Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study.
Lancet Infect Dis
; 21(6): 847-857, 2021 06.
Article
em En
| MEDLINE
| ID: mdl-33515511
ABSTRACT
BACKGROUND:
Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship.METHODS:
We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported.FINDINGS:
Between Oct 1, 2014, and April 30, 2018, 18â848â864 (10·9%) of 172â704â117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18â848â864 antibiotic prescriptions, 9â689â937 (51·4%) were inappropriate, 5â354â224 (28·4%) were potentially appropriate, 2â893â102 (15·3%) were appropriate, and 911â601 (4·8%) could not be linked to any diagnosis. A total of 23â266â494 individual antibiotics were prescribed, of which 18â620â086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5â056â058 [21·7%]), second-generation cephalosporins (3â823â410 [16·4%]), macrolides (3â554â348 [15·3%]), and fluoroquinolones (3â285â765 [14·1%]).INTERPRETATION:
Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance.FUNDING:
The National Natural Science Foundation of China.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções Respiratórias
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Infecções Bacterianas
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Padrões de Prática Médica
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Prescrição Inadequada
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Assistência Ambulatorial
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Gestão de Antimicrobianos
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Antibacterianos
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article