目的:在低收入和中等收入国家,儿童占抗生素消费的很大比例。在正规和非正规卫生部门发生过度使用。这项研究评估了坦桑尼亚姆贝亚和莫罗戈罗地区儿童血液中残留抗生素的患病率和预测因素。
方法:基于社区的横断面调查使用两阶段整群抽样将15岁以下的儿童包括在内。对于每个孩子,关于最近疾病的信息,寻求医疗保健的行为,和使用抗生素,还有一个干血斑样本,被收集。对样品进行串联质谱分析以量化15种常见抗生素的浓度。使用混合效应逻辑回归评估调查变量与残留抗生素之间的关联。
结果:总计,对1742名儿童进行了调查,1699年进行了分析。血液样本中残留抗生素的总体患病率为17.4%(296/1699),五岁以下儿童中最高。最常见的抗生素是甲氧苄啶(144/1699;8.5%),磺胺甲恶唑(102/1699;6.0%),甲硝唑(61/1699;3.6%)和阿莫西林(43/1699;2.5%)。血液中残留抗生素的最强预测因子是在家中观察到抗生素的存在(aOR=2.9;95%CI:2.0-4.1),并报告了最近两周的抗生素消费量(aOR=2.5;95%CI:1.6-3.9)。然而,一半(145/296)的儿童血液中残留抗生素,一些使用多种抗生素,在过去的两周内没有报告的病史或抗生素消费,在家里没有发现抗生素。
结论:这项研究表明,坦桑尼亚社区儿童的抗生素暴露率很高,尽管可能被低估了,尤其是半衰期短的化合物。相当比例的抗生素暴露是无法解释的,可能是由于未报告的自我药物治疗或环境途径。将生物监测纳入监测策略可以帮助更好地了解暴露模式并设计抗生素管理干预措施。
OBJECTIVE: Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania.
METHODS: The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression.
RESULTS: In total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0-4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6-3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home.
CONCLUSIONS: This study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.