Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study.

Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. The National Natural Science Foundation of China.

Zhao H ，Wei L ，Li H ，Zhang M ，Cao B ，Bian J ，Zhan S ... -  《-》

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

The assessment of antibiotic use for acute upper respiratory infections (AURIs) is important to promote the appropriateness of antibiotic prescribing. Evaluation of antibiotic prescriptions for AURIs at a national level is very limited in China. To investigate outpatient antibiotic prescriptions for AURIs in Chinese hospitals. This study used data from over 10 million outpatient and emergency department visits for AURIs, which contained information on drug prescription and diagnosis, from 94 cities and 28 provinces of mainland China. Antibiotic prescription rates for various subgroups and potential predictors of antibiotic use were estimated. Patterns of antibiotic prescriptions and proportions of individual antibiotics prescribed for different types of AURIs were analysed and reported. In total, 10 770 219 outpatient visits for AURIs were included in this study. Of these, 40.8% (95% confidence interval 40.7-40.8%) resulted in antibiotic prescriptions. Patient characteristics, including age, gender, payment type, AURI type, department and season of visit, were significantly associated with antibiotic prescriptions for AURIs. In total, 4 984 744 antibiotic agents were prescribed, of which 87.9% were broad-spectrum antibiotics and only 36.8% were prescribed in line with the guideline recommendations. Azithromycin (13.2%), cefdinir (11.7%), cefixime (8.3%) and cefaclor (8.2%) were the most commonly prescribed antibiotics for AURIs in China. Antibiotic prescribing for patients with AURIs in outpatient settings was prevalent nationwide in China. Antibiotic stewardship efforts targeting specific populations in outpatient settings are needed to reduce antibiotic use and promote appropriate antibiotic selection for AURIs in China.

Zhao H ，Bian J ，Han X ，Zhang M ，Zhan S ... -  《-》

Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.

Fleming-Dutra KE ，Hersh AL ，Shapiro DJ ，Bartoces M ，Enns EA ，File TM Jr ，Finkelstein JA ，Gerber JS ，Hyun DY ，Linder JA ，Lynfield R ，Margolis DJ ，May LS ，Merenstein D ，Metlay JP ，Newland JG ，Piccirillo JF ，Roberts RM ，Sanchez GV ，Suda KJ ，Thomas A ，Woo TM ，Zetts RM ，Hicks LA ... -  《-》

Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis.

Pulia M ，Kern M ，Schwei RJ ，Shah MN ，Sampene E ，Crnich CJ ... -  《Antimicrobial Resistance and Infection Control》

Assessing the appropriateness of community-based antibiotic prescribing in Alberta, Canada, 2017-2020, using ICD-9-CM codes: a cross-sectional study.

Antimicrobial resistance is a rising threat to human health, and, with up to 90% of antibiotics prescribed in the community, it is critical to examine Canadian antibiotic stewardship practices in outpatient settings. We carried out a large-scale analysis of appropriateness in community-based prescribing of antibiotics to adults in Alberta, reporting on 3 years of data from physicians practising in the province. The study cohort was composed of all adult (age 18-65 yr) Alberta residents who filled at least 1 antibiotic prescription written by a community-based physician between Apr. 1, 2017, and Mar. 6, 2020. We linked diagnosis codes from the clinical modification of the International Classification of Diseases, 9th Revision (ICD-9-CM), as used for billing purposes by the province's fee-for-service community physicians, to drug dispensing records, as maintained in the province's pharmaceutical dispensing database. We included physicians practising in community medicine, general practice, generalist mental health, geriatric medicine and occupational medicine. Following an approach used in previous research, we linked diagnosis codes with antibiotic drug dispensations, classified across a spectrum of appropriateness (always, sometimes never, no diagnosis code). We identified 3 114 400 antibiotic prescriptions dispensed to 1 351 193 adult patients by 5577 physicians. Of these prescriptions, 253 038 (8.1%) were "always appropriate," 1 168 131 (37.5%) were "potentially appropriate," 1 219 709 (39.2%) were "never appropriate," and 473 522 (15.2%) were not associated with an ICD-9-CM billing code. Among all dispensed antibiotic prescriptions, amoxicillin, azithromycin and clarithromycin were the most commonly prescribed drugs labelled "never appropriate." We found that nearly 40% of prescriptions dispensed to 1.35 million adult patients in Alberta's community-based settings over a 35-month period were inappropriate. This finding suggests that additional policies and programs to improve stewardship among physicians prescribing antibiotics for adult outpatients in Alberta may be warranted.

Leslie M ，Fadaak R ，Lethebe BC ，Szostakiwskyj JH ... -  《-》