Finley R
Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON.
Can Commun Dis Rep. 2014 Nov 7;40(Suppl 2):14-22. doi: 10.14745/ccdr.v40is2a03.
To describe patterns of antibiotic recommendations by office-based physicians from five regions in Canada between 2007 and 2011.
Values were estimated based on quarterly data from a sample of approximately 652 physicians stratified by region and specialty. For four consecutive quarters, each physician maintained a practice diary describing information on every patient visit during a randomly selected 48-hour period. This information was then extrapolated using a projection factor to estimate prescriptions by all physicians across Canada.
Over the five-year surveillance period, physicians saw patients for almost 1.5 billion diagnoses with approximately 120 million antimicrobial recommendations. In 2011 alone, 289 million clinical diagnoses were made of which 8% resulted in an antimicrobial being recommended. The majority of these (51%) were for the treatment of diseases of the respiratory system, 14% for infections of the urinary tract, and 11% for diseases of skin and subcutaneous tissue. Antimicrobial recommendations were highest for patients in the age groups of 0-2, 3-9, and 65 or older. Antimicrobial recommendation rates generally decreased between 2007 and 2011 except for diseases of the genitourinary system and diseases of the ear that remained stable. Overall, the most commonly recommended antimicrobials included macrolides, penicillins with extended spectrum, and fluoroquinolones. Although not as common, there was a 42% increase in the number of physician recommendations for third generation cephalosporins.
With the exception of third generation cephalosporins, the percentage of antimicrobial recommendations by office-based physicians in Canada remained stable or decreased between 2007 and 2011. Provincial differences were observed in the antimicrobial recommendations and rates, with the Atlantic region and Québec having higher rates of antimicrobial recommendations compared to the overall national level.
描述2007年至2011年加拿大五个地区的门诊医生开具抗生素的模式。
根据按地区和专业分层的约652名医生样本的季度数据进行估值。连续四个季度，每位医生都要记录一本诊疗日记，描述在随机抽取的48小时内每次患者就诊的信息。然后使用一个推算因子对这些信息进行推算，以估计加拿大所有医生的处方量。
在五年的监测期内，医生对近15亿例诊断进行了诊疗，开出了约1.2亿次抗菌药物处方。仅在2011年，就做出了2.89亿次临床诊断，其中8%的诊断结果是开出了抗菌药物。其中大多数（51%）用于治疗呼吸系统疾病，14%用于治疗泌尿系统感染，11%用于治疗皮肤和皮下组织疾病。0至2岁、3至9岁以及65岁及以上年龄组的患者接受抗菌药物处方的比例最高。除了生殖泌尿系统疾病和耳部疾病的抗菌药物处方率保持稳定外，2007年至2011年期间抗菌药物处方率总体呈下降趋势。总体而言，最常被推荐的抗菌药物包括大环内酯类、广谱青霉素类和氟喹诺酮类。虽然第三代头孢菌素的医生推荐数量增加了42%，但并不常见。
2007年至2011年期间，除第三代头孢菌素外，加拿大门诊医生开具抗菌药物的比例保持稳定或有所下降。在抗菌药物推荐和处方率方面观察到了省级差异，与全国总体水平相比，大西洋地区和魁北克省的抗菌药物推荐率更高。
