每月补充维生素 D 对老年人抗生素处方的影响：一项随机对照试验的事后分析。

Effect of monthly vitamin D supplementation on antibiotic prescribing in older adults: a post hoc analysis of a randomized controlled trial.

机构信息

School of Population Health, University of Auckland, Auckland, New Zealand.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Am J Clin Nutr. 2021 Jul 1;114(1):314-321. doi: 10.1093/ajcn/nqab015.

DOI:10.1093/ajcn/nqab015

PMID:33742207

Abstract

BACKGROUND

Observational studies have reported that low vitamin D status is associated with increased risk of antibiotic use. However, trials on the effect of vitamin D supplementation on antibiotics are limited and inconclusive.

OBJECTIVES

The main objective of this study was to determine the effect of monthly vitamin D supplementation on the proportion of adults with ≥1 prescriptions of antibiotics. The secondary outcomes were to determine the effect of monthly vitamin D supplementation on the number of antibiotic prescriptions and the number of days on antibiotics.

METHODS

This was a post hoc analysis of a randomized, double-blinded, placebo-controlled trial with community-based older adults who were randomly assigned to receive monthly 100,000 IU of vitamin D or identical placebo. All analyses were based on the principle of "intention to treat." RR from log-binomial models and the incidence rate ratio (IRR) from negative binomial models were estimated for primary and secondary outcomes after adjusting for age, sex, and ethnicity.

RESULTS

A total of 5108 participants aged 50-84 y were randomly assigned to vitamin D supplementation (n = 2558) or placebo (n = 2550) groups. During a median follow-up of 3.3 y, 4211 (82%) participants were prescribed antibiotics. There was no difference in the proportion of participants prescribed antibiotics between vitamin D (82%) and placebo (83%) groups (adjusted RR: 0.99; 95% CI: 0.97, 1.01; P = 0.42). Similarly, the number of antibiotic prescriptions per person-year did not differ between the 2 treatment groups (adjusted IRR: 0.98; 95% CI: 0.93, 1.04; P = 0.58). However, the number of days on antibiotics per person-year was significantly lower in the vitamin D group (mean ± SEM: 15 ± 0.7) compared with the placebo group (mean ± SEM: 17 ± 0.8) (adjusted IRR: 0.90; 95% CI: 0.82, 0.98; P = 0.01), especially for the tetracyclines (IRR: 0.65; 95% CI: 0.50, 0.85; P = 0.002).

CONCLUSIONS

Long-term, monthly, high-dose vitamin D3 supplementation did not prevent antibiotic prescribing in older adults, but the vitamin D group had fewer days per person-year on antibiotics. Further research is required to replicate these findings. This trial was registered at www.anzctr.org.au as ACTRN12611000402943.

摘要

背景

观察性研究报告称，维生素 D 状态较低与抗生素使用风险增加有关。然而，关于维生素 D 补充剂对抗生素影响的试验有限且结果不一致。

目的

本研究的主要目的是确定每月补充维生素 D 对成年人开具至少 1 份抗生素处方比例的影响。次要结局为确定每月补充维生素 D 对抗生素处方数量和抗生素使用天数的影响。

方法

这是一项基于社区的老年人群的随机、双盲、安慰剂对照试验的事后分析，参与者被随机分配接受每月 10 万国际单位的维生素 D 或相同的安慰剂。所有分析均基于“意向治疗”原则。在调整年龄、性别和种族后，使用对数二项式模型和负二项式模型估计主要和次要结局的相对风险（RR）和发病率比（IRR）。

结果

共有 5108 名 50-84 岁的参与者被随机分配至维生素 D 补充剂（n=2558）或安慰剂（n=2550）组。中位随访 3.3 年后，4211 名（82%）参与者开具了抗生素。维生素 D 组（82%）和安慰剂组（83%）开具抗生素的参与者比例无差异（调整 RR：0.99；95%CI：0.97，1.01；P=0.42）。同样，两组每人均年抗生素处方数量也无差异（调整 IRR：0.98；95%CI：0.93，1.04；P=0.58）。然而，维生素 D 组的人均抗生素使用天数明显低于安慰剂组（平均±SEM：15±0.7 天 vs 17±0.8 天）（调整 IRR：0.90；95%CI：0.82，0.98；P=0.01），尤其是四环素类（IRR：0.65；95%CI：0.50，0.85；P=0.002）。