优化印度尼西亚的抗生素使用:系统审查和证据综合,以告知干预机会
Ralalicia Limato1,2, Gilbert Lazarus1,3, Puck Dernison1,4
1Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
The Lancet regional health. Southeast Asia
|June 29, 2023
概括
低于最佳的抗生素使用驱动抗菌素耐药性 (AMR). 这次审查强调了印尼抗生素消费和处方适当性的关键差距,需要针对性干预以获得更好的结果.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 低于最佳的抗生素使用是抗菌素耐药性 (AMR) 和不良临床结果的关键驱动因素.
- 在资源较少的环境中,如印度尼西亚,对抗生素使用的数据有限.
- 本综述侧重于印度尼西亚的人类健康中的全身抗生素使用 (世卫组织ATC/DDD类别J01).
研究的目的:
- 审查印尼对系统性抗生素使用的研究.
- 综合有关抗生素消费和处方适当性的证据.
- 确定干预的机会,以改善抗生素的使用.
主要方法:
- 在五个国际和国家数据库 (2000-2021) 中进行系统搜索.
- 包括关于抗生素消费,处方适当性,抗菌药物管理 (AMS) 和看法的研究.
- 用消费和适当性的元分析进行数据合成,用于AMS的效果方向分析,以及用于感知的定性合成.
主要成果:
- 综合抗生素消耗:134.8 DDD/100个病床日 (住院患者) 和121.1 DDD/1000个居民/天 (门诊患者).
- 适当的处方率有所不同:根据Gyssens方法,为33.5% (医院) 和49.4% (初级保健);根据指南,总体为6.1% (医院) 和10.5% (初级保健).
- AMS干预表明了潜在的益处;感知调查揭示了知识差距和自我治疗.
结论:
- 迫切需要特定背景的干预措施,以改善印度尼西亚医疗保健机构的抗生素使用.
- 存在关键证据缺口,特别是在私人和非正式医疗保健部门.
- 需要有针对性的策略来解决不适当的抗生素使用和缓解AMR.
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