Bindel Lilly Josephine, Seifert Roland
Institute of Pharmacology, Hannover Medical School, 30625, Hannover, Germany.
Naunyn Schmiedebergs Arch Pharmacol. 2025 Aug 13. doi: 10.1007/s00210-025-04511-2.
Antibacterial drugs are used in the treatment of bacterial infections. Increasing bacterial resistance rates are threatening their efficacy and place a huge burden on public health. There is a strong link between consumption and irrational prescribing behaviour versus the development of bacterial resistance. This review summarises important aspects of European prescribing behaviour for antibacterial drugs in primary care. Attributes of rational and irrational prescribing behaviour are explained. The most important determinants are investigated and discussed. An update on the use of appropriate nomenclature is also provided. Based on the findings, proposals for action are presented. Unlike other studies that focus on single determinants or prescribing behaviour on an individual level, this review considers prescribing behaviour at a systemic level. A PubMed search was conducted for search terms of prescribing behaviour. Inclusion criteria were literature published in the last five years (starting from 2020), antibacterial drugs, prescribing behaviour and related factors, Europe or European countries, and primary care. Studies solely referring to the hospital sector were excluded. This is followed by an update to the nomenclature investigation, referring to a previous analysis by Seifert and Schirmer (Naunyn-Schmiedebergs Arch Pharmacol 394:2153-2166 (2021)). Prescribing behaviour is shaped by multiple interrelated systemic and individual-level factors. Systemic factors relate to the structure of the healthcare system, whereas individual determinants refer to the single treatment decisions. In Europe, there is a strong North-South shift, with more rational prescribing in the North and problematic behaviour in the South. No significant improvements in decreasing use or appropriate drug choice have been observed in recent years, and the impact of the pandemic on prescribing practices is negative. The use of appropriate nomenclature in the literature did not improve, with a dominance of problematic terms. Policy measures are considered the most effective way of changing prescribing behaviour. Systemic changes are required before individual prescribing behaviour can improve. Conducted interventions had a positive effect in most cases but varied in their effect. Initial actions include restricting the use of antibacterial drugs to specific indications, making financial changes to encourage the use of first-line drugs, and improving infrastructure to enable targeted treatment through diagnostics. However, regulatory restrictions must be accompanied by guidance and stewardship programmes to improve adherence. In general, reforming the nomenclature in the literature is necessary to improve communication and prevent misunderstandings. Rational prescribing behaviour is a requirement for achieving a decrease in bacterial resistance.
抗菌药物用于治疗细菌感染。不断上升的细菌耐药率正威胁着它们的疗效，并给公共卫生带来巨大负担。抗菌药物的使用与不合理处方行为和细菌耐药性的发展之间存在着紧密联系。本综述总结了欧洲初级保健中抗菌药物处方行为的重要方面。解释了合理与不合理处方行为的特征。对最重要的决定因素进行了调查和讨论。还提供了关于使用适当术语的最新情况。基于这些发现，提出了行动建议。与其他关注单一决定因素或个体层面处方行为的研究不同，本综述从系统层面考虑处方行为。通过在PubMed上搜索处方行为的检索词。纳入标准为过去五年（从2020年开始）发表的文献、抗菌药物、处方行为及相关因素、欧洲或欧洲国家以及初级保健。仅涉及医院部门的研究被排除。随后是术语调查的更新，参考了Seifert和Schirmer之前的分析（《瑙恩-施米德贝格药理学文献》394:2153 - 2166 (2021)）。处方行为受到多个相互关联的系统和个体层面因素的影响。系统因素与医疗保健系统的结构有关，而个体决定因素则指单个治疗决策。在欧洲，存在明显的南北差异，北方的处方行为更合理，而南方则存在问题行为。近年来，在减少使用或选择合适药物方面未观察到显著改善，并且疫情对处方实践产生了负面影响。文献中适当术语的使用并未得到改善，存在问题的术语占主导地位。政策措施被认为是改变处方行为的最有效方式。在个体处方行为能够改善之前，需要进行系统变革。实施的干预措施在大多数情况下都产生了积极效果，但效果各不相同。初步行动包括将抗菌药物的使用限制在特定适应症，进行财务调整以鼓励使用一线药物，以及改善基础设施以通过诊断实现靶向治疗。然而，监管限制必须辅以指导和管理计划以提高依从性。一般来说，改革文献中的术语对于改善沟通和防止误解是必要的。合理的处方行为是实现细菌耐药性降低的必要条件。
