Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study

Zhao, Hou-Yu; Bian, Jiaming; Xu, Han; Zhang, Mei; Zhan, Siyan

doi:10.1016/j.ijantimicag.2020.106193

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…In these prescriptions for adult patients with AURI that failed to conform with STGs, second- and third-generation cephalosporins were the most frequently prescribed. A similar prescribing pattern was observed in previous findings in Chinese hospitals for treating respiratory tract infections ( 41 , 42 ). This preference for upper-level broad-spectrum cephalosporins for the treatment of uncomplicated respiratory tract infections was also found in the U.S. ( 43 ) and European countries ( 44 ).…”

Section: Discussionsupporting

confidence: 88%

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China

Fu²,

Wushouer³

et al. 2022

Front. Public Health

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BackgroundThe excessive use of resources and poor quality of care are great concerns worldwide, particularly in China. In 2013, a model of systematic reforms was developed in Sanming to address the inefficiency and waste in public hospitals. However, limited empirical studies have evaluated the effect of Sanming healthcare reform on antibiotic appropriate use. This study aims to evaluate the impact of the healthcare reform on the appropriate use of antibiotics in county-level public hospitals in Sanming, China.MethodsWe conducted a retrospective observational study exploring trends in antibiotic use with an interrupted time series design. We selected three county-level hospitals in Sanming and extracted outpatient prescriptions of the Departments of Internal Medicine and the Department of Pediatrics between January 2011 and December 2017. Acute Upper Respiratory Tract Infection (AURI), Acute Bronchitis (AB) and Community Acquired Pneumonia (CAP) were selected as the sample diseases for our analysis. The primary outcome was the percentage of prescriptions conformed with standard treatment guidelines (STGs).ResultsA total of 142,180 prescriptions were included in the analysis. During the study period, the percentage of antibiotics prescriptions conformed with STGs boosted from 32.4% in 2011 to 82.3% in 2017. Moreover, after the reform, the rate of prescriptions that conformed with STGs showed significant increasing trends in children with AURI (β = 1.624, p < 0.001), children with AB (β = 3.123, p < 0.001), adult with AB (β = 1.665, p < 0.001), children with CAP (β = 3.123, p < 0.001), adult with CAP (β = 4.385, p < 0.001), but not in adult patients with AURI (β = −0.360, p = 0.022).ConclusionOur study confirmed that the Sanming healthcare reform helped to promote the appropriate use of antibiotics in county-level hospitals. This systematic approach to healthcare reform, characterized by an effective governance structure, dynamic financial compensation mechanisms, and specialized drug stewardship, is promising for future public hospital reforms.

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Section: Discussionsupporting

confidence: 88%

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China

Fu²,

Wushouer³

et al. 2022

Front. Public Health

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“…Further research investigating knowledge and attitudes of prison physicians regarding antimicrobial prescriptions, as well as on reasons for inappropriately prescribing antimicrobials in this context would be worthwhile. As already reported in studies conducted in the community [ 18 , 20 , 28 , 29 ], antimicrobial prescribing pattern and related appropriateness was associated with type of diagnoses, with pharyngitis, common cold and rhinosinusitis showing a significantly higher odds of being inappropriately treated with antimicrobials compared to bronchitis and influenza, as well as to symptomatic irreversible pulpitis with or without symptomatic apical periodontitis. It is well-known that these conditions rarely benefit of the use of antimicrobials, given their frequent viral origin and self-limiting nature, and this finding suggests the need for a more thoughtful attention to these diagnoses in the implementation of antimicrobial stewardship programs in prisons.…”

Section: Discussionsupporting

confidence: 55%

Pattern and Appropriateness of Antimicrobial Prescriptions for Upper Respiratory Tract and Dental Infections in Male Prisoners in Italy

et al. 2021

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Background: This study explored the antimicrobial prescribing pattern for upper respiratory tract and dental infections in prisoners in Italy, with specific attention paid to the appropriateness of indication and its potential determinants. Methods: This investigation was conducted through the consultation of clinical records of adult male inmates in a prison in the south of Italy. Results: Prescription of antimicrobials for upper respiratory tract infections ranged from 41.9% in influenza diagnoses to 88% in pharyngitis diagnoses, with high prevalence also for bronchitis (73.5%) and common cold (57.7%), and those for dental infections ranged from 82% in pulp necrosis and symptomatic apical periodontitis/pulp necrosis and localized acute apical abscess diagnoses, to 85.7% in symptomatic irreversible pulpitis with or without symptomatic apical periodontitis diagnoses. The most frequently prescribed antimicrobial was amoxicillin and clavulanic acid (33.8%), followed by amoxicillin (26.5%), macrolides (19.8%) and third-generation cephalosporins (7.9%). The overall antimicrobial overprescription was 69.4%, whereas an antimicrobial prescription was provided in all 52 cases in which it was indicated. The inappropriate antimicrobial prescriptions were significantly less likely for bronchitis, influenza and symptomatic irreversible pulpitis with or without symptomatic apical periodontitis compared to common cold/pharyngitis/rhinosinusitis, and when the antimicrobial prescription was provided by medical specialists compared to prison physicians, whereas antimicrobial overprescriptions without indications were significantly more frequent in patients with underlying chronic clinical conditions. Conclusions: A concerning widespread practice of inappropriate antimicrobial prescriptions in prisoners was found. Diagnoses-specific monitoring of antimicrobial use and prison-focused antimicrobial stewardship policies are strongly needed.

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“…And, Zhao. et al [33] had reported that children aged 6-17 years had the higher antibiotic prescription rate for URIs than preschoolers. Compare with other foreign studies, 27.1% of visits resulted in antibiotic prescriptions, considerably lower than reported in the South Korea (58.7%) [34] but higher than reported in the Spain (< 20%) [35].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study

Xue

Shen

et al. 2021

BMC Infect Dis

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Background In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database. Methods This was a retrospective cross-sectional study using a sampled database from the China Health Insurance Research Association (CHIRA). Study subjects included children younger than 5 years with outpatient visits in 2015 that resulted in a diagnosis of a upper respiratory infection. We calculated the percentage of visits who received antibiotics, the proportion of injection formulations, the percentage of combined antibiotics and the proportion of each antibiotic class. The patterns of antibiotic prescription were also described by medical institution type, city level and geographical region. Results Among the 92,821 visits, 27.1% were prescribed antibiotics, of which 27.0% received injection formulations. The rate of antibiotic prescribing varied by age group (P < 0.001), with the lowest (16.0%) in infants and the highest in patients at age 3 to < 4 years (29.9%) and age 4 to < 5 years (32.5%). The Midwestern region, underdeveloped cities and low-level hospitals represented relatively higher rates of prescribing antibiotics (P < 0.001) and higher proportions of injection dosage forms (P < 0.001). The most 3 common antibiotic classes prescribed of all visits with antibiotic prescriptions were the third-generation cephalosporins (34.9%), macrolides (24.3%), and the second-generation cephalosporins (23.3%). Conclusions In mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with URIs were at a low level, but still higher in underdeveloped regions and cities. Moreover, the overuse of the second and third generation cephalosporins, macrolides, remains a serious issue. Further efforts should be focused on reducing those non-first-line antibiotic prescribing and narrowing the gaps among regions and cities.

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Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study

Cited by 20 publications

References 27 publications

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China

Pattern and Appropriateness of Antimicrobial Prescriptions for Upper Respiratory Tract and Dental Infections in Male Prisoners in Italy

Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study

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