Weragama Keshani, Mudgil Poonam, Whitehall John
Department of Paediatrics, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
Children (Basel). 2022 Aug 13;9(8):1226. doi: 10.3390/children9081226.
Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis to further reduce rates of antibiotic prescription.
抗生素耐药性是一个日益严重的公共卫生危机，其原因包括不适当的抗生素处方，特别是抗生素的过度处方、抗生素治疗时间延长以及广谱抗生素的过度使用。尤其是儿科人群，那些因呼吸道症状前往急诊室就诊的儿童，抗生素处方率一直很高。进一步的研究表明，通过更有针对性的诊断方法来确定潜在病因，许多此类抗生素处方是可以避免的。本系统评价的目的是评估急诊环境下针对儿科呼吸道疾病的快速诊断检测对抗生素处方率的影响。为了回顾相关历史，我们对医学索引数据库（Medline）、荷兰医学文摘数据库（EMBASE）和考克兰系统评价数据库进行了全面检索。该评价纳入了18项研究，这些研究评估了各种快速诊断检测工具和结果指标。总体而言，快速诊断检测被发现是一种有效的诊断性抗生素管理方法，在改善抗生素处方行为方面具有很大潜力。需要进一步的研究来评估快速诊断检测与其他抗生素管理方法（包括临床决策辅助工具）的联合使用，并提高诊断后干预措施的特异性，以进一步降低抗生素处方率。
