PDF(Pubmed)
Abstract：
BACKGROUND: Inappropriate antibiotic use contributes significantly to the global challenge of antimicrobial resistance. While government-initiated population-level interventions are fundamental in addressing this issue, their full potential remains to be explored. This systematic review aims to assess the effectiveness of such interventions in reducing inappropriate antibiotic use among antibiotic providers and users in healthcare and community settings.
METHODS: We will conduct a systematic literature search across multiple databases and grey literature sources. We will include studies which evaluate the effectiveness of population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings in both high-income and low- and middle-income countries. This includes government-initiated measures targeting antibiotic use through education, restriction, incentivization, coercion, training, persuasion, context modification, behavior modeling, or barrier reduction. Two reviewers will independently perform screening to select eligible studies, followed by data extraction. The outcomes of interest are various measures of antibiotic prescription and consumption, such as Defined Daily Dose (DDD) or number of prescriptions per year. We anticipate including a broad range of study designs and outcome measures. Therefore, we will narratively synthesize results using the categories of the population-level policy interventions of the Behavior Change Wheel Framework. We will organize outcome data by economic contexts, target populations, and implementation settings.
CONCLUSIONS: This review will strengthen the evidence base for the use of population-level interventions to address inappropriate antibiotic use. Drawing lessons from global experiences, the findings will provide valuable guidance to health policymakers, public health authorities, and researchers on tailoring interventions to specific economic contexts, populations, and settings, thereby enhancing their capacity to drive substantial improvement in appropriate antibiotic use.
METHODS: We will conduct a systematic literature search across multiple databases and grey literature sources. We will include studies which evaluate the effectiveness of population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings in both high-income and low- and middle-income countries. This includes government-initiated measures targeting antibiotic use through education, restriction, incentivization, coercion, training, persuasion, context modification, behavior modeling, or barrier reduction. Two reviewers will independently perform screening to select eligible studies, followed by data extraction. The outcomes of interest are various measures of antibiotic prescription and consumption, such as Defined Daily Dose (DDD) or number of prescriptions per year. We anticipate including a broad range of study designs and outcome measures. Therefore, we will narratively synthesize results using the categories of the population-level policy interventions of the Behavior Change Wheel Framework. We will organize outcome data by economic contexts, target populations, and implementation settings.
CONCLUSIONS: This review will strengthen the evidence base for the use of population-level interventions to address inappropriate antibiotic use. Drawing lessons from global experiences, the findings will provide valuable guidance to health policymakers, public health authorities, and researchers on tailoring interventions to specific economic contexts, populations, and settings, thereby enhancing their capacity to drive substantial improvement in appropriate antibiotic use.
摘要：
背景：不适当的抗生素使用极大地导致了抗微生物药物耐药性的全球挑战。虽然政府发起的人口层面干预措施对于解决这一问题至关重要，他们的全部潜力仍有待探索。本系统评价旨在评估此类干预措施在减少医疗保健和社区环境中抗生素提供者和使用者不适当使用抗生素方面的有效性。
方法：我们将在多个数据库和灰色文献来源中进行系统的文献检索。我们将包括评估人口水平干预措施的有效性的研究，以减少高收入和低收入和中等收入国家在医疗保健和社区环境中不适当使用抗生素。这包括政府发起的通过教育针对抗生素使用的措施，限制,激励,胁迫,培训,说服,上下文修改,行为建模，或减少障碍。两名评审员将独立进行筛选，以选择符合条件的研究，其次是数据提取。感兴趣的结果是抗生素处方和消费的各种衡量标准，例如定义的每日剂量(DDD)或每年的处方数量。我们预计包括广泛的研究设计和结果测量。因此,我们将使用行为变化轮框架的人口水平政策干预措施的类别来叙述地综合结果。我们将按经济背景组织结果数据，目标人群,和实施设置。
结论：本综述将加强使用人群水平干预措施解决不适当抗生素使用的证据基础。借鉴全球经验，这些发现将为卫生政策制定者提供有价值的指导，公共卫生当局,以及针对特定经济环境定制干预措施的研究人员，人口,和设置，从而提高他们在适当抗生素使用方面的能力。
方法：我们将在多个数据库和灰色文献来源中进行系统的文献检索。我们将包括评估人口水平干预措施的有效性的研究，以减少高收入和低收入和中等收入国家在医疗保健和社区环境中不适当使用抗生素。这包括政府发起的通过教育针对抗生素使用的措施，限制,激励,胁迫,培训,说服,上下文修改,行为建模，或减少障碍。两名评审员将独立进行筛选，以选择符合条件的研究，其次是数据提取。感兴趣的结果是抗生素处方和消费的各种衡量标准，例如定义的每日剂量(DDD)或每年的处方数量。我们预计包括广泛的研究设计和结果测量。因此,我们将使用行为变化轮框架的人口水平政策干预措施的类别来叙述地综合结果。我们将按经济背景组织结果数据，目标人群,和实施设置。
结论：本综述将加强使用人群水平干预措施解决不适当抗生素使用的证据基础。借鉴全球经验，这些发现将为卫生政策制定者提供有价值的指导，公共卫生当局,以及针对特定经济环境定制干预措施的研究人员，人口,和设置，从而提高他们在适当抗生素使用方面的能力。
