Song Qihua, Li Jinxi, Zhou Pengfei, Chen Rui, Liu Zhen, Li Hui, Yin Xiaoxv
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Shenzhen Guangming District People's Hospital, People's Republic of China, Shenzhen, Guangdong, China.
Am J Infect Control. 2025 Aug 16. doi: 10.1016/j.ajic.2025.08.009.
Antibiotic prescription is a major driver of antimicrobial resistance. However, evidence on antibiotic prescription practices is inadequate globally. This study aimed to assess antibiotic prescription practices and identify its associated factors in primary care worldwide.
PubMed, Embase, Web of science, and Global Index Medicus by WHO were searched from studies published between January 2000 and September 2023. Quantitative studies that investigated the antibiotic prescriptions practices were included in this study. Each study was assessed by at least 2 independent reviewers. Risk of bias was assessed using a modified Hoy tool. Quantitative studies were merged using Meta-analysis with random effects modeling. This study was registered with PROSPERO, CRD42022354143.
A total of 174 studies were included. The pooled prevalence of antibiotic prescribing was 42.1% (95%CI [39.2%, 45.1%]). Subgroup analysis indicated that antibiotic prescribing in primary care have not changed significantly over the past 20years. The prevalence of inappropriate antibiotics prescriptions was 57.6% (95%CI [43.4%, 71.2%]). Patients with higher education levels were less likely to receive antibiotic prescriptions.
We observed high prevalence of antibiotic prescribing in primary care, especially in low- and middle-income countries. The prevalence of antibiotic prescription has not declined significantly over the past 20years. Therefore, it is necessary to review current antimicrobial stewardship strategies.
抗生素处方是抗菌药物耐药性的主要驱动因素。然而，全球范围内关于抗生素处方实践的证据并不充分。本研究旨在评估全球初级保健中的抗生素处方实践，并确定其相关因素。
检索了2000年1月至2023年9月期间发表的研究，来源包括PubMed、Embase、科学网和世界卫生组织的全球医学索引。本研究纳入了调查抗生素处方实践的定量研究。每项研究至少由2名独立评审员进行评估。使用改良的霍伊工具评估偏倚风险。采用随机效应模型的Meta分析对定量研究进行合并。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42022354143。
共纳入174项研究。抗生素处方的合并患病率为42.1%（95%CI[39.2%，45.1%]）。亚组分析表明，在过去20年中，初级保健中的抗生素处方没有显著变化。不适当抗生素处方的患病率为57.6%（95%CI[43.4%，71.2%]）。受教育程度较高的患者接受抗生素处方的可能性较小。
我们观察到初级保健中抗生素处方的患病率很高，尤其是在低收入和中等收入国家。在过去20年中，抗生素处方的患病率没有显著下降。因此，有必要审查当前的抗菌药物管理策略。
