van Houten M A, Luinge K, Laseur M, Kimpen J L
Beatrix Children's Hospital, University Hospital Groningen, The Netherlands.
Int J Antimicrob Agents. 1998 May;10(2):161-4. doi: 10.1016/s0924-8579(98)00022-3.
Antibiotics are among the most commonly prescribed drugs in paediatrics. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies are warranted. Before such policies can be implemented, detailed knowledge of antibiotic prescribing patterns is important. In this combined retrospective and prospective study the utilisation of antibiotics in a paediatric university hospital over three consecutive years has been analysed. Over an 8-week period (1 November-22 December) in 1994, 1995 and 1996 patient charts were reviewed with regard to antibiotic prescription (generic class, dose, duration and indication). A total of 1120 patients were admitted during the study periods. Antibiotics were prescribed at least once for 36% of hospitalised children, although only 12.3% of the patients receiving antibiotics had a proven bacterial infection. During a single hospitalisation 13, 4.7, 2.6, and 2.7% of all children received 2, 3, 4 or more than four antibiotics, respectively. Infants less than 2 years received antibiotics more frequently than older children (25 and 11% respectively, P=0.0256). More children admitted to the intensive care unit received antibiotics compared with patients admitted on medium care units (49.7 and 29.3% respectively, P < 0.0001). They received more often several different antibiotic courses (2.6 courses per patient versus 1.9 courses per patient, P < 0.0001). These children were also given more often intravenous rather than oral antibiotics (P < 0.0001) Significant differences could be found between the generic classes of antibiotics prescribed to children admitted to the intensive care unit and the medium care. However high variability in dose and duration of antibiotic therapy for the same clinical indication was shown. A high percentage of all hospitalised children receive antibiotics. In most cases antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards. The fact that children admitted to intensive care units and patients of younger age groups are at special risk of receiving multiple courses of antibiotics, together with the knowledge that antibiotic resistance develops in this setting, suggest that strategies to control antibiotic use should focus on these patient populations.
抗生素是儿科最常用的处方药之一。由于医疗保健成本总体上升、药物处方缺乏一致性以及抗生素耐药性的出现，抗生素使用的监测和控制日益受到关注，严格的抗生素政策势在必行。在实施此类政策之前，详细了解抗生素处方模式非常重要。在这项回顾性和前瞻性相结合的研究中，分析了一家儿科大学医院连续三年的抗生素使用情况。在1994年、1995年和1996年的8周期间（11月1日至12月22日），对患者病历进行了抗生素处方（通用类别、剂量、疗程和适应症）方面的审查。研究期间共收治了1120名患者。36%的住院儿童至少接受过一次抗生素治疗，尽管接受抗生素治疗的患者中只有12.3%被证实有细菌感染。在单次住院期间，所有儿童中分别有13%、4.7%、2.6%和2.7%接受了2种、3种、4种或4种以上抗生素治疗。2岁以下婴儿接受抗生素治疗的频率高于大龄儿童（分别为25%和11%，P=0.0256）。与中等护理病房收治的患者相比，重症监护病房收治的儿童接受抗生素治疗的更多（分别为49.7%和29.3%，P<0.0001）。他们更常接受几种不同的抗生素疗程（每位患者2.6个疗程，而每位患者1.9个疗程，P<0.0001）。这些儿童也更常接受静脉注射而非口服抗生素（P<0.0001）。在重症监护病房和中等护理病房收治的儿童所使用的抗生素通用类别之间可以发现显著差异。然而，对于相同的临床适应症，抗生素治疗的剂量和疗程存在很大差异。所有住院儿童中很大一部分接受了抗生素治疗。在大多数情况下，抗生素是在没有细菌感染证据的情况下凭经验开始使用的，要么在治疗开始前，要么在治疗后。重症监护病房收治的儿童和较年轻年龄组的患者有接受多种抗生素疗程的特殊风险，再加上已知在这种情况下会产生抗生素耐药性，这表明控制抗生素使用的策略应侧重于这些患者群体。
