Warembourg Marion, Lonca Nelly, Filleron Anne, Tran Tu Anh, Knight Michèle, Janes Alexia, Soulairol Ian, Leguelinel-Blache Géraldine
Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France.
Department of Pediatrics, Nimes University Hospital, University of Montpellier, Nimes, France.
Eur J Pediatr. 2020 Sep;179(9):1343-1351. doi: 10.1007/s00431-020-03605-8. Epub 2020 Mar 5.
The objective of this pilot study was to assess the overall adherence rate of the pediatric population to anti-infective drugs prescribed for acute infection at hospital discharge and to identify risk factors for non-adherence behavior. Pediatric patients discharged from a French university hospital with at least one oral drug prescription for acute infection were included for 3 months. Medication adherence and antibiotic knowledge were assessed through data collected by calling the parents. Overall adherence was assessed according to seven items: medication order filling, administered dose, time of intake, frequency of doses, medication omission, dose modification, and length of treatment. Seventy-five patients were included, and 63 interviews were exploited. The median age was 1.4 years, IQR = [0.7; 3.3]. Overall adherence to anti-infective agents concerned 34.9% of patients. The most frequently prescribed antibiotics were amoxicillin (29.3%), amoxicillin associated with clavulanic acid (25.3%), cotrimoxazole (18.7%), and cefixime (12.0%). A lack of parents' anti-infective knowledge was associated with non-adherence to anti-infective drugs.Conclusion: Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases. The misunderstanding of anti-infective treatment could be a risk factor for non-adherence. Implementation of preventive actions such as therapeutic education or pharmaceutical counseling at hospital discharge could improve adherence to anti-infective agents. What Is Known: • Non-adherence to anti-infective drugs involves the emergence and spread of antibiotic resistance. • Very few studies have assessed medication adherence in acute infectious diseases in pediatrics after hospital discharge. What Is New: • Only 35% of children were overall adherent to anti-infective drugs in acute infectious disease after hospital discharge. • Most patients (89%) had a good primary adherence but very few (40%) had good secondary adherence mainly due to dose omission and dose modification.
这项试点研究的目的是评估儿科人群在出院时对开具的用于急性感染的抗感染药物的总体依从率，并确定不依从行为的风险因素。纳入了从一家法国大学医院出院且至少有一张急性感染口服药物处方的儿科患者，为期3个月。通过致电家长收集的数据评估药物依从性和抗生素知识。根据七个项目评估总体依从性：医嘱执行情况、给药剂量、服药时间、给药频率、漏服药物、剂量调整和治疗时长。共纳入75例患者，进行了63次访谈。中位年龄为1.4岁，四分位间距IQR = [0.7; 3.3]。抗感染药物的总体依从率为34.9%。最常开具的抗生素是阿莫西林（29.3%）、阿莫西林与克拉维酸联用（25.3%）、复方磺胺甲恶唑（18.7%）和头孢克肟（12.0%）。家长缺乏抗感染知识与不依从抗感染药物有关。结论：三分之二的门诊患者在急性传染病中不依从抗感染药物治疗。对抗感染治疗的误解可能是不依从的一个风险因素。在出院时实施如治疗教育或药学咨询等预防措施可提高对抗感染药物的依从性。已知信息：• 不依从抗感染药物会导致抗生素耐药性的出现和传播。• 很少有研究评估儿科患者出院后在急性传染病中的药物依从性。新发现：• 出院后在急性传染病中只有35%的儿童总体依从抗感染药物治疗。• 大多数患者（89%）有良好的初始依从性，但很少有患者（40%）有良好的后续依从性，主要原因是漏服剂量和调整剂量。
