Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
Department of Medicine and Department of Public Health Sciences, Penn State Hershey College of Medicine, 500 University Drive, Hershey, PA 17033-0855, USA.
Int J Antimicrob Agents. 2016 Dec;48(6):666-673. doi: 10.1016/j.ijantimicag.2016.09.008. Epub 2016 Oct 14.
Whilst the 'Principles of clinical use of antibiotics' was released by the Ministry of Health of the People's Republic of China in 2004, limited research has been conducted to evaluate the quality of antibiotic use in real-world practice. In this study, we sought to examine antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China. De-identified outpatient and emergency department pharmacy records containing antimicrobials were extracted from the hospital electronic health records system. Antimicrobial prescribing patterns and out-of-pocket medical costs for antimicrobials were evaluated by patient demographics and the primary diagnosis. Antimicrobial prescriptions stratified by patient age group (<5, 5-17, 18-49, 50-64 and ≥65 years) were also examined. A total of 363 642 antimicrobial prescriptions in 2014 were obtained, corresponding to 197 781 unique patients. Approximately 18% of antimicrobial-containing prescriptions were for acute upper respiratory infection and bronchitis, 15% for fever or cough, 5% for gastritis and duodenitis and non-infective gastroenteritis and colitis, and 7% for other diagnoses without clear indications of bacterial infection. Cephalosporins were the most frequently prescribed antibiotic class (55%). Age-specific antimicrobial prescriptions showed different patterns between children and adults. A total of US$4.6 million were spent as out-of-pocket costs on antimicrobials in 2014, and the median antimicrobial cost per prescription was $9. Unnecessary antibiotic use is still common in real-world clinical practice and remains a public health challenge. Antibiotic-related medical expenditure also presents an important economic burden.
尽管 2004 年中华人民共和国卫生部发布了《临床抗生素使用原则》，但很少有研究评估真实世界实践中抗生素使用的质量。在这项研究中，我们试图检查中国上海一家大型三级医院的抗生素处方模式。从医院电子病历系统中提取了包含抗生素的门诊和急诊科药房记录。根据患者人口统计学特征和主要诊断评估了抗生素处方模式和抗生素的自付医疗费用。还检查了按患者年龄组（<5 岁、5-17 岁、18-49 岁、50-64 岁和≥65 岁）分层的抗生素处方。2014 年共获得 363642 份抗生素处方，对应 197781 名患者。大约 18%的含抗生素处方用于急性上呼吸道感染和支气管炎，15%用于发热或咳嗽，5%用于胃炎和十二指肠炎以及非感染性胃肠炎和结肠炎，7%用于其他诊断，没有明确的细菌感染迹象。头孢菌素是最常开的抗生素类别（55%）。特定年龄的抗生素处方在儿童和成人之间呈现出不同的模式。2014 年抗生素的自付费用总计 460 万美元，每处方抗生素的中位数费用为 9 美元。在真实世界的临床实践中，不必要的抗生素使用仍然很常见，仍然是一个公共卫生挑战。抗生素相关的医疗支出也构成了重要的经济负担。
