Pharmacy Practice Department, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
Am J Infect Control. 2023 Mar;51(3):289-294. doi: 10.1016/j.ajic.2022.07.009. Epub 2022 Jul 20.
The 2019 WHO Access, Watch, Reserve (AWaRe) antibiotic classification framework aims to prevent irrational prescribing of antibiotics used to treat widespread infections. This study explored antibiotic prescribing pattern for appropriate indications by family physicians and general dentists in primary health care practices.
A retrospective review of patients' electronic medical records was conducted over 6 months, from May 1, 2020, to November 30, 2020. The data were collected from 24 general family medicine and dental practices within the North West Armed Forces in Tabuk city. Antibiotic prescribing for systemic use (J01) was assessed by the number of prescriptions and the number defined daily doses (DDDs) and then analyzed according to the AWaRe classification. The prescribing of antibiotics for appropriate indications was assessed through comparing the prescription pattern with the recently published and relevant clinical guidelines. Multivariate logistic regression analysis was used to predict the association between the prescribing of AWaRe category and some demographic and disease-related factors.
In total, 752 prescriptions of antibiotics were collected. Watch-group antibiotics such as second-generation cephalosporin and macrolides were more likely prescribed (51.1%) based on the number of prescriptions and (52.2%) based on DDDs compared with Access-group antibiotics (48.9%) and (47.8%), respectively. The percentages of Watch group antibiotics for children and adults were 66.7% and 42.9%, respectively. Adherence to prescribing guidelines was poor for children (27.2%) and adults (64%). Being a child (adjusted odds ratio [OR]: 2.89; 95% confidence interval [CI] = 1.46-5.78), diagnosis with acute respiratory tract infection (adjusted OR, 2.62; 95% CI = 1.03-6.69), and urinary tract infection (adjusted OR, 4.69; 95% CI = 2.09-10.56) were associated with higher prescriptions of Watch-group antibiotics.
a higher prescribing of Watch-group antibiotics and poor adherence to antibiotic guidelines were observed, especially for children. The findings of this study identified targets for further improvement and interventions needed to develop better antibiotic-prescribing practices.
2019 年世卫组织准入、观察、保留（AWaRe）抗生素分类框架旨在防止不合理使用抗生素来治疗广泛感染。本研究探讨了初级保健实践中家庭医生和普通牙医对适当适应证的抗生素处方模式。
对 2020 年 5 月 1 日至 11 月 30 日期间 6 个月内的 24 家全科家庭医学和牙科诊所的患者电子病历进行回顾性审查。使用抗生素的处方数量和定义日剂量（DDD）评估系统使用（J01）的抗生素处方，并根据 AWaRe 分类进行分析。通过比较处方模式与最近发表的相关临床指南，评估抗生素的适应证。采用多变量逻辑回归分析预测 AWaRe 类别与一些人口统计学和疾病相关因素之间的关联。
共收集 752 份抗生素处方。与 Access 类抗生素（分别为 48.9%和 47.8%）相比，处方数量（51.1%）和 DDD（52.2%）更有可能开 Watch 类抗生素，如第二代头孢菌素和大环内酯类抗生素。儿童和成人的 Watch 类抗生素比例分别为 66.7%和 42.9%。儿童（调整后优势比 [OR]：2.89；95%置信区间 [CI] 1.46-5.78）和成人（调整后 OR：64%）的抗生素处方指南遵循率较低。诊断为急性呼吸道感染（调整后 OR，2.62；95%CI 1.03-6.69）和尿路感染（调整后 OR，4.69；95%CI 2.09-10.56）的儿童更容易开 Watch 类抗生素。
观察到 Watch 类抗生素的处方率较高，抗生素指南的遵循率较差，尤其是儿童。本研究的结果确定了进一步改进和干预的目标，以制定更好的抗生素处方实践。
