Global Health-Health Systems and Policy: Medicines, Focusing Antibiotics, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
Int J Environ Res Public Health. 2018 Dec 23;16(1):27. doi: 10.3390/ijerph16010027.
The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient⁻doctor interaction as major factors among healthcare providers. We further discuss initiatives that, if taken and implemented, can have an impact on and improve the current situation in Europe.
抗生素的不必要使用以及抗生素耐药性（ABR）的迅速增长，是对全球健康、发展和可持续性的广泛公认的威胁。虽然 ABR 的根本原因无疑是抗生素总体使用量，但受多种相互关联因素影响的不合理使用抗生素是一个主要促成因素。在这里，我们旨在介绍和描述欧洲不合理使用抗生素的一些主要驱动因素。我们在 PubMed、Google Scholar、Cochrane 等数据库以及各种机构网站（世界卫生组织、欧洲观察站、欧盟委员会）中广泛搜索了当前的文献，以提供对欧洲不合理使用抗生素的一些选定驱动因素的新视角。我们还使用滚雪球法（即使用论文的参考文献来确定其他论文）搜索相关文献。在这篇叙述性综述中，我们提出，推动抗生素耐药性的公众主要因素是缺乏公众知识和意识、无需处方和剩余抗生素即可获得抗生素，以及开处方者和配药者的知识、态度和看法、医疗培训不足、药品促销、缺乏快速和充分的诊断测试以及医患互动。我们进一步讨论了如果采取和实施这些措施，将对欧洲目前的情况产生影响并加以改善。
