Division of Infection Control, Chiba University Hospital, 1-8-1 Inohana Chuo-Ku, Chiba, 260-8677, Japan.
Division of Pharmacy, Chiba University Hospital, 1-8-1 Inohana Chuo-Ku, Chiba, 260-8677, Japan.
J Infect Chemother. 2021 Mar;27(3):461-465. doi: 10.1016/j.jiac.2020.10.022. Epub 2020 Nov 9.
Community-acquired pneumonia (CAP) is one of the most common causes of pediatric infection requiring hospitalization. Antimicrobial resistance due to the inappropriate use poses a threat worldwide. Our objective is to analyze and optimize the trends of antibiotics used for pediatric inpatients with CAP in a claims database provided by the Ministry of Health, Labour and Welfare.
Our database randomly sampled 10% of the hospitalized patients every October from 2011 to 2014. Patients aged <15 years in whom antibiotic therapy was initiated within two days of admission were listed. Subsequently, we investigated the antibiotics administered on the first day of prescription.
A total of 4,831 antibiotics were prescribed for 3,909 patients. Many patients aged ≤ five years were treated with β-lactams alone whereas many patients aged ≥ six years were treated with a single antibiotic, such as a macrolide, tetracycline, and quinolone, which covers atypical bacteria. Combination therapy was primarily used in children aged ≥ six years (nearly 30%); the main combination was a β-lactam and non-β-lactam covering atypical bacteria. Ampicillin-sulbactam was the most frequently prescribed β-lactam in children of all ages other than infants. Ampicillin, however, was most often prescribed in infants, but its usage rate was low at other ages.
Antibiotics were appropriately prescribed and were similar to that recommended in the 2011 guidelines for pediatric inpatients with CAP. However, combination therapy was frequently prescribed in children aged ≥ six years. According to the revised guidelines in 2017, ampicillin should be used more frequently for patients hospitalized with CAP.
社区获得性肺炎（CAP）是儿童感染中最常见的需要住院治疗的原因之一。由于使用不当导致的抗生素耐药性在全球范围内构成威胁。我们的目的是分析和优化 2011 年至 2014 年期间卫生部、劳动和福利提供的索赔数据库中儿科住院患者使用抗生素的趋势。
我们的数据库每年 10 月随机抽取 10%的住院患者。列出入院后两天内开始接受抗生素治疗的年龄<15 岁的患者。随后，我们调查了处方第一天使用的抗生素。
共为 3909 名患者开具了 4831 种抗生素。许多年龄≤五岁的患者单独使用β-内酰胺类药物治疗，而许多年龄≥六岁的患者则使用单一抗生素治疗，如大环内酯类、四环素类和喹诺酮类药物，这些药物可以覆盖非典型细菌。联合治疗主要用于年龄≥六岁的儿童（近 30%）；主要的联合用药是β-内酰胺类和非β-内酰胺类药物，可覆盖非典型细菌。除婴儿外，氨苄西林-舒巴坦是所有年龄段儿童最常开的β-内酰胺类药物。然而，氨苄西林在婴儿中最常被开，但在其他年龄段的使用率较低。
抗生素的使用是适当的，与 2011 年儿科 CAP 住院患者指南推荐的相似。然而，联合治疗在年龄≥六岁的儿童中经常使用。根据 2017 年修订的指南，对于住院治疗 CAP 的患者，应更频繁地使用氨苄西林。
