Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China.
Int J Antimicrob Agents. 2024 Feb;63(2):107073. doi: 10.1016/j.ijantimicag.2023.107073. Epub 2023 Dec 22.
This quasi-experimental study aimed to investigate the changes in antibiotic use tailored by adjusting provincial antibiotic restriction lists in China using interrupted time-series analysis from 2013 to 2019. Antibiotic use was assessed as defined daily dose (DDD) per 1000 patients per day. Trends and level changes were analysed with segmented regression. The study identified 19 antibiotic formulations in four provinces with adjusted restriction levels (intervention group) and 110 formulations in the rest provinces without adjustments (comparison group). Antibiotics restriction level changed between two categories: (1) between 'highly-restricted' and 'restricted' and (2) between 'restricted' and 'non-restricted'. Analysis revealed distinct trend changes for antibiotics moving between 'highly-restricted' and 'restricted' (β = 0.0211, P = 0.003) and 'restricted' to 'highly-restricted' (β = -0.0039, P = 0.128) compared to the comparison group. After a 2-y adjustment period, when moving from 'restricted' to 'highly-restricted', absolute antibiotic utilisation significantly decreased (P < 0.001), with a relative decrease of 100.8% (P < 0.001) compared to the comparison group. Besides, individual antibiotics with higher consumption displayed greater responsiveness to adjustment. These findings underscore the changes in restriction level adjustments on antibiotics, highlighting antibiotic restriction list policies as crucial tools for antimicrobial stewardship.
本准实验研究旨在使用 2013 年至 2019 年的中断时间序列分析，调查中国通过调整省级抗生素限制清单来调整抗生素使用的变化。抗生素使用评估为每 1000 名患者每天的定义日剂量（DDD）。采用分段回归分析趋势和水平变化。研究确定了四个调整限制水平的省份的 19 种抗生素制剂（干预组）和其余没有调整的 110 种抗生素制剂（对照组）。抗生素限制水平在两个类别之间发生变化：（1）“高度限制”和“限制”之间，（2）“限制”和“非限制”之间。分析显示，抗生素从“高度限制”到“限制”（β=0.0211，P=0.003）和“限制”到“高度限制”（β=-0.0039，P=0.128）的趋势变化明显与对照组相比。经过 2 年的调整期，当从“限制”变为“高度限制”时，抗生素的绝对使用量显著下降（P<0.001），与对照组相比，相对减少了 100.8%（P<0.001）。此外，消费较高的个别抗生素对调整的反应更大。这些发现强调了抗生素限制水平调整的变化，突出了抗生素限制清单政策作为抗菌药物管理的关键工具。
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