PMID- 32977855 OWN - NLM STAT- MEDLINE DCOM- 20210902 LR - 20240329 IS - 2047-2994 (Electronic) IS - 2047-2994 (Linking) VI - 9 IP - 1 DP - 2020 Sep 25 TI - Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012-2017. PG - 159 LID - 10.1186/s13756-020-00821-7 [doi] LID - 159 AB - BACKGROUND: The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. METHODS: Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. RESULTS: Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = - 2.4518, P = 0.005) and showed a downward trend (coefficient = - 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = - 0.0553, P = 0.035; coefficient = - 0.0294, P = 0.037; coefficient = - 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of beta-lactamase-sensitive penicillins to total antibiotic use (coefficient = - 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = - 0.0423, P = 0.017; coefficient = - 0.0223, P = 0.006, respectively). An immediate decline (coefficient = - 1.9292, P = 0.002) and a downward trend (coefficient = - 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. CONCLUSIONS: Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ss-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future. FAU - Wang, Xuemei AU - Wang X AD - School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. FAU - Tang, Yuqing AU - Tang Y AD - School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. FAU - Liu, Chenxi AU - Liu C AD - School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. FAU - Liu, Junjie AU - Liu J AD - School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China. FAU - Cui, Youwen AU - Cui Y AD - School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. FAU - Zhang, Xinping AU - Zhang X AUID- ORCID: 0000-0002-0688-2417 AD - School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. xpzhang602@hust.edu.cn. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200925 PL - England TA - Antimicrob Resist Infect Control JT - Antimicrobial resistance and infection control JID - 101585411 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Anti-Bacterial Agents/*therapeutic use MH - Antimicrobial Stewardship/*methods MH - China MH - Drug Prescriptions/*statistics & numerical data MH - Drug Resistance, Multiple, Bacterial MH - Evidence-Based Medicine MH - Humans MH - Interrupted Time Series Analysis MH - Practice Patterns, Physicians' MH - Prescription Drug Overuse/prevention & control MH - Primary Health Care MH - Quality Indicators, Health Care PMC - PMC7519519 OTO - NOTNLM OT - Antibiotic consumption OT - Interrupted time series analysis OT - Primary care OT - Quality indictors of European surveillance of antimicrobial consumption (ESAC QIs) OT - Restrictive-prescribing stewardship COIS- The authors declare no conflict of interest. EDAT- 2020/09/27 06:00 MHDA- 2021/09/03 06:00 PMCR- 2020/09/25 CRDT- 2020/09/26 05:20 PHST- 2020/07/03 00:00 [received] PHST- 2020/09/21 00:00 [accepted] PHST- 2020/09/26 05:20 [entrez] PHST- 2020/09/27 06:00 [pubmed] PHST- 2021/09/03 06:00 [medline] PHST- 2020/09/25 00:00 [pmc-release] AID - 10.1186/s13756-020-00821-7 [pii] AID - 821 [pii] AID - 10.1186/s13756-020-00821-7 [doi] PST - epublish SO - Antimicrob Resist Infect Control. 2020 Sep 25;9(1):159. doi: 10.1186/s13756-020-00821-7.