Lee Vivien Min Er, Low Si Hui, Koh Sky Wei Chee, Szuecs Anna, Loh Victor Weng Keong, Sundram Meena, Valderas José M, Hsu Li Yang
Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore.
Antibiotics (Basel). 2024 Jul 25;13(8):695. doi: 10.3390/antibiotics13080695.
Data on primary care antibiotic prescription practices for children in Singapore, which are essential for health care policy, are lacking. We aimed to address this gap and to benchmark prescription practices against international standards. A retrospective cohort database study on antibiotic prescriptions for children (aged < 18 years) who visited six public primary care clinics in Singapore between 2018 and 2021 was conducted. Data were categorised according to the World Health Organization's Access, Watch, Reserve (WHO AWaRe) classification. Quality indicators from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the National Institute for Health and Care Excellence (NICE) guidelines were used as a measure of appropriateness of antibiotic prescribing at the individual and overall patient level. In 831,669 polyclinic visits by children between 2018 and 2021, there was a significant reduction in mean antibiotics prescribed per month during pandemic years (2020-2021) compared to pre-pandemic (2018-2019) (MD 458.3, 95% CI 365.9-550.7). Most prescriptions (95.8%) for acute conditions fell within the WHO AWaRe "Access" group. Antibiotic prescription significantly exceeded (55.2%) the relevant quality indicator for otitis media (0-20%). The proportion of children receiving appropriate antibiotics for acute respiratory infections ( = 4506, 51.3%) and otitis media ( = 174, 49.4%) was low compared to the quality indicator (80-100%). There is a need to develop local evidence-based primary care antibiotic guidelines, as well as to support the development of stewardship programmes.
新加坡儿童初级保健抗生素处方实践的数据对于卫生保健政策至关重要，但目前缺乏此类数据。我们旨在填补这一空白，并将处方实践与国际标准进行对比。我们对2018年至2021年间在新加坡六家公立初级保健诊所就诊的18岁以下儿童的抗生素处方进行了一项回顾性队列数据库研究。数据根据世界卫生组织的“准入、观察、储备”（WHO AWaRe）分类进行分类。欧洲抗菌药物消费监测网络（ESAC-Net）和英国国家卫生与临床优化研究所（NICE）指南中的质量指标被用作衡量个体和总体患者层面抗生素处方适宜性的标准。在2018年至2021年间儿童的831,669次门诊就诊中，与疫情前（2018 - 2019年）相比，疫情期间（2020 - 2021年）每月开具的平均抗生素数量显著减少（MD 458.3，95% CI 365.9 - 550.7）。大多数急性病症的处方（95.8%）属于WHO AWaRe“准入”组。抗生素处方显著超过（55.2%）中耳炎的相关质量指标（0 - 20%）。与质量指标（80 - 100%）相比，急性呼吸道感染（n = 4506，51.3%）和中耳炎（n = 174，49.4%）患儿接受适宜抗生素治疗的比例较低。有必要制定基于本地证据的初级保健抗生素指南，并支持开展管理计划。
