Jessica King (
Timothy Powell-Jackson, London School of Hygiene and Tropical Medicine.
Health Aff (Millwood). 2022 Jun;41(6):911-920. doi: 10.1377/hlthaff.2021.01782.
Antimicrobial resistance is one of the most serious threats to global health, but little progress has been made in reversing its spread. Inappropriate use of antibiotics in humans is a major driver of antimicrobial resistance, and rates are high and growing in lower- and middle-income countries. Antibiotics are thought to be subject to supplier-induced demand, whereby providers prescribe them to patients who do not know they are unnecessary. We conducted a randomized field experiment in 227 private health facilities in Tanzania, with standardized patients presenting uncomplicated upper respiratory tract infection symptoms. Standardized patients were randomly assigned to express knowledge (informed) or not (uninformed) that antibiotics were not required to treat them. There was a very high rate of inappropriate antibiotic prescription, with 86.0 percent of informed standardized patients and 94.8 percent of uninformed standardized patients prescribed an antibiotic, for an adjusted difference of 7.8 percentage points between the groups. This small effect suggests that broader health systems factors are at play and that interventions should be aimed at systems, health facilities, and providers.
抗菌药物耐药性是对全球健康的最严重威胁之一，但在扭转其蔓延方面进展甚微。人类对抗生素的不适当使用是抗菌药物耐药性的主要驱动因素，中低收入国家的使用率高且呈上升趋势。人们认为抗生素受到供应商诱导需求的影响，即提供者开处方给不知道自己不需要的患者。我们在坦桑尼亚的 227 家私营医疗机构进行了一项随机现场试验，使用有标准症状的模拟患者来模拟上呼吸道感染。标准化患者被随机分配表达（知情）或不表达（不知情）他们不需要抗生素来治疗的知识。抗生素的处方非常不适当，有 86.0%的知情模拟患者和 94.8%的不知情模拟患者开了抗生素处方，两组之间的调整差异为 7.8 个百分点。这一微小的效果表明，更广泛的卫生系统因素在起作用，干预措施应该针对系统、卫生机构和提供者。
