Université de Paris, Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004 Paris, France.
IQVIA, La Défense, France.
J Antimicrob Chemother. 2020 Aug 1;75(8):2344-2352. doi: 10.1093/jac/dkaa162.
To assess recent community antibiotic prescribing for French children and identify areas of potential improvement.
We analysed 221 768 paediatric (<15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA's EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing.
GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9-26.3) versus 21.6 (95% CI 21.0-22.2) per 100 visits, respectively; P < 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3-50.3) versus 35.6% (95% CI 34.1-37.1), P < 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years.
Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.
评估法国儿童近期社区抗生素处方情况，并确定潜在的改进领域。
我们分析了 2015 年 3 月至 2017 年 2 月期间，在全国范围内抽取的 680 名法国全科医生和 70 名社区儿科医生（IQVIA 的 EPPM 数据库）的 221768 例儿科（<15 岁）就诊病例，除外健康儿童就诊。我们分别计算了全科医生和儿科医生每 100 次就诊的抗生素处方率。对于呼吸道感染（RTI），我们描述了广谱抗生素的使用情况和治疗持续时间。我们使用泊松回归分析确定与抗生素处方相关的因素。
全科医生开具的抗生素多于儿科医生[处方率分别为 26.1（95%CI 25.9-26.3）和 21.6（95%CI 21.0-22.2）/100 次就诊；P<0.0001]。RTI 占抗生素处方的 80%以上，全科医生和儿科医生开具的抗生素中，分别有 40.8%和 23.6%是用于治疗疑似病毒性 RTI。对于 RTI，每 100 次就诊的抗生素处方率为：中耳炎，68.1 和 79.8；咽炎，67.3 和 53.3；鼻窦炎，67.9 和 77.3；肺炎，80.0 和 99.2；支气管炎，65.2 和 47.3；普通感冒，21.7 和 11.6；细支气管炎 31.6 和 20.1；以及其他疑似病毒性 RTI，分别为 24.1 和 11.0，用于全科医生和儿科医生。对于 RTI，全科医生开具的广谱抗生素比例更高[49.8%（95%CI 49.3-50.3）与 35.6%（95%CI 34.1-37.1）；P<0.0001]，且抗生素疗程相似（P=0.21）。调整诊断后，抗生素处方率与季节和患者年龄无关，但 50 岁及以上的全科医生明显更高。
未来的抗生素管理活动应针对疑似病毒性 RTI、广谱抗生素的使用和 50 岁及以上的全科医生。
