促进适当使用抗生素

自从1920年代亚历山大·弗莱明（Alexander Fleming）发现青霉素以来，已经开发了150种抗菌药物，用于人类或兽医使用。这些药物对传染病和人口健康的影响非常显着。现在可以使用医生开出的抗生素成功控制一种曾经认为的严重细菌感染。并非总是如此，因为我们的祖父母可能会作证：细菌感染通常是致命的，可用于治疗此类感染的选择受到限制。

医生们一直敦促减少一个tibiotics they prescribe when it is safe and appropriate to do so.

This “golden age” of discovery may, however, soon come to an end, as more and more bacteria are becoming resistant to the antibiotics available to us. It is for this reason that healthcare organizations across the world have been focusing on developing stewardship policies to promote the appropriate use of antibiotics. In England, the situation is no different, and the Department of Health and Social Care have developed an antimicrobial resistance strategy. As part of the plan, doctors have been urged to reduce the amount of antibiotics they prescribe when it is safe and appropriate to do so. As the majority of antibiotic prescribing occurs in primary care, healthcare providers working in this setting are set specific prescribing targets.

It is important to establish if the polices are working from an antibiotic stewardship perspective, but also that these polices are fair, and do not penalize communities in the most need of care. Our work aimed to address these questions. To do this, we used antibiotic prescribing data from the NHS, as well as working out the characteristics of the local areas in England using nationally available data sources.

Our study

在英格兰，减少抗生素处方的计划似乎正在起作用

Overall, we found that, in England, the plan to reduce antibiotic prescribing appears to be working: since 2014, antibiotic prescribing has reduced by around 14 per cent. We also found that prescribing of certain classes of antibiotics, namely those considered broad spectrum, have also reduced.

When we considered local factors in our analysis, we showed that the most deprived areas of England had the highest levels of antibiotic prescribing. When we adjusted for two long-term conditions – diabetes and Chronic Obstructive Pulmonary Disease – both of which are associated with increased antibiotic use, we still found higher levels of antibiotic prescribing in the most deprived areas of England. We also showed that geography was an important factor too: compared to London, all other areas of England had higher levels of antibiotic prescribing – with the East of England, and the North East of England having the highest levels.

考虑当地需求

您可能会问为什么这很重要？好吧，这是一个很好的问题。我们的工作表明，除了减少抗生素处方的国家战略外，也必须考虑当地需求。例如，与生活在更富裕地区的人们相比，生活在贫困地区的人们可能对抗生素的健康需求更大。全国一小大的适合所有目标可能不一定要考虑到这一点。如果贫困地区的抗生素需求更大，那么在这些地区工作的医生可能会因开处方而受到不公正的惩罚。这对从事初级保健的医生来说是不公平的，但也可能会对患者产生影响。

抗生素管理政策似乎正在减少整体抗生素处方，这是一件积极的事情，尽管整个英格兰的处方仍存在很大差异。将来的规定目标是正确的，以确保最受剥夺的社区不适当惩罚，这是适当的。

The bottom line is if someone is in medical need of an antibiotic, they should be prescribed it, regardless of the characteristics of their local area or where they live.