台灣兒童抗生素問題處方之研究   全文下載

Off-Label Antibiotic Use in the Pediatric Population: A Population-based Study in Taiwan

台灣抗生素濫用導致嚴重抗藥性的問題，而兒童又是容易被處方抗生素的群體，本研究探討門診兒童抗生素非適應症用藥之問題處方，並分析其影響因素。本研究採次級資料分析，主要資料來源為2002至2005年「全民健康保險研究資料庫」之系統抽樣檔，由於健保資料庫屬於申報資料檔，因此本研究之分析並未包括未申報之用藥資料及自費品項；本研究之研究對象為12歲以下之兒童，抗生素藥品依據中央健保局之藥理分類定義。研究結果發現兒童抗生素處方共66,446張；非適應症用藥問題處方發生率33.33%；非適應症用藥問題處方在時間趨勢、不同處方調劑類型、病患特性、醫師特性及機構特性皆有顯著差異。台灣兒童抗生素處方中非適應症用藥比例相當高，在年齡較高、年資較高之醫師、非教學醫院、私立醫療機構、地區醫院等特性較容易處方，可能影響兒童用藥安全及健康至鉅，值得多加注意及探討，此外，未來研究可進一步尋找非適應症用藥的根本原因。"

This study investigated the epidemiology and determinants of off-label antibiotic use in children in Taiwan. This was a retrospec-tive, population-based study using the 2002-2005 Taiwan’s National Health Insurance Research Database (NHIRD). The study subjects consisted of children under 12 years old. The prescriptions of antibiotics were retrieved from the pharmacy claims of NHIRD. Multivari-able logistic regression models were used to assess the associations between patients’ and providers’ demographics and off-label use of antibiotics. Among 66,446 antibiotic prescriptions identified, off-label use accounted for 33.33%. The percentages of off-label use varied with time trend, dispensing type, patient characteristics, physician characteristics and institution characteristics. Off-label use of antibiotics is very common among Taiwanese children, especially in the cases whose prescriptions were issued by senior and experienced physicians, as well as those from private, non-teaching or regional hospitals. Off-label use can seriously affect pediatric drug safety and health, and are worthy of more concern and discussion. In addition, the study in the future would still need to explore the possible root causes of off label use.