Chowdhury Fahmida, Bhuiya Saju, Abdul Aleem Mohammad, Shuvo Tanzir Ahmed, Mamun Gazi Md Salahuddin, Kumar Ghosh Probir, Shahrin Lubaba, Khan Samin Yasar, Islam Md Ariful, Rahman Mahmudur
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh.
Centre for Higher Studies and Research (CHSR), Bangladesh University of Professionals (BUP), Dhaka 1216, Bangladesh.
Antibiotics (Basel). 2025 Feb 14;14(2):199. doi: 10.3390/antibiotics14020199.
To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO's AWaRe classification. We analyzed data from hospital-based influenza surveillance from January 2011 to December 2020 across nine Bangladeshi tertiary-level hospitals. Surveillance physicians collected WHO-defined SARI patient data, including demographics, clinical characteristics, and antibiotic prescriptions. Descriptive statistics and parametric and non-parametric tests were used for the analysis. Of 21,566 SARI patients [median age 20 years (IQR: 1.33-45), 66% male], 91% were prescribed at least one antibiotic. A total of 25,133 antibiotics were prescribed, of which 47.0% were third-generation cephalosporins, 16.5% were macrolides, and 11.1% were beta-lactam/beta-lactamase inhibitors. According to the AWaRe classification, 28.7% were in the Access group, while 71.3% were in the Watch group, and none were from the Reserve group. A downward trend in Access group (30.4% to 25.1%; = 0.010) and an upward trend in Watch group antibiotic prescription (69.6% to 74.9%; = 0.010) were observed. We identified that patients aged < 5 years (aOR: 1.80; 95% CI: 1.44-2.25), who were treated in government hospitals (aOR: 1.45; 95% CI: 1.35-1.57), patients with the presence of lung diseases (aOR: 1.56; 95% CI: 1.35-1.80) had an increased likelihood of being prescribed Watch group antibiotics. : This study reveals a concerning pattern of antibiotic overuse among SARI patients in Bangladesh, with a growing trend over the past decade towards increased Watch group antibiotic prescriptions. Only one-third of the prescribed antibiotics were from the Access group, falling short of the two-thirds threshold recommended by the WHO. Effective ASPs are crucial to optimize antibiotic prescriptions and mitigate the risk of antimicrobial resistance.
为协助制定抗菌药物管理计划（ASP），我们利用世界卫生组织（WHO）的AWaRe分类法，分析了重症急性呼吸道感染（SARI）患者抗生素处方的模式和趋势。我们分析了2011年1月至2020年12月期间孟加拉国九家三级医院基于医院的流感监测数据。监测医生收集了WHO定义的SARI患者数据，包括人口统计学、临床特征和抗生素处方。采用描述性统计以及参数和非参数检验进行分析。在21566例SARI患者中（中位年龄20岁，四分位间距：1.33 - 45岁，66%为男性），91%的患者至少开具了一种抗生素。共开具了25133种抗生素，其中47.0%为第三代头孢菌素，16.5%为大环内酯类，11.1%为β-内酰胺/β-内酰胺酶抑制剂。根据AWaRe分类，28.7%属于可及组，71.3%属于慎用组，无储备组药物。可及组出现下降趋势（从30.4%降至25.1%；P = 0.010），慎用组抗生素处方呈上升趋势（从69.6%升至74.9%；P = 0.010）。我们发现，年龄<5岁的患者（调整后比值比：1.80；95%置信区间：1.44 - 2.25）、在政府医院接受治疗的患者（调整后比值比：1.45；95%置信区间：1.35 - 1.57）、患有肺部疾病的患者（调整后比值比：1.56；95%置信区间：1.35 - 1.80）更有可能被开具慎用组抗生素。本研究揭示了孟加拉国SARI患者抗生素过度使用的令人担忧的模式，在过去十年中，慎用组抗生素处方呈上升趋势。所开具的抗生素中只有三分之一来自可及组，未达到WHO建议的三分之二阈值。有效的ASP对于优化抗生素处方和降低抗菌药物耐药风险至关重要。
