Maguire F, Murphy M E, Rourke M, Morgan F, Brady G, Byrne E, O’Callaghan M E
School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
HRB Centre for Primary Care Research, Royal College of Surgeons Ireland, Dublin 2, Ireland
Ir Med J. 2018 Dec 6;111(10):835.
Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.
引言 本研究旨在分析6岁以下儿童上呼吸道感染（URTI）病例中，在爱尔兰日间及非工作时间全科医疗服务（GP）中的抗生素处方情况。近年来，该群体享受免费全科医疗服务的资格发生了大规模变化。方法 对2015年至2017年为期三年的两周内出现URTI症状的6岁以下儿童进行横断面研究。使用多因素逻辑回归分析与抗生素处方及首选抗生素依从性相关的因素。结果 在研究期间，我们样本中有1007名6岁以下患者出现了URTI症状。引入免费全科医疗服务后，患者接受抗生素处方的可能性降低了50%。总体而言，日间服务中的抗生素处方率从70%降至50%，非工作时间服务中的抗生素处方率从72%降至60%。在非工作时间就诊的患者更有可能接受抗生素治疗（比值比：1.42），而接受延迟抗生素治疗的可能性较小（比值比：0.53）。所有处方中有四分之一到三分之一是延迟抗生素处方。逐年趋势显示处方量下降了13%，首选抗生素的使用量增加了13%。结论 免费全科医疗服务的引入导致抗生素处方量显著减少，这可能是由于家长就医行为的改变或其他原因。抗生素处方在非工作时间服务中更为常见，且按照国际标准来看，其使用率仍然很高。本研究强调了围绕全科医生抗菌药物管理持续开展工作的重要性，尤其是在非工作时间服务中。
