Arason V A, Kristinsson K G, Sigurdsson J A, Stefánsdóttir G, Mölstad S, Gudmundsson S
Department of Family Medicine, Sólvangur Health Centre, University of Iceland, Hafnarfjördur, Iceland.
BMJ. 1996 Aug 17;313(7054):387-91. doi: 10.1136/bmj.313.7054.387.
To study the correlation of antimicrobial consumption with the carriage rate of penicillin resistant and multiresistant pneumococci in children.
Cross sectional and analytical prevalence study.
Five different communities in Iceland.
Prevalence of nasopharyngeal carriage of penicillin resistant pneumococci in children aged under 7 years in relation to antibiotic use as determined by information from parents, patient's records, and total sales of antimicrobials from local pharmacies in four study areas.
Total antimicrobial sales for children (6223 prescriptions) among the four areas for which data were available ranged from 9.6 to 23.2 defined daily doses per 1000 children daily (1.1 to 2.6 courses yearly per child). Children under 2 consumed twice as much as 2-6 year olds (20.5 v 10.9 defined daily doses per 1000 children daily). Nasopharyngeal specimens were obtained from 919 children, representing 15-38% of the peer population groups in the different areas. Pneumococci were carried by 484 (52.7%) of the children, 47 (9.7%) of the isolates being resistant to penicillin or multiresistant. By multivariate analysis age (< 2 years), area (highest antimicrobial consumption), and individual use of antimicrobials significantly influenced the odds of carrying penicillin resistant pneumococci. By univariate analysis, recent antimicrobial use (two to seven weeks) and use of co-trimoxazole were also significantly associated with carriage of penicillin resistant pneumococci.
Antimicrobial use, with regard to both individual use and total antimicrobial consumption in the community, is strongly associated with nasopharyngeal carriage of penicillin resistant pneumococci in children. Control measures to reduce the prevalence of penicillin resistant pneumococci should include reducing the use of antimicrobials in community health care.
研究儿童抗菌药物使用量与青霉素耐药及多重耐药肺炎球菌携带率之间的相关性。
横断面分析性患病率研究。
冰岛的五个不同社区。
根据来自家长的信息、患者记录以及四个研究区域当地药房抗菌药物的总销售额，确定7岁以下儿童中青霉素耐药肺炎球菌的鼻咽部携带率与抗生素使用情况的关系。
在可获取数据的四个区域中，儿童的抗菌药物总销售量（6223张处方）为每1000名儿童每天9.6至23.2限定日剂量（每名儿童每年1.1至2.6个疗程）。2岁以下儿童的用药量是2至6岁儿童的两倍（每1000名儿童每天20.5对比10.9限定日剂量）。从919名儿童中获取了鼻咽部标本，占不同区域同龄人群体的15%至38%。484名（52.7%）儿童携带肺炎球菌，其中47株（9.7%）分离株对青霉素耐药或多重耐药。多变量分析显示，年龄（<2岁）、区域（抗菌药物消费量最高）以及个人使用抗菌药物显著影响携带青霉素耐药肺炎球菌的几率。单变量分析显示，近期使用抗菌药物（2至7周）以及使用复方新诺明也与携带青霉素耐药肺炎球菌显著相关。
无论是个人使用抗菌药物还是社区抗菌药物的总消费量，均与儿童鼻咽部携带青霉素耐药肺炎球菌密切相关。降低青霉素耐药肺炎球菌患病率的控制措施应包括减少社区医疗保健中抗菌药物的使用。
