合理使用抗生素和社区抗生素耐药（英文）0appropriateantibiotic use and antibiotic resistance in the

AppropriateAntibioticUseandAntibioticResistanceintheCommunity KateGrant MSProjectDirectorGetSmartVirginiaVirginiaDepartmentofHealth ImportanceofPneumococcalInfectionsintheU S 2000CDCActiveBacterialCoreSurveillance ABCs PenicillinResistanceinS pneumoniae UnitedStates1979 2000 1979 1994 CDCSentinelSurveillanceNetwork 1995 2000 CDCActiveBacterialCoreSurveillance ABCS SystemEmergingInfectionsProgram DrugResistantStreptococcuspneumoniae EmergedinSpainandSouthAfricaEmergedintheU S inthelastdecadeUseofantibioticsforviralinfectionsThreateninguseofantibioticsforcommoninfections ResistanceandAntibioticPrescribing RiskfactorsforresistantS pneumoniaeare youngage 1year highersocioeconomicstatusday careattendancerecentreceiptofantibiotics 2 5timesgreaterrisk Pediatrics1993 92 761 7 ReasonsforAntibioticOveruseConclusionsfrom8FocusGroups PatientConcernswantclearexplanationgreennasaldischargeneedtoreturntowork childcare PhysicianConcernspatientexpectsantibioticdiagnosticuncertaintytimepressure Barden ClinPediatric1998 37 665 672 AntibioticPrescription PatientSatisfactionandAntibiotics Hamm JFamPract1996 43 56Mangione Smith Pediatrics1999 103 711 8 Satisfactionpredictedby timespentbyMDexplainingillnesspatientunderstandingoftreatmentchoiceSatisfactionnotpredictedbyreceiptofantibiotics CanResistanceTrendsBeReversed PublichealthcampaigninIcelandfollowingdramaticincreaseintheratesofpenicillin resistantpneumococcifrom2 3 to20 in4yearsRatesfellfrompeakof20 in1993to16 9 in1994Carriageratesofresistantstrainsamongdaycareattendeesdroppedfrom20 to15 insameperiodJAMA1996 275 175 CommunityandClinicianEducationCanEffectivelyReduceAntibioticUse Intervention Distributionofmaterialsandpresentationstoclinicstaff parents daycareproviders communitygroupsSmallgrouppresentationsforclinicians AcontrolledinterventiontrialwasconductedinseveralnorthernWisconsincommunitiesduring1997 98 Outcome 11 reductioninliquidantibioticprescriptionsfollowingintervention 12 increaseincontrolregion BelongiaPediatrics2001 108 575 583 UPDATE NAMCSdata 2000 Children 15Population basedantibioticprescriptionsdecreased40 Visit basedantibioticprescriptionsdecreased29 DeclinescoincidewithincreasedmediaattentionAntibioticresistancehascontinuedtoincreasethroughthe1990 s JAMA2002 287 3096 3102 CDCTreatmentGuidelines www cdc gov drugresistance community technical htm PrinciplesofJudiciousAntimicrobialUse OtitisMedia KeyMessages Episodesofotitismediashouldbeclassifiedasacuteotitismedia AOM orotitismediawitheffusion OME AntibioticsarenotindicatedforinitialtreatmentofOME PrinciplesofJudiciousAntimicrobialUse RhinitisandSinusitis KeyMessages Rhinitis antibioticsshouldnotbegivenforviralrhinosinusitisSinusitis prolongedURIsymptomsmoresevereURIsymptoms i e facialpainorswelling highfever antibiotictreatmentwiththemostnarrow spectrumagent PrinciplesofJudiciousAntimicrobialUse Pharyngitis KeyMessages DiagnoseasgroupAstrepPenicillinisthedrugofchoiceintreatinggroupAstrepuseerthromycinifpenicillinallergic PrinciplesofJudiciousAntimicrobialUse CoughandBronchitis KeyMessages Cough bronchitisrarelyneedsantibioticsAntibiotictreatmentforprolongedcough 10days maybeneededMycoplasmapneumonia usemacrolideagentforchildren 5 AppropriateAntibioticUseSummary OnlyprescribeantibiotictherapywhenclearlybeneficialUseanappropriate targeted agentUsetheappropriatedoseandduration PreventionPneumococcalVaccination 23 valentpolysaccharidevaccine PPV 60 effectiveinpreventingbacteremicpneumococcalinfectioninimmunocompetentadults7 valentconjugatevaccine PCV 7 forchildrenage3 59months 95 effectiveinpreventinginvasivediseaseinyoungchildren Bartlett ClinInfectDis2000 31 347 382CDC MMWR2000 49 RR 9 1 34 HEDISPerformanceMeasures NationalCommitteeforQualityAssuranceTwomeasuresforchildrenURIdiagnosis rateofantibioticprescribing 3mos 18yrsPharyngitisdiagnosis rateofgroupAstreptestsgivento2 16y owhoareprescribedantibioticsPilottestingcompleted publiccommentperiodfordraftmeasuresclosedMarch21 2003 CDCLessonsLearned PrescribersandpatientsareallpartoftheproblemInterventionsmusttargetbothgroupsNoteveryonelearnsthesamewayInterventionsshouldbemultifaceted Virginia sAppropriateAntibioticUseCampaign MissionTopromotethejudicioususeofantibioticsandtoreducetheproblemofantibioticresistanceinVirginia GeneralStrategyforaCampaigntoPromoteJudiciousUseofAntibioticsinVirginia Ongoing comprehensiveeducationCliniciansConsensusguidelinesPrintedmaterialstogivepatientsEducationalprogramGeneralpublicMassmediaMaterialsfromhealthplans insurersOtheragencies institutionsprovidingservicestoparents ie daycare ConsumerEducation Conductpublicawareness educationcampaignUtilizemassmediaforinformationdisseminationDistributeconsumereducationmaterialsthroughmanychannels pharmaciesetc Developandimplementchildcareprovidertrainingcurriculum VDHandMSVFPartnership GoalsToprovideclinicallyrelevantinformationtophysiciansregardingappropriateantibioticuse Toprovideinformationandresourcestoassistcliniciansineducatingpatientsregardingappropriateantibioticuse LettertoDaycareProviders ViralPrescriptionPads WhatWeKnow IncreasingantibioticresistancethreatenssuccessofantibiotictreatmentforcommoninfectionsDecreasedantibioticusehasbeenshowntoreverseantibioticresistanttrendsManyconsumersuseantibioticsinappropriately educationwilltargetchildcare schoolsandparentsEffectivemeasures