 were pooled into the 645 municipalities of SSP. Linear regression was performed to estimate consumption levels that would have occurred in 2011 and 2012 if no law regulating OTC sales had been issued in 2010. These values were compared to actual observed levels, estimating the effect of this law. Linear regression was performed to find association of antibiotic consumption levels and of a greater effect of the law with municipality level data on SED obtained from a nationwide census.
Oral antibiotic consumption in SSP rose from 8.44 defined daily doses per 1,000 inhabitants per day (DID) in 2008 to 9.95 in 2010, and fell to 8.06 DID in 2012. Determinants of a higher consumption were higher human development index, percentage of urban population, density of private health establishments, life expectancy and percentage of females; lower illiteracy levels and lower percentage of population between 5 and 15 years old. A higher percentage of females was associated with a stronger effect of the law.
SSP had similar antibiotic consumption levels as the whole country of Brazil, and they were effectively reduced by the policy.
抗生素使用不当是细菌对抗生素产生耐药性的主要驱动因素之一，会增加传染病的发病率和死亡率，并提高医疗保健成本。抗生素消费水平已显示会因收入和受教育机会等社会经济决定因素（SED）而有所不同。在许多拉丁美洲国家，近年来在实施非处方药（OTC）销售限制之前，抗生素在私人药店无需医生处方即可轻松购买。巴西于2010年10月颁布了一项废除非处方药销售的法律。本研究旨在找出巴西圣保罗州（SSP）抗生素消费的社会经济决定因素，并估计2010年法律的影响。
将2008年至2012年期间在圣保罗州私营部门发生的所有口服抗生素销售数据汇总到圣保罗州的645个市。进行线性回归以估计如果2010年未颁布规范非处方药销售的法律，2011年和2012年可能出现的消费水平。将这些值与实际观察到的水平进行比较，以估计该法律的效果。进行线性回归以找出抗生素消费水平以及该法律的更大影响与从全国人口普查获得的关于社会经济决定因素的市级数据之间的关联。
圣保罗州的口服抗生素消费量从2008年的每1000居民每天8.44限定日剂量（DID）上升到2010年的9.95，2012年降至8.06 DID。较高消费的决定因素包括较高的人类发展指数、城市人口百分比、私立医疗机构密度、预期寿命和女性百分比；较低的文盲率以及5至15岁人口的较低百分比。女性比例较高与该法律的更强效果相关。
圣保罗州的抗生素消费水平与巴西全国相似，并且该政策有效地降低了这些水平。
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