[Investigation on the rational use of antibacterial agents by Chinese pediatricians in 2016].

[Investigation on the rational use of antibacterial agents by Chinese pediatricians in 2016].

Zhonghua Er Ke Za Zhi. 2018 Dec 02;56(12):897-906

Authors: National Health and Family Planning Commission Expert Committee on Rational Use of Medicines for Children Pharmaceutical Group

Abstract
Objective: To obtain baseline data of pediatricians' clinical use of antibacterial agents in children in China, and provide evidence for the follow-up of guidelines for the diagnosis and treatment of children's clinical medications and the development of rational drug management measures and norms. Methods: A multi-center cross-sectional study was designed to conduct a network electronic questionnaire survey of doctors with child prescription rights in hospitals of all provinces, municipalities and autonomous regions across the country through cluster sampling to understand the current status of antibacterial drugs use in 2016. Results: The survey information of 3 494 pediatricians in tertiary hospitals was finally included. (1) Ranking of the importance of children's medication focus: 54.5% of doctors ranked first the "safety" and 43.5% ranked second the "efficacy" . (2) The most urgent antibacterial agents for children are reported as macrolides (11.9%), third-generation cephalosporins (4.8%), penicillins (4.2%), sulfonamides (2.5%), and carbapenems (2.4%). (3) The top five drugs that are urgently needed to obtain children's indications are: macrolides (26.4%), quinolones (19.9%), aminoglycosides (10.4%), and other antibacterials (9.0%) and the 3rd generation cephalosporins (5.1%). (4) For children with bacterial upper respiratory tract infections, antibacterial drugs should be used in the order of penicillins, second-generation cephalosporins, third-generation cephalosporins, azithromycin or erythromycin, medicamycin or unscented erythromycin or ester erythromycin. (5) The most important basis for empirical use of antibacterials, 42.0% of doctors chose "clinical signs and symptoms", followed by "imaging results" (41.0%). (6) 87.0% of the doctors chose" to read the drug instructions manual before using the drug" as the main way to understand the drug; for the adverse reactions of the antibacterial drugs, the top three rankings of the surveyed doctors were "allergic reactions" (93.3%). "hepatic/kidney functional side effects" (91.1%) and "myelosuppression" (48.2%). (7) The three main problems of children's drug risk selected by the surveyed doctors are "lack of indications for children's medication" (85.5%), "abuse of antimicrobials" (71.2%) and"formulations and specifications for lack of children's drugs". (69.2%). (8) The key link for children's rational drug use, the choice of the doctors to investigate is "clarifying and improving the indications for children's medication" (89.0%), "strengthening the rational use of drugs and clinical guidelines for children" (66.2%) and "developing and producing pharmaceutical dosage form for children and its specifications" (62.6%). Conclusions: Pediatricians are generally reasonable in the basic concepts and knowledge, attitudes and practices of rational use of antibiotics: they can put the safety of medications first, pay attention to reading the instructions before using drugs, and pay attention to the adverse reactions of children. For the drugs that result in adverse reactions in children, it is urgent to understand their indications. Pediatricians use clinical symptoms, signs and imaging findings as an empirical basis for the selection of drugs for bacterial upper respiratory tract infections and antimicrobial agents. The investigation found that macrolides, third-generation cephalosporins, penicillins and other drugs are the most urgent antibacterial drugs in pediatrics, and found that a considerable number of antibacterials lack the indications for children, lack of dosage forms and specifications for children, presence of abuse, etc. The problem is that there are hidden dangers in the use of antibiotics in children. The survey concluded that for pediatricians, the basic concepts and knowledge, attitudes and practices of the rational use of antimicrobials continue to be strengthened. It is necessary to clarify and improve the indications for children's medications, strengthen the training of rational medications and clinical guidelines, and vigorously develop and produce children's medicine dosage forms and their specifications for existing antibacterial drugs. All these are the key links for children's rational use of antibacterials.

PMID: 30518003 [PubMed - in process]

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