Population Health Sciences, University of Bristol, Bristol, UK
Population Health Sciences, University of Bristol, Bristol, UK.
BMJ Open. 2022 Mar 25;12(3):e056348. doi: 10.1136/bmjopen-2021-056348.
The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China.
Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only).
Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies.
Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
抗生素的不恰当使用是导致抗菌药物耐药性的一个关键因素。在中国，抗生素的处方和使用量超过了建议水平，且在国际上相对较高。了解影响抗生素使用的因素对于提供有效的循证干预措施至关重要。我们进行了一项范围综述，以了解关于中国抗生素使用的关键行为、文化、经济和社会影响的实证研究。
2003 年至 2018 年初期间，在 Econlit、Medline、PsycINFO、社会科学引文索引和 Cochrane 系统评价数据库中进行了搜索。所有研究类型都符合条件，包括观察性和干预性研究、基于社区和临床环境的定性和定量设计。两位作者独立筛选纳入的研究。制定了一个数据提取表格，其中包含研究设计、与抗生素使用相关的行为、行为影响以及干预研究的效果信息。
干预研究自 2014 年以来显著增加，主要集中在国家政策和实践指令对中国二级和三级医疗保健环境中抗生素使用的影响上。大多数研究采用实用设计，例如前后比较。影响抗生素使用的因素可归纳为四个主题：抗生素处方；对抗生素的依从性；自我用药行为和非处方销售抗生素。许多研究强调了在没有处方的情况下使用抗生素治疗常见感染的情况，这得益于剩余药物的可用性和从当地药店采购。
旨在改变抗生素处方行为的干预措施显示出积极影响的证据，但需要使用更稳健的研究设计（如随机试验）并纳入过程评估的进一步研究，以更好地评估结果。需要评估国家政策在初级保健层面的效果，并进一步探索抗生素自我用药的影响因素，以制定解决这一行为的干预措施。
