Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
J Antimicrob Chemother. 2020 Aug 1;75(8):2044-2058. doi: 10.1093/jac/dkaa124.
To summarize studies on prescribing medicine to general outpatients through the WHO/International Network for Rational Use of Drugs (INRUD) prescribing indicators with a focus on antibiotic prescription.
A systematic review and random-effects meta-analysis of studies on the WHO prescribing indicators with a focus on the percentage of encounters with antibiotics prescribed (PEAP) was performed. The databases PubMed, Web of Science, EMBASE and Global Index Medicus were searched.
Twenty-six studies with a total of over 34 000 prescription encounters were included in the systematic review, showing a mean of two medicines per encounter. In each meta-analysis, a range of 19 to 25 studies was included. The percentages of medicines prescribed with an international non-proprietary name (INN) and from the essential medicines list (EML) were 91% and 96% of the total number of medicines, respectively, while 19% of encounters contained injections. Studies with over 25 000 prescription encounters reported an average PEAP of 58% and PEAP showed an increasing trend over the years included in this review. Multivariable meta-regression showed that PEAP increased with the average number of medicines per encounter (estimate = 0.83, P value = 0.0005). The number of medicines, study design and year of prescription explained over 40% of the variation in PEAP across studies.
Patterns of medicine use within and close to the WHO reference values were reported for the number of medicines, INN prescribing, prescription of injections and compliance with the EML, on average. Prescription of antibiotics requires attention as amounts much higher than the reference values were prescribed, which were even higher with polypharmacy and increasing over the years included in this review.
通过世界卫生组织/国际合理用药网络（INRUD）的处方指标总结关于一般门诊患者处方用药的研究，重点关注抗生素处方。
对 WHO 处方指标的系统评价和随机效应荟萃分析，重点关注抗生素处方的处方比例（PEAP）。检索了 PubMed、Web of Science、EMBASE 和 Global Index Medicus 数据库。
系统评价共纳入了 26 项研究，总计超过 34000 次处方，平均每次就诊开具 2 种药物。在每次荟萃分析中，纳入了 19 至 25 项研究。以国际非专利名称（INN）和基本药物清单（EML）开具的药物比例分别为所用药物总数的 91%和 96%，而 19%的就诊包含注射剂。超过 25000 次就诊的研究报告的平均 PEAP 为 58%，且 PEAP 呈逐年上升趋势。多变量荟萃回归显示，PEAP 随每次就诊开具的药物数量增加而增加（估计值=0.83，P 值=0.0005）。药物数量、研究设计和处方年份解释了研究间 PEAP 变异的 40%以上。
报告了药物数量、INN 处方、注射处方和 EML 遵循情况的用药模式，接近 WHO 参考值。抗生素处方需要引起关注，因为开出的数量远远高于参考值，而且随着多种药物联合应用和研究期间的增加而增加。
