Gasson J, Blockman M, Willems B
Improving Global Health Fellow, Health Impact Assessment, Western Cape Department of Health, South Africa; NHS Thames Valley and Wessex Leadership Academy, UK; THET/UK Aid in association with Health Education England, UK.
S Afr Med J. 2018 Mar 28;108(4):304-310. doi: 10.7196/SAMJ.2017.v108i4.12564.
Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance.
To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines.
A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition.
Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%).
This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.
南非初级医疗保健中抗生素处方实践的相关知识有限。鉴于全球抗生素耐药性问题，由于80%的人类抗生素使用发生在初级医疗保健中，这方面的知识至关重要。
评估开普敦都会区初级医疗保健机构的抗生素处方情况，并与现行国家指南进行比较，同时评估处方未遵循指南的原因。
于2016年4月/5月进行了一项回顾性病历审查。对开普敦都会区八家具有代表性的初级医疗保健机构中每位在两天内就诊患者的记录进行审查。记录了在这两天中任何提出新投诉患者的治疗情况。预防性抗生素疗程、结核病治疗以及非感染性诊断的患者被排除在外。将治疗情况与《南非2014年版初级医疗保健水平标准治疗指南》和《基本药物清单》进行比较。
在纳入的654份记录中，68.7%显示开具了抗生素。总体指南遵循率为45.1%。不同机构之间以及根据所治疗的生理系统、处方是针对成人还是儿科患者以及所开具的抗生素，遵循率存在显著差异。医疗保健专业类型和患者性别对遵循率没有显著影响。不遵循的主要原因是诊断未记录（30.5%）、不需要使用抗生素（21.6%）、剂量不正确（12.9%）、药物不正确（11.5%）以及治疗持续时间不正确（9.5%）。
本研究表明指南遵循情况较差。抗生素的不合理使用与抗生素耐药性增加相关。迫切需要改善开普敦都会区初级医疗保健中的抗生素处方实践。
