非洲儿科医疗中的不合理抗生素处方：一项系统综述与荟萃分析。
完整摘要 · 中文译文
背景：不适当的抗生素使用，包括偏离指南建议、剂量错误和过度处方，是一个重要的公共卫生问题。本系统综述和荟萃分析评估了非洲儿科人群中不适当抗生素使用的流行率及相关因素。 方法：按照PRISMA指南和PICOC框架，在PubMed、Web of Science和African Journals Online中进行了全面检索。使用混合方法评价工具（MMAT）评估研究质量。采用STATA 17以随机效应模型进行荟萃分析。 结果：从3，085条记录中，11项研究符合纳入标准。不适当抗生素使用的合并流行率为44%。部分国家的发生率高达75.1%、73.9%和71.5%，而其他地区报告的发生率较低，为11%和19.3%。回顾性研究的合并流行率为51.2%（I² = 99.5%），前瞻性研究为35.4%（I² = 99%）。常用处方抗生素包括复方磺胺甲噁唑、阿莫西林和头孢曲松。不适当实践涉及剂量错误（10.1%-19.5%）和疗程错误（17.47-18.8%）。危险因素包括较低年龄、使用三种或以上抗生素（AOR：2.8，95% CI：1.245-6.462，p = 0.013）以及住院时间延长。 结论：非洲儿科不适当抗生素使用高度流行，受年龄、住院和多重用药驱动，凸显了针对性抗菌药物管理干预的必要性。 影响：本研究首次汇集了非洲各地的证据，表明近一半的抗生素 给儿童开具的抗生素存在不合理使用。研究结果呼吁开展更有力、更有针对性的抗生素管理行动，以改善处方实践并遏制非洲医疗环境中日益增长的耐药威胁。
完整摘要 · 英文原文
BACKGROUND: Inappropriate antibiotic use, including deviations from guideline recommendations, incorrect dosages, and over-prescription, is a critical public health concern. This systematic review and meta-analysis assessed the prevalence and factors associated with inappropriate antibiotic use in pediatric populations across Africa. METHOD: A comprehensive search was conducted in PubMed, Web of Science, and African Journals Online, following PRISMA guidelines and the PICOC framework. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Meta-analysis was performed with STATA 17 using a random-effects model. RESULT: From 3,085 records, 11 studies met inclusion. The pooled prevalence of inappropriate antibiotic use was 44%. Rates reached 75.1%, 73.9%, and 71.5% in some countries, while lower rates of 11% and 19.3% were reported elsewhere. Retrospective studies showed a pooled prevalence of 51.2% (I² = 99.5%), and prospective studies 35.4% (I² = 99%). Commonly prescribed antibiotics included cotrimoxazole, amoxicillin, and ceftriaxone. Inappropriate practices involved incorrect dosages (10.1%-19.5%) and durations (17.47-18.8%). Risk factors included younger age, three or more antibiotics (AOR: 2.8, 95% CI: 1.245-6.462, p = 0.013), and prolonged hospitalization. CONCLUSION: Inappropriate pediatric antibiotic use in Africa is highly prevalent, driven by age, hospitalization, and polypharmacy, underscoring the need for targeted stewardship interventions. IMPACT: This study is the first to bring together evidence across Africa showing that nearly half of antibiotics prescribed to children are used inappropriately. The findings call for stronger, targeted antibiotic stewardship efforts to improve prescribing practices and curb the growing threat of resistance in African healthcare settings.