Central Australian Aboriginal Congress, 14 Leichhardt Terrace, Alice Springs, 0870, Northern Territory, Australia.
Centre for Remote Health, Flinders University, Corner Simpson & Skinner Streets, Alice Springs, 0870, Northern Territory, Australia.
Infect Dis Health. 2021 Aug;26(3):173-181. doi: 10.1016/j.idh.2021.02.001. Epub 2021 Mar 17.
Inappropriate antimicrobial prescribing contributes to the emergence of antimicrobial resistance. Gaps exist in the understanding of antimicrobial prescribing in the remote setting. We aimed to assess adherence to guidelines and appropriateness of antimicrobial prescribing in Central Australia.
A retrospective study assessing antimicrobial prescriptions in ten Aboriginal clinics (three in remote communities and seven in regional centre) using a validated evaluation tool. Antimicrobials prescribed between 1 January-31 December 2018 were randomly selected for inclusion into the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing.
A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines. Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory-tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively.
A quarter of antimicrobial prescriptions written in select remote central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.
不适当的抗菌药物处方会导致抗菌药物耐药性的出现。在偏远地区，人们对抗菌药物处方的理解存在差距。我们旨在评估中澳地区的抗菌药物处方是否符合指南并评估其适宜性。
本研究采用经过验证的评估工具，对十家土著诊所（三个位于偏远社区，七个位于区域中心）的抗菌药物处方进行回顾性研究。随机选择 2018 年 1 月 1 日至 12 月 31 日期间开具的抗菌药物处方纳入研究。主要结局指标为指南遵循率和不适当处方率。
共纳入 180 份处方（96.1%为土著人，32.2%为男性）。99 份（55.0%）处方由全科医生开具，57 份（31.7%）由护士开具，24 份（13.3%）由其他人员开具。43 份（25.7%）可评估处方被认为不适当，75 份（44.4%）未遵循指南。由全科医生开具的处方更不符合指南，尤其是位于偏远社区的全科医生。不适当处方的最常见原因是剂量/频率不正确和抗菌药物不适用。皮肤和软组织感染是最常见的适应证，41 份处方中有 29 份（70.7%）被认为是合适的。下呼吸道感染的处方适宜率最低，只有 7 份处方中的 1 份（14.3%）被认为是合适的。适宜率最低的抗菌药物分别为环丙沙星、阿莫西林克拉维酸和头孢氨苄，分别为 50%、56%和 62%。
在中澳地区的一些偏远地区的土著初级保健诊所中，开具的四分之一的抗菌药物处方被认为是不适当的。建议实施全面的抗菌药物管理计划。
