Vellinga Akke, Luke-Currier Addiena, Garzón-Orjuela Nathaly, Aabenhus Rune, Anastasaki Marilena, Balan Anca, Böhmer Femke, Lang Valerija Bralić, Chlabicz Slawomir, Coenen Samuel, García-Sangenís Ana, Kowalczyk Anna, Malania Lile, Tomacinschii Angela, van der Linde Sanne R, Bongard Emily, Butler Christopher C, Goossens Herman, van der Velden Alike W
School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland.
Research Unit for General Practice, Department of Public Health, University of Copenhagen, DK-2200 Copenhagen, Denmark.
Antibiotics (Basel). 2023 Mar 14;12(3):572. doi: 10.3390/antibiotics12030572.
Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.
高达80%的抗生素是在社区中开具的。按适应症进行处方评估将有助于确定可改进的领域。2020年1月至2月在13个欧洲国家的全科医疗中对连续呼吸道感染（RTI）会诊进行了时点患病率审计研究（PPAS-1），并于2022年再次进行（PPAS-4）。计算了欧洲抗生素消费监测质量指标（ESAC-QI）以确定可改进之处。PPAS-1共记录了3618次会诊，PPAS-4记录了2655次会诊。PPAS-1中26%、PPAS-4中12%的会诊怀疑有细菌病因，PPAS-1中30%、PPAS-4中16%的会诊开具了抗生素。根据ESAC-QI，患有支气管炎的成年患者接受抗生素治疗的比例不应超过30%，除丹麦和西班牙外，任何国家的参与医疗机构均未达到这一标准。对于急性上呼吸道感染患者（≥1岁），开具抗生素的比例应低于20%，大多数国家的全科医疗达到了这一标准，但爱尔兰（两次PPAS）、克罗地亚（PPAS-1）和希腊（PPAS-4）除外，这些国家急性或慢性鼻窦炎的抗生素处方率（0-20%）也超标。对于成人肺炎，90-100%的处方率是可接受的，而大多数国家的这一比例较低。所有国家扁桃体炎（≥1岁）的抗生素处方率均超过了ESAC-QI（0-20%），PPAS-1中为69%，PPAS-4中为75%。总之，将ESAC-QI应用于PPAS结果使我们能够按适应症评估抗生素的合理处方情况，并对全科医疗和国家进行基准比较。
