Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549.
London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
J Antimicrob Chemother. 2020 Jan 1;75(1):14-29. doi: 10.1093/jac/dkz348.
Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans.
We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations.
We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption.
National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.
全球对抗微生物药物耐药性（AMR）作为一个紧迫的公共卫生问题的认识，已激发了国家和国际层面的努力。其中最重要的是遏制抗生素过度和不当使用的干预措施。然而，这些举措的影响尚未完全了解，因此难以评估进一步政策干预的预期效果和可持续性。我们进行了一项系统评价，以总结现有的关于减少人类中不合理使用抗生素的国家强制执行干预措施的影响的证据。
我们在七个数据库中进行了检索，并查阅了检索到的文章的参考文献列表。为了被纳入，文章必须评估国家负责使用计划的影响。我们排除了仅描述政策实施的研究。
我们确定了 34 篇详细介绍了 21 个高收入和中上收入国家干预措施的文章。针对不合理抗生素获取的干预措施包括抗生素委员会、临床指南和处方限制。有一致的证据表明，这些措施在减少抗生素消耗和处方方面是有效的。针对不合理抗生素需求的干预措施包括针对医疗保健专业人员和公众的教育运动。这方面的证据参差不齐，有几项研究表明，这些干预措施对整体抗生素消耗没有影响。
减少不合理获取抗生素的国家层面干预措施可能是有效的。然而，证据仅限于高收入和中上收入国家，需要更多关于干预措施长期持续影响的证据。还应该同时推动标准化的结果衡量标准，以便比较不同环境中的干预措施。
