Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Suite #3030, 1620 Tremont Street, Boston, MA, 02120, USA.
Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Drug Saf. 2018 Dec;41(12):1333-1342. doi: 10.1007/s40264-018-0697-4.
Numerous initiatives over the past decade have targeted the problem of antibiotic overuse in the US; however, the cumulative impact of such initiatives upon recent patterns of use is not known.
The aims of this study were to (1) describe general trends in outpatient antibiotic use among adults over the period 2006-2015; and (2) identify rapid shifts in use during this time period as potential indicators for key events.
This was an observational study set in the ambulatory setting. Patients ≥ 18 years of age were selected from the Optum Clinformatics Datamart™, a commercial insurance claims database. The outcome measures of interest were prescriptions filled/1000 enrolled individuals, by year or quarter. We used linear regression to identify trends in use over multiple years, and change-point regression to identify rapid shifts in use within individual years.
From 2006 to 2015, antibiotic use declined significantly, decreasing by 12% for adults younger than 65 years of age (913-807 prescriptions/1000 individuals, p = 0.0001) and by 5% for adults ≥ 65 years of age (991-943 prescriptions/1000 individuals, p = 0.018). With change-point regression, we identified a number of rapid shifts in the use of specific antibiotic classes, such as downward shifts in the use of quinolones and macrolides during the second quarter of 2008 and 2013, respectively.
Over the period 2006-2015 outpatient use of antibiotics decreased substantially among adults. Rapid shifts in use occurring in 2008 and 2013 may reflect the presence of key drivers of change, such as abrupt changes in access to care or perceived antibiotic safety.
过去十年中，美国针对抗生素滥用问题采取了多项举措；然而，尚不清楚这些举措对近期使用模式的综合影响。
本研究旨在（1）描述 2006 年至 2015 年期间成年患者门诊抗生素使用的总体趋势；（2）确定在此期间使用的快速变化，将其作为关键事件的潜在指标。
本研究为观察性研究，设置于门诊环境中。从 Optum Clinformatics Datamart™（商业保险索赔数据库）中选择年龄≥18 岁的患者。关注的结局指标为每年或每季度的处方数/每千名参保者。我们使用线性回归来识别多年的使用趋势，使用变化点回归来识别每年的使用快速变化。
2006 年至 2015 年期间，抗生素使用显著下降，年龄小于 65 岁的成年人下降了 12%（913-807 份处方/每千名患者，p=0.0001），年龄≥65 岁的成年人下降了 5%（991-943 份处方/每千名患者，p=0.018）。通过变化点回归，我们确定了特定抗生素类别的使用出现了一些快速变化，例如 2008 年第二季度和 2013 年分别出现了喹诺酮类和大环内酯类药物使用的下降。
2006 年至 2015 年期间，成年患者门诊抗生素使用量大幅下降。2008 年和 2013 年出现的使用快速变化可能反映了变革的关键驱动因素的存在，例如获得医疗服务的突然变化或对抗生素安全性的认知变化。
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