Weragama Keshani, Mudgil Poonam, Whitehall John
Department of Paediatrics, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
Antibiotics (Basel). 2021 Nov 8;10(11):1366. doi: 10.3390/antibiotics10111366.
Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.
由于微生物病原体随着时间推移对抗生素产生耐药性的倾向，抗菌药物耐药性问题由此出现。为应对这一日益严重的危机，已制定抗菌药物管理计划（ASPs），通过开展基于教育的研讨会、制定处方指南以及进行快速呼吸道病原体（RRP）检测等举措，限制不必要的抗生素处方。因呼吸道症状到急诊就诊的儿科患者是特别容易出现不恰当抗生素处方行为的高危人群，因此是针对性抗菌药物管理计划的理想队列。本系统评价的目的是评估抗菌药物管理计划在这一临床背景下的疗效和安全性。我们对PubMed、Medline、EMBASE和Cochrane系统评价数据库进行了系统检索，以回顾当前证据。该评价纳入了13项研究，这些研究评估了一系列管理干预措施和结局指标。总体而言，抗菌药物管理计划降低了抗生素处方率，增加了窄谱抗生素的处方量，并缩短了抗生素治疗疗程。发现基于教育的多模式干预措施以及使用RRP检测的干预措施最为有效。虽然我们发现有力证据表明抗菌药物管理计划在减少抗生素处方方面有效，但仍需进一步研究以评估其是否能转化为等效的临床结局。
