Pagano Federica, De Marco Giulio, Trojano Benedetta, Amato Chiara, Micillo Maria, Cecere Gaetano, Guarino Alfredo, Lo Vecchio Andrea
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
PhD National Program in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
Antibiotics (Basel). 2025 Mar 18;14(3):313. doi: 10.3390/antibiotics14030313.
A previous study settled in the Campania Region (Southern Italy) has proven the effectiveness of a multifaceted antimicrobial stewardship program in reducing prescription rates and use of broad-spectrum molecules in the Primary Care setting. Since autumn 2022, the amoxicillin shortage has been reported at a national level, and respiratory pathogens resurged in children after the easing of COVID-19 pandemic restrictions. We aimed to assess the impact of amoxicillin shortage on antimicrobial prescription patterns and quality indexes in the same setting as the past AMS campaign. We conducted a retrospective review of antibiotic prescriptions in a primary care pediatric practice, focusing on amoxicillin, amoxicillin-clavulanate, third-generation cephalosporins, macrolides, and quinolones. To assess drug accessibility, we monitored antibiotic availability in pharmacies within the same healthcare district. We then analyzed monthly prescription rates per 100 consultations in relation to drug availability patterns and calculated the amoxicillin/amoxicillin-clavulanate index and the Access/Watch index as quality indicators. From November 2022 to May 2023, 90% of the surveyed pharmacies reported an amoxicillin shortage lasting 5 to 7 months. Concomitantly, we observed a significant shift in the prescription pattern for amoxicillin-clavulanate (3.53 to 13.82; = 0.009) and third-generation cephalosporins (2.45 to 4.83; = 0.026), that resulted in a decline of the amoxicillin/amoxicillin-clavulanate index (1.38 to 0.56; = 0.009). The lack of amoxicillin could have led to increased prescriptions of second-line antibiotics in Italian regions, reverting the effect of successful stewardship measures.
之前一项在坎帕尼亚大区（意大利南部）开展的研究已证明，多方面抗菌药物管理计划在降低基层医疗环境中广谱分子的处方率和使用方面是有效的。自2022年秋季以来，全国范围内报告了阿莫西林短缺情况，并且在新冠疫情限制措施放宽后儿童呼吸道病原体再次出现。我们旨在评估在与过去抗菌药物管理活动相同的环境中，阿莫西林短缺对抗菌药物处方模式和质量指标的影响。我们对一家基层医疗儿科诊所的抗生素处方进行了回顾性审查，重点关注阿莫西林、阿莫西林 - 克拉维酸、第三代头孢菌素、大环内酯类和喹诺酮类药物。为了评估药物可及性，我们监测了同一医疗区内药店的抗生素供应情况。然后，我们分析了每100次会诊的月度处方率与药物供应模式的关系，并计算了阿莫西林/阿莫西林 - 克拉维酸指数和获取/关注指数作为质量指标。从2022年11月到2023年5月，90%的受调查药店报告阿莫西林短缺持续了5至7个月。与此同时，我们观察到阿莫西林 - 克拉维酸（从3.53到13.82； = 0.009）和第三代头孢菌素（从2.45到4.83； = 0.026）的处方模式发生了显著变化，这导致阿莫西林/阿莫西林 - 克拉维酸指数下降（从1.38到0.56； = 0.009）。阿莫西林的短缺可能导致意大利各地区二线抗生素处方增加，使成功的管理措施效果逆转。
