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

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1、AppropriateAntibioticUseandAntibioticResistanceintheCommunityKateGrant,MSProjectDirectorGetSmartVirginiaVirginiaDepartmentofHealthImportanceofPneumococcalInfectionsintheU.S.1st3,300Meningitis2nd60,000Bloodstreaminfection1st7millionOtitisMedia1st125,000PneumoniaRankCasespe

2、rYearTypeofInfection2000CDCActiveBacterialCoreSurveillance(ABCs)PenicillinResistanceinS.pneumoniae,UnitedStates1979-20001979-1994:CDCSentinelSurveillanceNetwork1995-2000:CDCActiveBacterialCoreSurveillance(ABCS)SystemEmergingInfectionsProgramDrugResistantStreptococcuspneumo

3、niaeEmergedinSpainandSouthAfricaEmergedintheU.S.inthelastdecadeUseofantibioticsforviralinfectionsThreateninguseofantibioticsforcommoninfectionsResistanceandAntibioticPrescribingRiskfactorsforresistantS.pneumoniaeare:youngage(<1year)highersocioeconomicstatusday-careattendan

4、cerecentreceiptofantibiotics(2-5timesgreaterrisk)Pediatrics1993;92:761-7.ReasonsforAntibioticOveruseConclusionsfrom8FocusGroupsPatientConcernswantclearexplanationgreennasaldischargeneedtoreturntowork/childcarePhysicianConcernspatientexpectsantibioticdiagnosticuncertaintyt

5、imepressureBarden,ClinPediatric1998;37:665-672AntibioticPrescriptionPatientSatisfactionandAntibioticsHamm,JFamPract1996;43:56Mangione-Smith,Pediatrics1999;103:711-8Satisfactionpredictedby:timespentbyMDexplainingillnesspatientunderstandingoftreatmentchoiceSatisfactionnotpr

6、edictedbyreceiptofantibioticsCanResistanceTrendsBeReversed?PublichealthcampaigninIcelandfollowingdramaticincreaseintheratesofpenicillin-resistantpneumococcifrom2.3%to20%in4yearsRatesfellfrompeakof20%in1993to16.9%in1994Carriageratesofresistantstrainsamongdaycareattendeesdro

7、ppedfrom20%to15%insameperiodJAMA1996;275;175CommunityandClinicianEducationCanEffectivelyReduceAntibioticUseIntervention:Distributionofmaterialsandpresentationstoclinicstaff,parents,daycareproviders,communitygroupsSmallgrouppresentationsforcliniciansAcontrolledinterventiont

8、rialwasconductedinseveralnorthernWisconsincommunitiesduring1997-98.Outcome:11%reductionin