Antimicrobial prescription pattern and appropriateness for respiratory tract infection in outpatients: a systematic review and meta-analysis.

IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Gashaw Enbiyale Kasse, Suzanne M Cosh, Judy Humphries, Md Shahidul Islam
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引用次数: 0

Abstract

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).

Conclusion: 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.

Systematic review registration: Systematic review registration: CRD42023468353.

门诊患者呼吸道感染的抗菌药处方模式和适宜性:系统回顾和荟萃分析。
背景:全球每年有数百万人死于抗菌药耐药性。抗菌药处方不当(如过度使用、使用不足或选择偏离既定指南)会导致抗菌药耐药性风险增加。本研究旨在确定呼吸道感染抗菌药物处方的使用率和适当性:本综述按照 PRISMA 指南进行。在 2023 年 10 月 1 日至 2023 年 12 月 15 日期间,不受时间限制地检索了 Web of Science、PubMed、ProQuest Health and Medicine 和 Scopus。研究由第一作者和共同作者独立筛选。我们纳入了报告呼吸道感染抗菌药物处方模式和适宜性的原创研究。纳入研究的质量通过乔安娜-布里格斯研究所(Joanna Briggs Institute)的《横断面研究批判性评估检查表》进行评估。采用漏斗图和 Egger 回归检验对发表偏倚进行了评估。采用随机效应模型来估算抗生素的汇总处方率和不当使用率。按照国家、研究时间、数据来源和年龄组进行了分组分析:在总共 1220 项已确定的研究中,有 36 项研究被纳入综述。抗菌药物处方率从 25% (95% CI 0.24-0.26) 到 90% (95% CI 0.89-0.91) 不等。汇总的抗菌药物处方率为 66%(95% CI 0.57 至 0.73)。按地区进行的分组分析显示,抗菌药物处方率最高的地区是非洲(79%,95% CI 0.48-0.94),最低的地区是欧洲(47%,95% CI 0.32-0.62)。Access组的阿莫西林和阿莫西林-克拉维酸酯抗菌药以及Watch组的阿奇霉素和红霉素是最常用的抗菌药。这项研究显示,开具抗菌药处方的主要原因是急性支气管炎、咽炎、鼻窦炎和普通感冒。不适当抗菌药处方的汇总率为 45%(95% CI 0.38-0.52)。所纳入的研究中有 28 项报告称,开具无适当适应症的抗菌药物处方是导致抗菌药物处方不当的主要原因。此外,按地区进行的分组分析表明,亚洲的抗菌药物处方不当率较高,为 49%(95% CI 0.38-0.60)。漏斗图和 Egger 检验的结果显示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当使用率仍然很高,而且各国之间存在差异。应开展进一步研究,以了解导致门诊患者不必要使用抗菌药物处方的因素:系统综述注册CRD42023468353。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Systematic Reviews
Systematic Reviews Medicine-Medicine (miscellaneous)
CiteScore
8.30
自引率
0.00%
发文量
241
审稿时长
11 weeks
期刊介绍: Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies. The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.
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