Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Epidemiology and Public Health University of Basel, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Epidemiology and Public Health University of Basel, Basel, Switzerland; Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
Lancet Infect Dis. 2020 Feb;20(2):179-187. doi: 10.1016/S1473-3099(19)30572-9. Epub 2019 Dec 13.
Antibiotic resistance is a major threat to global health. Although detailed information about antibiotic use in high-income countries is available, little is known regarding the use of antibiotics and cumulative exposure to antibiotics in low-income and middle-income countries (LMICs). We aimed to quantify antibiotic exposure in children younger than 5 years in LMICs.
We did a cross-sectional study in sick children younger than 5 years who attended a health-care facility in eight LMICs (Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda) between May, 2006, and December, 2016. Demographic and Health Surveys were used to estimate the cumulative number of illnesses related to a fever or cough and the cumulative number of visits to a health-care facility because of these illnesses for each country. We also used clinical observation data from nationally representative health-care facility-based Service Provision Assessment (SPA) surveys to estimate the proportion of children who were prescribed an antibiotic during a visit to a health-care facility and the number of antibiotic prescriptions issued that were unrelated to fever or respiratory problems. By combining these estimates, and using bootstrap analysis to compute uncertainty intervals, we estimated cumulative antibiotic exposure in children from birth up to age 5 years in each LMIC.
From SPA surveys, we identified 22 519 clinical observations of children younger than 5 years who visited a health-care facility because of an illness between July, 2007, and December, 2016. From DHS surveys, we identified 68 826 children younger than 5 years who visited a health-care facility between May, 2006, and November, 2016. 85·4% of health-care facility visits were related to either a fever or cough. Antibiotics were prescribed to 80·5% of children diagnosed with respiratory illness, 50·1% with diarrhoea, and 28·3% with malaria. The mean number of antibiotic prescriptions issued to children between birth and age 5 years across the eight LMICs was 24·5 (95% CI 22·6-26·7), ranging from 7·1 (6·3-7·9) in Senegal to 59·1 (54·1-64·6) in Uganda.
Between birth and age 5 years, children in LMICs are prescribed a remarkably high number of antibiotics. A large proportion of these prescriptions appear to be unnecessary. National and local efforts to reduce unnecessary prescription of antibiotics to children would likely improve both patient wellbeing (in terms of preventing side-effects) and reduce the global threat of antimicrobial resistance.
None.
抗生素耐药性是对全球健康的主要威胁。尽管有关高收入国家抗生素使用的详细信息已有，但对于低收入和中等收入国家（LMICs）的抗生素使用和累积抗生素暴露情况却知之甚少。我们旨在量化 5 岁以下儿童的抗生素暴露情况。
我们在 2006 年 5 月至 2016 年 12 月期间，在 8 个 LMIC 中患有疾病的 5 岁以下儿童中进行了一项横断面研究（海地，肯尼亚，马拉维，纳米比亚，尼泊尔，塞内加尔，坦桑尼亚和乌干达）。使用人口与健康调查来估计每个国家与发烧或咳嗽有关的累积疾病次数以及因这些疾病而就诊的累积次数。我们还使用全国代表性的基于卫生保健设施的服务提供评估（SPA）调查的临床观察数据来估计在就诊期间因发烧或呼吸道问题而开处方的儿童比例以及开具的与发烧或呼吸道问题无关的抗生素处方数量。通过结合这些估计值，并使用自举分析来计算不确定区间，我们估计了每个 LMIC 中从出生到 5 岁儿童的累积抗生素暴露情况。
从 SPA 调查中，我们确定了 2007 年 7 月至 2016 年 12 月期间因疾病就诊的 5 岁以下儿童的 22519 项临床观察结果。从 DHS 调查中，我们确定了 2006 年 5 月至 2016 年 11 月期间就诊的 68826 名 5 岁以下儿童。85.4％的就诊与发烧或咳嗽有关。抗生素被开给 80.5％被诊断患有呼吸道疾病的儿童，50.1％患有腹泻的儿童和 28.3％患有疟疾的儿童。八个 LMIC 中，出生至 5 岁儿童开具的抗生素处方平均数量为 24.5（95％CI 22.6-26.7），从塞内加尔的 7.1（6.3-7.9）到乌干达的 59.1（54.1-64.6）。
在出生到 5 岁之间，LMIC 国家的儿童开了大量的抗生素。其中很大一部分似乎是不必要的。减少对儿童不必要的抗生素处方的国家和地方努力，可能会改善患者的健康状况（从预防副作用的角度），并减少全球对抗微生物药物耐药性的威胁。
无。
