约旦儿童急性呼吸道感染抗生素处方情况。

Antibiotic prescribing for acute respiratory infections in children in Jordan.

机构信息

Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan.

Department of Clinical Pharmacy, Royal Medical Services, Amman, Jordan.

出版信息

Int Health. 2017 Mar 1;9(2):124-130. doi: 10.1093/inthealth/ihx003.

DOI:10.1093/inthealth/ihx003

PMID:28338813

Abstract

BACKGROUND

Most acute respiratory infections (ARIs) in children are due to viral etiology; however, over-prescribing of antibiotics for ARIs is common. The aim of this investigation was to identify antibiotic prescribing prevalence for children with ARIs and to identify predictors of broad-spectrum antibiotic prescribing.

METHODS

This was a prospective cross sectional study in a sample of ambulatory care settings in Jordan. Children (<18 years) presenting with ARIs were assessed in terms of patient's demographics, antibiotic prescription and clinical diagnosis. Multivariable logistic regression analysis was used to identify predictors of broad-spectrum antibiotic prescription.

RESULTS

Antibiotics were prescribed for 78.4% (4575/5829) of children with ARIs. Antibiotic prescription for ARIs for which antibiotics are not indicated was 69.2% (2688/3883). Broad-spectrum antibiotic prescription occurred in 51.1% (2337/4575) of all antibiotic-prescribed participants. Some of the predictors of broad-spectrum antibiotic prescription were: otitis media (OR 4.93 [95% CI 3.44-7.14]), tonsillitis (OR 6.03 [95% CI 4.39-8.33]), age 0-5 years (OR 1.17 [95% CI 1.02-1.38]) compared to age 6-12 years, fever (OR 2.14 [95% CI 1.78-2.59]), outpatient setting (OR 73 [95% CI 2.17-3.42]) and military sector (OR 2.29 [95% CI 1.82-2.90]).

CONCLUSIONS

Antibiotic prescribing is high and often inappropriate. Predictors of broad-spectrum antibiotic prescribing were identified. Health policy initiatives should involve all stakeholders to minimize inappropriate antibiotic prescription and to prevent poor outcomes associated with such practice.

摘要

背景

大多数儿童急性呼吸道感染（ARI）是由病毒引起的；然而，对 ARI 过度开具抗生素的情况很常见。本研究的目的是确定 ARI 儿童抗生素的开具情况，并确定广谱抗生素开具的预测因素。

方法

这是一项在约旦门诊环境中进行的前瞻性横断面研究。对患有 ARI 的儿童进行患者人口统计学、抗生素处方和临床诊断评估。使用多变量逻辑回归分析来确定广谱抗生素处方的预测因素。

结果

78.4%（5829/7829）的 ARI 患儿开具了抗生素。对没有指征的 ARI 开具抗生素的比例为 69.2%（2688/3883）。所有使用抗生素的患者中，广谱抗生素处方的比例为 51.1%（2337/4575）。广谱抗生素处方的一些预测因素包括：中耳炎（OR 4.93 [95% CI 3.44-7.14]）、扁桃体炎（OR 6.03 [95% CI 4.39-8.33]）、0-5 岁年龄组（OR 1.17 [95% CI 1.02-1.38]）与 6-12 岁年龄组相比，发热（OR 2.14 [95% CI 1.78-2.59]）、门诊环境（OR 73 [95% CI 2.17-3.42]）和军队部门（OR 2.29 [95% CI 1.82-2.90]）。