Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Research Centre for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.
1 rue Boileau, Versailles 78000, France.
J Antimicrob Chemother. 2018 May 1;73(5):1395-1401. doi: 10.1093/jac/dky018.
To assess time trends of outpatient antibiotic utilization using different measures and explore their discrepancies.
Based on French sales data from the IQVIA SDM database, 2009-16, we assessed time trends in outpatient antibiotic utilization using PrID, DID, PID and SID (defined as the number of prescriptions, DDDs, packages and standard units per 1000 inhabitants per day, respectively). We explored discrepancies between trends in PrID and DID by modelling the number of DDDs per prescription.
Outpatient antibiotic utilization (n = 538.2 million projected prescriptions) decreased in terms of PrID, PID and SID (-10%, -8% and -8%, respectively; negative regression slopes; P < 0.01), but remained stable according to DID (+2%; slope 0.009; P = 0.4). The number of DDDs per prescription increased over time (+14%; slope 0.019; P < 0.001). The proportions of amoxicillin and amoxicillin/clavulanate were positively associated with the number of DDDs per prescription (adjusted coefficients 0.10 and 0.15, respectively; both P < 0.05), as well as the proportion of adult and hospital prescriptions (adjusted coefficients 0.07 and 0.05, respectively; both P < 0.05). The discrepancy between DID and PrID disappeared when the DDD of amoxicillin was increased to values higher than the current DDD.
Time trends in outpatient antibiotic utilization expressed as PrID, DID, PID and SID provided conflicting results. We caution against using DID alone when monitoring antibiotic utilization. Instead, we recommend monitoring both DID and PrID as they provide different types of relevant information, especially when studying trends at a national level.
使用不同指标评估门诊抗生素使用的时间趋势，并探讨其差异。
基于 IQVIA SDM 数据库中的法国销售数据（2009-16 年），我们使用 PrID、DID、PID 和 SID（分别定义为每千名居民每天的处方数、DDD 数、包装数和标准单位数）评估门诊抗生素使用的时间趋势。我们通过对每个处方的 DDD 数进行建模，探索 PrID 和 DID 趋势之间的差异。
门诊抗生素使用（预计 5.382 亿张处方）按 PrID、PID 和 SID 呈下降趋势（分别减少 10%、8%和 8%；负回归斜率；P<0.01），但按 DID 则保持稳定（增加 2%；斜率 0.009；P=0.4）。每个处方的 DDD 数随时间增加（增加 14%；斜率 0.019；P<0.001）。阿莫西林和阿莫西林/克拉维酸的比例与每个处方的 DDD 数呈正相关（调整后的系数分别为 0.10 和 0.15；均 P<0.05），以及成人和医院处方的比例（调整后的系数分别为 0.07 和 0.05；均 P<0.05）。当阿莫西林的 DDD 增加到高于当前 DDD 值时，DID 和 PrID 之间的差异消失。
以 PrID、DID、PID 和 SID 表示的门诊抗生素使用的时间趋势提供了相互矛盾的结果。我们警告在监测抗生素使用时不要单独使用 DID。相反，我们建议同时监测 DID 和 PrID，因为它们提供了不同类型的相关信息，特别是在研究国家层面的趋势时。
