Sýklalyfjaávísanir barna á aldrinum 0-4 ára hjá Heilsugæslu höfuðborgarsvæðisins á árunum 2016-2018

Inngangur: Eitt mesta afrek læknisfræðinnar er talið vera uppgötvun sýklalyfja en ekki leið þó á löngu áður en ónæmi kom fram í bakteríum sem ógnaði heilsu almennings. Í dag er ofnotkun og óskynsamleg notkun sýklalyfja ein helsta ástæðan fyrir þróun sýklalyfjaónæmis. Vorið 2017 fór Heilsugæsla höfuðborgarsvæðisins (HH) af stað með átak með það að markmiði að draga úr sýklalyfjanotkun barna á Íslandi. Aðalmarkmið þessarar rannsóknar var því að kanna hvort sýklalyfjanotkun barna 0-4 ára hafi dregist saman á rannsóknartímabilinu (2016-2018), sömuleiðis hvort lyfjamynstrið hafi breyst sem og ávísunarvenjur heimilislækna. Efniviður og aðferðir: Framkvæmd var lýsandi afturskyggn rannsókn þar sem notast var við megindlega aðferðafræði. Upplýsingar úr sjúkraskrá í Sögu-gagnagrunni HH voru fengnar til að afla upplýsinga um sýklalyfjaávísanir í flokki J01 til barna á aldrinum 0-4 ára og ICD-10 greiningar. Kí-kvaðrat-próf var notað til að meta hvort marktækur munur væri á fjölda sýklalyfjaávísana eftir mismunandi flokkabreytum og Quasi-poisson-dreifing var notuð til að meta þróun á fjölda sýklalyfjaávísana milli ára. Marktækni var skilgreind með 95% öryggi (p-gildi<0,05). Niðurstöður: Fjöldi sýklalyfjaávísana yfir rannsóknartímabilið var frá 263,6-289,6 ávísunum á hverja 1000 íbúa ári, og fækkaði ávísunum marktækt á árabilinu 2017-2018 (p = 1.6*10-7). Breiðvirk penicillín (J01 CA) voru yfir helmingur allra sýklalyfjaávísana. Fór notkun þeirra marktækt vaxandi milli ára (p = 2,2*10-16). Yfir helmingur allra sýklalyfjaávísana var vegna miðeyrnabólgu og þar á eftir vegna lungnabólgu og húðsýkingar. Marktæk aukning var á notkun breiðvirkra penicillína við miðeyrnabólgu (p = 2,2*10-16) og lungnabólgu (p = 3,9*10-9). Vegna húðsýkinga var cefalexin yfir helmingur ávísana, en ekki var um marktækan mun að ræða milli ára (p = 0,06). Ályktanir: Ljóst er að sýklalyfjaávísunum fór fækkandi eftir að átak HH hófst og ávísunarvenjur heimilislækna breyttust. Samræmast þær breytingar nú að miklu leyti ráðlögðum leiðbeiningum, að undanskildum sýklalyfjaávísunum vegna berkjubólgu, hálsbólgu og vegna augnsýkinga.Introduction: One of the greatest achievements in the history of medicine was the discovery of antibiotics. Soon, however, the emergence of antibiotic resistant bacteria posed a public-health danger. Today, overuse and inappropriate prescribing of antibiotics is driving antibiotic resistance. In the spring of 2017, the Primary Health Care of the Capital Area (HH) launched a campaign to reduce the use of antibiotics in children. The aim of this study was to investigate whether the antibiotic use of 0-4-year old children had decreased during the study period (2016-2018). It also sought to assess changes in the prescribing patterns of general practitioners (GPs). Materials and methods: A descriptive retrospective study was performed using quantitative methodology. Clinical data from the HH medical records database was obtained (class J01 antibiotic prescriptions for children (0-4-ys), ICD-10 diagnoses). Chi-square test was used to evaluate a statistically significant association in the number of antibiotic prescriptions by different categorical variables. Quasi-Poisson distribution was used to evaluate year-on-year antibiotic prescriptions changes. Significance was defined with 95% confidence (p-value < 0,05). Results: The number of prescriptions during the study period ranged from 263,6 to 289,6 prescriptions/1000 inhabitants/year. Reduction in the number of prescriptions between 2017-2018 was significant (p = 1.6*10-7). Broad-spectrum penicillins (J01 CA) accounted for over half of all prescriptions, which increased significantly between years (p = 2,2*10-16). More than half of all prescriptions were for otitis media followed by pneumonia and skin infections. A significant increase in use of broad-spectrum penicillins for otitis media (p = 2,2*10-16) and pneumonia (p = 3,9*10-9) was seen. Cephalexin accounted for more than half of the prescriptions for skin infections, although there was no significant difference between years (p = 0,06). Conclusion: The results indicate a decrease in antibiotic prescribing after the start of the HH-campaign, and a change in the GPs’ prescribing habits. These changes mostly correspond to the recommended guidelines for antibiotic prescribing, except antibiotics for bronchitis, pharyngitis and eye infections

Encouraging rational antibiotic prescribing behaviour in primary care–prescribing practice among children aged 0–4 years 2016–2018 : an observational study

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.OBJECTIVE: To study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland. DESIGN: An observational, descriptive, retrospective study using quantitative methodology. SETTING: Primary healthcare in the Reykjavik area with a total population of approximately 220,000. SUBJECTS: A total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018. MAIN OUTCOME MEASURES: Reduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database. RESULTS: The number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p  < 0.0001. CONCLUSION: The results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.Peer reviewe