Di Martino Mirko, Lallo Adele, Kirchmayer Ursula, Davoli Marina, Fusco Danilo
Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112 - 00147, Roma, Italy.
BMC Public Health. 2017 Nov 17;17(1):886. doi: 10.1186/s12889-017-4905-4.
According to scientific literature, antibacterials are prescribed for common pediatric conditions that do not benefit from antibiotic therapy. The link between antibiotic use and bacterial resistance is well known. Antibiotic overprescribing generates high social costs and severe consequences for children. Our objectives were to analyze antibiotic prescription patterns in pediatric outpatients residing in the Lazio region (Italy), to identify physicians' characteristics associated with increased propensity for prescription, to identify the priority axes for action to improve the rational use of antibiotics.
We enrolled all children aged 13 years or less in 2014. Antibiotic prescription patterns were analyzed during a one-year follow-up period. The main outcome measures were the antibiotic prescription prevalence, and the geographic variation in antibiotic prescribing. Multilevel models were performed to analyze variation. Variation was expressed as Median Odds Ratios (MORs). If the MOR is 1.00, there is no variation between clusters. If there is considerable between-cluster variation, the MOR will be large.
We enrolled 636,911 children. Most of them were aged 6-13 years (57.3%). In 2015, the antibiotic prescription prevalence was 46% in the 0-13, 58% in the 0-5, and 37% in the 6-13 age group. Overall, penicillins were the most prescribed antibiotics, their consumption increased from 43% to 52% during the 2007-2015 period. In 2015, the antibiotic prescription prevalence ranged from 30% to 62% across local health districts (LHDs) of the region. Moreover, a significant (p < 0.001) variation was observed between physicians working in the same LHD: MORs were equal to 1.52 (1.48-1.56) and 1.46 (1.44-1.48) in the 0-5 and 6-13 age groups, respectively. The probability of prescribing antibiotics was significantly (p < 0.001) lower for more-experienced physicians.
Pediatric antibiotic use in the Lazio region is much higher than in other European countries. The intra-regional drug prescribing variability underlines the lack of therapeutic protocols shared at regional level and raises equity issues in access to optimal care. Both LHD managers and individual physicians should be involved in training interventions to improve the targeted use of antibiotics and mitigate the effect of contextual variables, such as the spatial-related socioeconomic status of the patient/parent binomial.
根据科学文献，抗菌药物被用于治疗那些无法从抗生素治疗中获益的常见儿科疾病。抗生素使用与细菌耐药性之间的联系已广为人知。抗生素的过度处方会产生高昂的社会成本，并给儿童带来严重后果。我们的目标是分析居住在意大利拉齐奥地区的儿科门诊患者的抗生素处方模式，确定与处方倾向增加相关的医生特征，确定改善抗生素合理使用的优先行动方向。
我们纳入了2014年所有13岁及以下的儿童。在为期一年的随访期内分析抗生素处方模式。主要结局指标为抗生素处方患病率以及抗生素处方的地理差异。采用多水平模型分析差异。差异以中位数比值比（MORs）表示。如果MOR为1.00，则各群组之间无差异。如果群组间存在显著差异，则MOR会较大。
我们纳入了636,911名儿童。其中大多数年龄在6 - 13岁（57.3%）。2015年，0 - 13岁年龄组的抗生素处方患病率为46%，0 - 5岁年龄组为58%，6 - 13岁年龄组为37%。总体而言，青霉素是处方最多的抗生素，其消费量在2007 - 2015年期间从43%增至52%。2015年，该地区各地方卫生区（LHDs）的抗生素处方患病率在30%至62%之间。此外，在同一LHD工作的医生之间观察到显著差异（p < 0.001）：0 - 5岁和6 - 13岁年龄组的MOR分别为1.52（1.48 - 1.56）和1.46（1.44 - 1.48）。经验更丰富的医生开具抗生素的概率显著更低（p < 0.001）。
拉齐奥地区儿科抗生素的使用远高于其他欧洲国家。区域内药物处方的变异性凸显了区域层面缺乏共享的治疗方案，并引发了获得最佳治疗的公平性问题。LHD管理者和个体医生都应参与培训干预，以改善抗生素的靶向使用，并减轻诸如患者/家长二元组的空间相关社会经济地位等背景变量的影响。
