Abstract
BackgroundAntibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China.MethodsEnglish and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis.ResultsOf 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver’s self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue.ConclusionThe prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.
Highlights
Antibiotic resistance poses a significant threat to public health globally
Study characteristics and quality Of the 98 eligible studies included in our review, 79 studies reported the prevalence of antibiotic utilization of children, including 34 studies on outpatient [35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68], 40 studies on inpatient [69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108], and one study on both outpatient and inpatient [109]
42 studies reported the risk factors for antibiotic utilization [20, 35, 36, 42, 45, 46, 52, 53, 58, 60, 67, 70, 76, 77, 83,84,85, 91, 92, 99, 110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131], of which, four studies focused on children, 19 studies focused on physicians, 30 studies reported from caregivers, 11 studies reported from retail pharmacies, and one study reported from hospital.(Table S3, Table S4, Table S5,Table S6 in Additional file 1)
Summary
Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. About 50% of antibiotics were prescribed to children who were suffering from viral infection or non-infectious diseases, and the proportion of antibiotic prescriptions under 15 years old was three times than other ages [16, 17]. Children may have little or even no benefit from antibiotics [22], promotion of rational use of antibiotics and reduction in antibiotic resistance in children has become an urgent problem [23, 24] To combat this problem, the Chinese government has launched relevant policies continuously since 2009. National action plan combating antimicrobial resistance proposed to carry out health education on the rational use of antibiotics in primary and secondary schools [28]
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