背景:全球每年有数百万人死于抗菌素耐药性。抗菌药物的不适当处方(例如,过度使用,使用不当,或与既定指南不同的选择)可能会导致抗菌素耐药性的风险增加。这项研究旨在确定呼吸道感染抗菌药物处方的发生率和适当性。
方法:本综述按照PRISMA指南进行。WebofScience,PubMed,ProQuest健康与医学,和Scopus在2023年10月1日至2023年12月15日之间进行了搜索,没有时间限制。研究由第一作者和合著者独立筛选。我们纳入了报告抗菌药物处方模式和呼吸道感染适当性的原始研究。纳入研究的质量通过JoannaBriggs研究所的横断面研究关键评估清单进行评估。使用漏斗图和Egger回归检验对发表偏倚进行评估。采用随机效应模型来估计合并的抗生素处方和不适当率。亚组分析按国家进行,学习期间,数据源,和年龄组。
结果:在总共1220项确定的研究中,36项研究纳入审查。抗菌药物处方率范围为25%(95%CI0.24-0.26)至90%(95%CI0.89-0.91)。合并的抗菌药物处方率为66%(95%CI0.57至0.73)。按地区分组分析显示,非洲的抗菌药物处方率最高(79%,95%CI0.48-0.94),欧洲最低(47%,95%CI0.32-0.62)。来自Access组的阿莫西林和阿莫西林-克拉维酸抗菌药物,以及观察组的阿奇霉素和红霉素,是最常用的抗菌剂。这项研究表明,抗菌处方的主要原因是急性支气管炎,咽炎,鼻窦炎,和普通感冒。合并的不适当抗菌药物处方率为45%(95%CI0.38-0.52)。纳入的28项研究报告说,没有适当适应症的处方抗菌药物是不适当抗菌药物处方的主要原因。此外,按地区进行的亚组分析显示,亚洲抗菌药物不适当处方率较高,为49%(95%CI0.38-0.60).漏斗图和Egger检验的结果表明没有实质性的发表偏倚(Egger检验:p=0.268)。
结论:抗菌药物的处方率和不适当使用率仍然很高,且因国家而异。应进行进一步的研究,以产生有关导致门诊患者不必要的抗菌药物处方的因素的信息。
背景:系统综述注册:CRD42023468353。
BACKGROUND: Millions of people die every year as a result of antimicrobial resistance worldwide. An inappropriate prescription of antimicrobials (e.g., overuse, inadequate use, or a choice that diverges from established guidelines) can lead to a heightened risk of antimicrobial resistance. This study aimed to determine the rate and appropriateness of antimicrobial prescriptions for respiratory tract infections.
METHODS: This review was conducted in accordance with the PRISMA guidelines. Web of Science, PubMed, ProQuest Health and Medicine, and Scopus were searched between October 1, 2023, and December 15, 2023, with no time constraints. Studies were independently screened by the first author and the co-authors. We included original studies reporting antimicrobial prescription patterns and appropriateness for respiratory tract infections. The quality of included studies\' was assessed via the Joanna Briggs Institute\'s Critical Appraisal Checklists for Cross-Sectional Studies. The assessment of publication bias was conducted using a funnel plot and Egger\'s regression test. A random effect model was employed to estimate the pooled antibiotic prescribing and inappropriate rates. Subgroup analysis was conducted by country, study period, data source, and age group.
RESULTS: Of the total 1220 identified studies, 36 studies were included in the review. The antimicrobial prescribing rate ranged from 25% (95% CI 0.24-0.26) to 90% (95% CI 0.89-0.91). The pooled antimicrobial prescription rate was 66% (95% CI 0.57 to 0.73). Subgroup analysis by region revealed that the antimicrobial prescription rate was highest in Africa (79%, 95% CI 0.48-0.94) and lowest in Europe (47%, 95% CI 0.32-0.62). Amoxicillin and amoxicillin-clavulanate antimicrobials from the Access group, along with azithromycin and erythromycin from the Watch group, were the most frequently used antimicrobial agents. This study revealed that the major reasons for antimicrobial prescription were acute bronchitis, pharyngitis, sinusitis, and the common cold. The pooled inappropriate antimicrobial prescription rate was 45% (95% CI 0.38-0.52). Twenty-eight of the included studies reported that prescribing antimicrobials without proper indications was the main cause of inappropriate antimicrobial prescriptions. Additionally, subgroup analysis by region showed a higher inappropriate antimicrobial prescription rate in Asia at 49% (95% CI 0.38-0.60). The result of the funnel plot and Egger\'s tests revealed no substantial publication bias (Egger\'s test: p = 0.268).
CONCLUSIONS: The prescribing rate and inappropriate use of antimicrobials remain high and vary among countries. Further studies should be conducted to generate information about factors contributing to unnecessary antimicrobial prescriptions in outpatients.
BACKGROUND: Systematic review registration: CRD42023468353.