Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
Clin Infect Dis. 2023 Feb 8;76(3):e1054-e1061. doi: 10.1093/cid/ciac500.
There is a need to evaluate antibiotic use, duration of therapy, and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use.
We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy, and appropriateness of antibiotic prescriptions by 5 main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions, and neighbors or family members).
Ninety percent of children received an antibiotic during follow-up, and on average, by the end of follow-up a child had spent 4.3% of their first 5 years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%), and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery, and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics.
Stewardship programs should target medical personnel for a primary care stewardship program even in a context in which antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.
需要评估中低收入国家的抗生素使用、治疗持续时间和管理情况，以指导制定具有全球范围且能有效减少不必要抗生素使用的适当管理计划。
我们前瞻性地从 303 名儿童队列中收集疾病发生和抗生素使用信息。我们评估了 5 位主要抗生素处方医生（医生和护士、药剂师、护理助理、自我处方和邻居或家庭成员）的抗生素使用发生率、治疗持续时间和适当性。
90%的儿童在随访期间接受了抗生素治疗，平均而言，到随访结束时，儿童在其生命的前 5 年中，有 4.3%的时间使用了抗生素。最常见的处方医生是医生/护士（79.4%），其次是药剂师（8.1%）、自我处方（6.8%）、护理助理（3.7%）和家人或邻居（1.9%）。在开具的 3702 个抗生素疗程中，30.9%是因为发热，25.3%是因为腹泻，2.8%是因为急性下呼吸道疾病，2.7%是因为痢疾，38.2%是因为不明疾病。对于开始治疗的主要疾病，疗程超过推荐时长的情况很常见，有 27.3%的疗程超过推荐时长，这代表本队列抗生素使用天数减少了 13.2%。
即使在抗生素可由公众自由获得且几乎没有限制的情况下，管理计划也应针对初级保健医务人员，并且在培训中应强调适当的治疗时长。
