北京市基层医疗机构儿童抗菌药物使用及合理性分析

Analysis of antibiotic use and rationality for children in primary healthcare institutions from Beijing

目的了解北京市社区卫生服务机构处方点评机制下基层医疗机构儿童抗菌药物使用情况及合理性,为促进基层医疗机构合理使用抗菌药物提供参考。方法提取北京市社区卫生服务机构处方点评系统中基层医疗机构2019年的全部儿童处方数据,根据世界卫生组织与国际合理用药网络(WHO/INRUD)的相关指标描述抗菌药物使用情况,根据药品的解剖学、治疗学及化学(ATC)分类法,WHO AWaRe分级目录和诊断情况分析抗菌药物的使用结构。结果共纳入288家基层医疗机构,共涉及10422张儿童处方;在高收入区、中等收入区、低收入区的机构数量分别为119、80、89家,涉及处方数量分别为2430、2163、5829张;其中抗菌药物处方有1447张(占13.9%)。在1447张处方中,抗菌药物联用处方率为1.4%(20张),抗菌药物注射剂处方率为9.7%(141张),处方点评结果为不合理的抗菌药物处方率为4.8%(69张);最常使用的3类抗菌药物分别为大环内酯类(40.2%)、第二代头孢菌素类(26.5%)和第三代头孢菌素类(23.4%);可用级、慎用级、备用级和不推荐使用级抗菌药物处方占比分别为9.1%、92.1%、0.3%和0;诊断中,扁桃体炎的抗菌药物处方率最高(31.9%)。在69张不合理的抗菌药物处方中,用药不适宜处方最多(56张,占81.2%)。结论北京市基层医疗机构儿童抗菌药物处方率低于WHO抗菌药物处方率标准(20.0%~26.8%),但慎用级抗菌药物使用率太高。

OBJECTIVE To investigate the antibiotic use and rationality for children in community health service institutions from Beijing,and to provide reference for promoting rational use of antibiotics in primary healthcare institutions.METHODS All the prescriptions for children from primary healthcare institutions in 2019 were extracted from prescription review system of community health service institutions in Beijing.The use of antibiotics was described according to the related indicators of the World Health Organization/International Network for Rational Use of Drug(WHO/INRUD).The structure of antibiotics use was analyzed according to the anatomical therapeutic chemical(ATC)classification as well as the WHO AWaRe classification and diagnosis.RESULTS A total of 288 primary healthcare institutions and 10422 prescriptions for children were included.The number of institutions in high-income areas,middle-income areas and low-income areas were 119,80 and 89 respectively,and the number of prescriptions involved were 2430,2163 and 5829 respectively,including 1447 prescriptions involving antibiotics(13.9%).Among 1447 prescriptions,the rate of prescriptions involving combined use of antibiotics was 1.4%(20 pieces);the rate of prescriptions involving antibiotics injection was 9.7%(141 pieces);4.8%antibiotics prescriptions were rated as unreasonable(69 pieces).The three most commonly used antibiotics were the macrolides(40.2%),the second-generation cephalosporins(26.5%)and the third-generation cephalosporins(23.4%).The proportion of antibiotics prescriptions from groups of access,caution,reserve and not recommended were 9.1%,92.1%,0.3%,and 0,respectively.The rate of antibiotics prescriptions for tonsillitis was the highest(31.9%).Among 69 irrational antibiotics prescriptions,main of them were irrational drug use(56 pieces,81.2%).CONCLUSIONS The rate of antibiotics prescriptions for children in primary healthcare institutions from Beijing is lower than the standard of WHO antibiotics prescription rate(20.0%-26.8%),but the use rate of antibiotics at caution grade is too high.