Dekker Anne R J, Verheij Theo J M, van der Velden Alike W
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Fam Pract. 2017 Apr 1;34(2):169-174. doi: 10.1093/fampra/cmw125.
Childhood infections are common in general practice. Although clinical guidelines recommend restrictive antibiotic use for children, antibiotics are too often prescribed.
The aim of this study was to obtain insight in antibiotic prescribing for children related to clinical diagnoses. This is pivotal to define improvement strategies in the antibiotic management.
In this observational study, we used consultation data collected from 45 general practices in the Netherlands in 2012. Infectious disease episode incidences, the number of antibiotic prescriptions per 1000 person-years, the proportion of episodes with an antibiotic prescription and the choice of antibiotic subclass were analysed for the most relevant diagnoses over different ages.
A total of 262 antibiotic courses were prescribed per 1000 person-years on average, with the highest number among children of 1 year (714/1000 person-years). Antibiotics were prescribed in 24% of infectious disease episodes. Acute upper respiratory tract infection (RTI) was the most common reason to visit the GP (173/1000 person-years), and the second most frequent indication to prescribe antibiotics. Antibiotics were most often prescribed for acute otitis media (58/1000 person-years). Amoxicillin dominated prescribing (55%), followed by macrolides (14%) and amoxicillin/clavulanate (10%), prescribing of narrow-spectrum antibiotics was low (10%).
This detailed insight in antibiotic management of childhood infections shows targets for Dutch improvement strategies: (i) prevent antibiotic prescribing for acute upper RTI and bronchitis; (ii) stimulate the use of narrow-spectrum antibiotics; and (iii) reduce the use of macrolides and amoxicillin/clavulanate. Furthermore, this information is helpful to compare antibiotic policy between countries.
儿童感染在普通医疗实践中很常见。尽管临床指南建议对儿童限制使用抗生素，但抗生素的处方却过于频繁。
本研究的目的是深入了解与临床诊断相关的儿童抗生素处方情况。这对于确定抗生素管理的改进策略至关重要。
在这项观察性研究中，我们使用了2012年从荷兰45家普通诊所收集的会诊数据。分析了不同年龄段最相关诊断的传染病发作发病率、每1000人年的抗生素处方数量、有抗生素处方的发作比例以及抗生素亚类的选择。
平均每1000人年共开出262个抗生素疗程，1岁儿童的处方数量最高（714/1000人年）。24%的传染病发作使用了抗生素。急性上呼吸道感染（RTI）是看全科医生最常见的原因（173/1000人年），也是开抗生素的第二常见指征。抗生素最常用于急性中耳炎（58/1000人年）。阿莫西林在处方中占主导地位（55%），其次是大环内酯类（14%）和阿莫西林/克拉维酸（10%），窄谱抗生素的处方率较低（10%）。
对儿童感染抗生素管理的这一详细洞察显示了荷兰改进策略的目标：（i）避免为急性上呼吸道RTI和支气管炎开具抗生素；（ii）鼓励使用窄谱抗生素；（iii）减少大环内酯类和阿莫西林/克拉维酸的使用。此外，这些信息有助于比较各国的抗生素政策。
