家长知识、寻求抗生素行为与儿童呼吸道感染中不当抗生素使用：行为驱动因素及对抗菌药物耐药性影响的叙述性综述

文献信息

中文摘要

背景： 不当使用抗生素是抗菌药物耐药性（AMR）的主要可改变驱动因素之一。呼吸道感染儿童获得了大量本可避免的处方，其原因既在于行为、沟通和可及性，也在于临床需要。
目的： 综合关于儿童呼吸道感染中不当抗生素使用的临床、处方者相关、家长相关、沟通相关、可及性和社会经济驱动因素的证据，并评价针对这些驱动因素的干预措施的证据。
方法： 我们按照SANRA标准开展了一项叙述性综述。检索了PubMed/MEDLINE、Scopus和Web of Science，并以Google Scholar作为补充，检索2014年1月至2025年12月发表的英文同行评议研究。三十项研究构成了核心主题综合。补充检索识别了用于评价抗菌药物管理干预措施的试验和综述。
结果： 在意大利和芬兰等国家，儿童非复杂性呼吸道感染处方显著减少，而严重并发症的发生并未增加。同样，关于急性中耳炎的研究显示获益较低但副作用较多。尽管家长常常对此过程存在误解，但仅有知识并不足以保证正确做法。大量研究显示，医生错误估计了家长的需求，许多儿童最终接受了家长甚至并未要求的抗生素。该问题的原因之一是患者购买非处方药物、使用剩余抗生素以及获得可负担医疗服务的机会受限。研究显示，沟通、审计和临床决策支持培训有助于减少抗生素处方，而国家培训项目未能取得类似成功。
结论： 儿童中不当使用抗生素是家庭、就诊、药房和卫生系统等不同层面影响的结果。由于所提供的大多数证据为横断面研究，这些因素应被视为关联而非已确定的原因。有一些证据提示，将针对临床医生的策略与药物调配和可及性相结合，比仅开展教育更有前景。

英文摘要

BACKGROUND: Inappropriate antibiotic use is one of the main modifiable drivers of antimicrobial resistance (AMR). Children with respiratory tract infections receive a large share of avoidable prescriptions, and the reasons lie as much in behavior, communication, and access as in clinical need.
OBJECTIVE: To synthesize evidence on the clinical, prescriber-related, parental, communication-related, access-related, and socioeconomic drivers of inappropriate antibiotic use in children with respiratory tract infections, and to appraise the evidence for interventions that target these drivers.
METHODS: We conducted a narrative review guided by the SANRA criteria. PubMed/MEDLINE, Scopus, and Web of Science, supplemented by Google Scholar, were searched for English-language peer-reviewed studies published between January 2014 and December 2025. Thirty studies formed the core thematic synthesis. A supplementary search identified trials and reviews used to appraise stewardship interventions.
RESULTS: In countries like Italy and Finland, there was a significant decrease in pediatric prescriptions for uncomplicated respiratory infections, despite not being any increase in the occurrence of serious complications. Similarly, studies on acute otitis media indicated low benefits but abundant side effects. Although the parents were often misinformed about this process, knowledge alone was not sufficient to guarantee proper practice. Numerous studies revealed that physicians estimated the parents' needs incorrectly, and numerous children ended up receiving antibiotics that were not even asked for by their parents. One of the reasons for this issue was that patients were purchasing non-prescription medications, using leftover antibiotics, and limiting their access to affordable medical care. Research showed that communication, auditing, and clinical decision support training helped in reducing antibiotic prescriptions, while national training programs were not able to provide similar successes.
CONCLUSIONS: The inappropriate utilization of antibiotics among children is a result of influences from different levels: household, consultations, pharmacy and health system levels. These factors should be treated as associations instead of identified causes due to the fact that the majority of the evidence provided is cross-sectional. There is some evidence suggesting that a combination of clinician-targeted strategies with dispensing and access for medications is more promising than just education alone.