Department of Public Health Sciences, Global Health - Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden.
Department of Infection Prevention and Control, Mater Dei Hospital, Msida MSD, Malta.
J Antimicrob Chemother. 2019 Apr 1;74(4):1116-1124. doi: 10.1093/jac/dky544.
To determine the 1 year antibiotic prescribing patterns by GPs for acute respiratory tract complaints (aRTCs) in Malta.
In this repeated cross-sectional surveillance study, GPs collected data for patients seen for aRTCs during a designated 1 week period each month, between May 2015 and April 2016. GPs received three text reminders during surveillance weeks and were contacted by phone at most four times during the year. GPs also received 3 monthly individual- and aggregate-level feedback reports on their antibiotic prescribing patterns. Descriptive statistics were used to examine patient, consultation and clinical characteristics, and to describe GPs' prescribing patterns.
Participating GPs (n = 33) registered 4641 patients with an aRTC, of whom 2122 (45.7%) received an antibiotic prescription. The majority (99.6%) of antibiotics prescribed were broad-spectrum and the most commonly prescribed antibiotics were macrolides (35.5%), followed by penicillins with a β-lactamase inhibitor (33.2%) and second-generation cephalosporins (14.2%). Specifically, co-amoxiclav (33.2%), clarithromycin (19.6%), azithromycin (15.1%) and cefuroxime axetil (10.9%) represented 78.8% of all antibiotics prescribed. Patients with tonsillar exudate (99.1%), purulent sputum (84%), otorrhoea (78%), tender cervical nodes (74.4%) and fever (73.1%) received most antibiotics. The diagnoses that received the highest proportion of antibiotic treatment were tonsillitis (96.3%), otitis media (92.5%) and bronchitis (87.5%). Wide variation in the choice of antibiotic class by diagnosis was observed.
GP antibiotic prescribing in Malta is high. The abundant use of broad-spectrum antibiotics, particularly macrolides, is of particular concern and indicates that antibiotics are being used inappropriately. Efforts must be made to improve GP awareness of appropriate antibiotic prescribing.
确定马耳他全科医生（GP）治疗急性呼吸道疾病（aRTC）时开具抗生素的 1 年模式。
在这项重复的横断面监测研究中，GP 在 2015 年 5 月至 2016 年 4 月期间，每月选择 1 周专门收集因 aRTC 就诊的患者数据。在监测周内，GP 会收到 3 次文本提醒，且在这一年中最多会被电话联系 4 次。GP 还会收到 3 次关于他们抗生素处方模式的个人和总体的每月反馈报告。采用描述性统计来检查患者、咨询和临床特征，并描述 GP 的处方模式。
参与的 GP（n=33）登记了 4641 名患有急性呼吸道疾病的患者，其中 2122 名（45.7%）接受了抗生素处方。开出的抗生素绝大多数（99.6%）为广谱抗生素，最常开的抗生素为大环内酯类（35.5%），其次是含β-内酰胺酶抑制剂的青霉素（33.2%）和第二代头孢菌素（14.2%）。具体而言，复方阿莫西林（33.2%）、克拉霉素（19.6%）、阿奇霉素（15.1%）和头孢呋辛酯（10.9%）占所有抗生素处方的 78.8%。扁桃体有渗出物（99.1%）、脓性痰（84%）、耳漏（78%）、颈淋巴结触痛（74.4%）和发热（73.1%）的患者接受了大部分抗生素治疗。接受抗生素治疗比例最高的诊断为扁桃体炎（96.3%）、中耳炎（92.5%）和支气管炎（87.5%）。观察到按诊断选择抗生素种类的差异很大。
马耳他的 GP 抗生素处方使用率很高。大量使用广谱抗生素，特别是大环内酯类，特别令人担忧，表明抗生素使用不当。必须努力提高 GP 对适当使用抗生素的认识。
