AbstractAntibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference.

摘要抗生素通常在不需要或具有不必要的广谱活性时被不适当地处方。这是一个严重的问题，可能导致抗菌药物耐药性（AMR）的发展。本研究以世界卫生组织指标和框架为参考，评估莫桑比克楠普拉一家四级医院住院儿科患者的抗生素处方模式。

A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0–10 years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories.

使用从病历中获得的次要数据进行了回顾性研究。研究人群包括0-10岁的儿童，他们在莫桑比克楠普拉的四级医院病房住院。使用指标和WHO将抗生素分类为已知类别来评估抗生素处方的模式。

Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1–3 years and 28 days-12 months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria.

应用描述性统计。研究期间共开出464种抗生素。1-3岁和28天-12个月的年龄组服用了更多的抗生素。最常见的抗生素是头孢曲松和结晶青霉素，它们经常用于患有支气管肺炎，胃肠炎和疟疾的患者。

74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection.

74.8%的抗生素处方属于接入组，而23.7%属于观察组。储备组没有抗生素处方。每个处方的平均抗生素数量为1.51（标准差±0.725）。抗生素处方率为97.5%，注射处方率为96.20%。

All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy.

所有处方的抗生素都在基本药物清单上，并以通用名称开具。这些结果令人担忧，并突出了加强抗菌优化措施的紧迫性，以及在抗生素处方中实施AWaRe框架作为基本策略。

IntroductionAntibiotic use in hospitals, particularly inappropriate use, has been a crucial factor in the global rise of antimicrobial resistance (AMR), a global public health problem affecting humans, animals, agriculture, and the environment1,2. AMR is increasingly being reported globally, associated with an estimated 4.95 million deaths in 2019, including 1.27 million deaths directly attributable to AMR3,4.

引言医院中抗生素的使用，特别是不适当的使用，一直是全球抗菌素耐药性（AMR）上升的关键因素，AMR是影响人类，动物，农业和环境的全球公共卫生问题1,2。全球报告的AMR越来越多，2019年估计有495万人死亡，其中127万人直接归因于AMR3,4。

It is particularly alarming in sub-Saharan Africa, where excessive and inappropriate use could lead to more than 10 million deaths annually by 2050 if not addressed1,3. Programs that provide antimicrobial optimization are necessary, and are considered an essential element in the global response to AMR5.The World Health Organization (WHO) developed the Access, Watch, and Reserve (AWaRe) antibiotic classification framework in 2017, and revised it in 2019 and 2021, to guide the empirical treatment of common diseases in children and adults.

这在撒哈拉以南非洲尤其令人担忧，如果不加以解决，到2050年，过度和不适当的使用每年可能导致1000多万人死亡1,3。提供抗菌优化的计划是必要的，并且被认为是全球应对AMR5的重要因素。世界卫生组织（WHO）于2017年制定了获取，观察和保留（AWaRe）抗生素分类框架，并于2019年和2021年对其进行了修订，以指导儿童和成人常见疾病的经验性治疗。

This guide is essential for healthcare professionals around the world, aligning with the WHO Model Lists of Essential Medicines and optimizing the quality and quantity of antibiotic prescriptions, helping to combat global antimicrobial resistance6,7,8,9. The Access group comprises first- or second-line antibiotics for common empirical treatments and should be widely available.

本指南对于世界各地的医疗保健专业人员至关重要，与世卫组织基本药物模型清单保持一致，优化抗生素处方的质量和数量，有助于对抗全球抗菌药物耐药性6,7,8,9。接入组包括用于常见经验性治疗的一线或二线抗生素，应广泛使用。

The Watch group includes antibiotics with a high risk of resistance, to be used only in specific indications. These need to be monitored and prioritized as targets for management programs. The Reserve group contains last-resort antibiotics, used only in special circumstances to preserve their efficacy10.The WHO AWaRe classification is a crucial tool for monitoring antibiotic prescriptions and optimizing antimicrobial programs, helping in the fight against ant.

观察组包括具有高耐药风险的抗生素，仅用于特定适应症。。储备组包含最后手段的抗生素，仅在特殊情况下使用以保持其功效10。WHO意识分类是监测抗生素处方和优化抗菌方案的关键工具，有助于对抗蚂蚁。

Table 1 Distribution of Antibiotics Prescribed According to Age.Full size tableDistribution of antibiotics according to specific diseaseAccording to Table 2, the most prescribed antibiotics were crystalline penicillin (33.41%), sulfamethoxazole and trimethoprim (18.53%), ceftriaxone (18.53%), and gentamicin (11.21%).

表1根据年龄处方的抗生素分布。全尺寸表根据特定疾病分配抗生素根据表2，处方最多的抗生素是结晶青霉素（33.41%），磺胺甲恶唑和甲氧苄啶（18.53%），头孢曲松（18.53%）和庆大霉素（11.21%）。

Crystalline penicillin was predominantly prescribed for patients suffering from bronchopneumonia (57; 56.4%), followed by febrile convulsions (20; 58.8%), malaria (19; 45.2%), and gastroenteritis (14; 7.0%). Sulfamethoxazole-trimethoprim was most frequently prescribed for patients suffering from gastroenteritis (80; 43.2%).

结晶青霉素主要用于患有支气管肺炎的患者（57；56.4%），其次是高热惊厥（20；58.8%），疟疾（19；45.2%）和胃肠炎（14；7.0%）。磺胺甲恶唑甲氧苄啶最常用于胃肠炎患者（80；43.2%）。

Ceftriaxone was the primary choice for patients suffering from gastroenteritis (50; 27.0%), followed by malaria (12; 28.6%), febrile convulsions (6; 17.6%), and typhoid fever (5; 45.5%). Gentamicin was predominantly prescribed for patients suffering from bronchopneumonia (28; 27.7%), malaria (4; 9.5%), and febrile seizures (3; 8.8%)..

头孢曲松是胃肠炎患者的主要选择（50；27.0%），其次是疟疾（12；28.6%），高热惊厥（6；17.6%）和伤寒（5；45.5%）。庆大霉素主要用于患有支气管肺炎（28；27.7%），疟疾（4；9.5%）和高热惊厥（3；8.8%）的患者。。

Table 2 Distribution of Antibiotics by Specific Diseases.Full size tableDistribution of prescribed antibiotics according to WHO's AWaRe classificationAs shown in Table 3, 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions for antibiotics from the Reserve group.

表2抗生素在特定疾病中的分布。处方抗生素的全尺寸表分布根据WHO的AWaRe分类如表3所示，处方抗生素的74.8%属于接入组，而23.7%属于观察组。储备组没有抗生素处方。

Among the antibiotics in the Access group, crystalline penicillin (155 prescriptions), sulfamethoxazole and trimethoprim (86 prescriptions), and gentamicin (52 prescriptions) were the most common. In the Watch group, ceftriaxone was the most prescribed antibiotic (95 prescriptions)..

在接入组的抗生素中，结晶青霉素（155个处方），磺胺甲恶唑和甲氧苄啶（86个处方）和庆大霉素（52个处方）是最常见的。在观察组中，头孢曲松是处方最多的抗生素（95张处方）。。

Table 3 Distribution of Antibiotics Prescribed According to the WHO AWaRe Classification.Full size tableWHO/INRUD core prescribing indicatorsAccording to Table 4, the average number of antibiotics per prescription was 1.51 (SD ± 0.725). The maximum number of antibiotics per prescription was 4. The percentage of antibiotic prescriptions was 97.5%, with 96.20% by injectable route.

表3根据WHO AWaRe分类规定的抗生素分布。全尺寸表WHO/INRUD核心处方指标根据表4，每个处方的平均抗生素数量为1.51（SD±0.725）。每个处方最多使用4种抗生素。抗生素处方比例为97.5%，注射途径为96.20%。

All antibiotics prescribed were on the list of essential medicines..

所有处方的抗生素都在基本药物清单上。。

Table 4 World Health Organization/ International Network of Rational Use of Drugs (INRUD) core prescribing indicators used to assess the study's prescriptions.Full size tableDiscussionThis study represents the first in Mozambique to assess the patterns of antibiotic use in hospitalized children in a quaternary care hospital, using the WHO AWaRe classification.

表4世界卫生组织/国际合理用药网络（INRUD）用于评估研究处方的核心处方指标。全尺寸表格讨论这项研究是莫桑比克首次使用WHO AWaRe分类评估四级保健医院住院儿童抗生素使用模式。

The research findings show the worrying trend of inappropriate prescribing in the country. This puts an additional burden on patients, who are forced to bear the costs of this irrational prescribing.Our study revealed a predominant prescription of antibiotics for children aged 1 to 3 years (39.91%) and those between 28 days and 12 months (37.07%).

研究结果表明，该国不适当处方的趋势令人担忧。。

Among children aged 28 days to 1 year, the most prescribed drugs included sulfamethoxazole and trimethoprim, crystallized penicillin, ceftriaxone, ampicillin, and gentamicin. Conversely, for children aged 1 to 3 years, the most commonly prescribed antibiotics were metronidazole, ampicillin, ceftriaxone, and gentamicin.

在28天至1岁的儿童中，处方最多的药物包括磺胺甲恶唑和甲氧苄啶，结晶青霉素，头孢曲松，氨苄西林和庆大霉素。相反，对于1至3岁的儿童，最常用的抗生素是甲硝唑，氨苄西林，头孢曲松和庆大霉素。

These findings align with a study in pediatric patients at a hospital in Ghana, which also emphasized the frequency of gentamicin and ampicillin. Furthermore, ceftriaxone, gentamicin, ampicillin, crystallized penicillin, and metronidazole emerged as the most prescribed antibiotics for both age groups19.

这些发现与加纳一家医院对儿科患者的研究一致，该研究也强调了庆大霉素和氨苄青霉素的频率。此外，头孢曲松，庆大霉素，氨苄西林，结晶青霉素和甲硝唑成为两个年龄组中处方最多的抗生素19。

In an Ethiopian study, a combination of ampicillin and gentamicin was prescribed for patients under one month of age, as well as for those between one month and 1 to 5 years of age. Notably, there was a high prevalence of ceftriaxone in children aged 1 month to 1 year20. These studies highlight similar prescribing patterns, influenced by specific contextual factors in sub-Saharan African countries.Concerning the distribution of antibiotics based on specific.

在埃塞俄比亚的一项研究中，氨苄西林和庆大霉素的联合用药适用于一个月以下的患者以及一个月至1至5岁的患者。值得注意的是，头孢曲松在1个月至1岁的儿童中的患病率很高20。这些研究强调了受撒哈拉以南非洲国家特定背景因素影响的类似处方模式。关于基于特定抗生素的分布。

Data availability

数据可用性

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。

AbbreviationsAMR:

缩写AMR：

Antimicrobial resistance

细菌耐药性

AWaRe:

意识到：

Access, watch and reserve

访问、监视和保留

IBM:

IBM公司：

International business machines corporation

国际商业机器公司

INRUD

INRUD

:

:

International network of rational use of drugs

国际合理用药网络

SPSS:

SPSS：

Statistical package for the social sciences

社会科学统计软件包

SD:

标准差：

Standard deviation

标准偏差

WHO:

谁：

World health organization

世界卫生组织

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Download referencesAcknowledgementsThe authors thank Hannah Malone for her thorough revision of the language and grammar to improve readability of the manuscript.FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.Author informationAuthors and AffiliationsInstitute of Collective Health, Federal University of Mato Grosso, Av.

下载参考文献致谢作者感谢Hannah Malone对语言和语法的彻底修订，以提高手稿的可读性。资助这项研究没有得到公共，商业或非营利部门资助机构的任何特定资助。作者信息作者和附属机构马托格罗索联邦大学集体健康研究所，Av。

Fernando Correa da Costa, 2367 - Bairro Boa Esperança, Cuiabá, Mato Grosso, 78060-900, BrazilSancho Pedro Xavier & Ageo Mario Cândido da SilvaSchool of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, 01246904, BrazilAudêncio VictorAuthorsSancho Pedro XavierView author publicationsYou can also search for this author in.

Fernando Correa da Costa，2367-Bairro Boa Esperança，Cuiabá，马托格罗索州，78060-900，巴西Sancho Pedro Xavier&Ageo Mario Cândido da Silva圣保罗大学公共卫生学院（USP），Avenida Doutor Arnaldo，715，圣保罗，01246904，巴西Audêncio Victor作者Sancho佩德罗·哈维尔查看作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarAgeo Mario Cândido da SilvaView author publicationsYou can also search for this author in

PubMed Google ScholarAgeo Mario Cándido da SilvaView作者出版物您也可以在

PubMed Google ScholarAudêncio VictorView author publicationsYou can also search for this author in

PubMed Google ScholarAudêncio VictorView作者出版物您也可以在

PubMed Google ScholarContributionsAll authors were involved in the conceptualization of the study and in the review and submission of the manuscript. SX was involved in data analysis and SX, AV and AS were involved in interpretation and Manuscript appropriation. All authors read and approved the final manuscript.Corresponding authorCorrespondence to.

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Reprints and permissionsAbout this articleCite this articleXavier, S.P., da Silva, A.M.C. & Victor, A. Antibiotic prescribing patterns in pediatric patients using the WHO access, watch, reserve (AWaRe) classification at a quaternary hospital in Nampula, Mozambique.

转载和许可本文引用本文Xavier，S.P.，da Silva，A.M.C.＆Victor，A.在莫桑比克楠普拉的一家四级医院使用WHO access，watch，reserve（AWaRe）分类对儿科患者进行抗生素处方模式。

Sci Rep 14, 22719 (2024). https://doi.org/10.1038/s41598-024-72349-4Download citationReceived: 06 December 2023Accepted: 05 September 2024Published: 30 September 2024DOI: https://doi.org/10.1038/s41598-024-72349-4Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

科学报告1422719（2024）。https://doi.org/10.1038/s41598-024-72349-4Download引文接收日期：2023年12月6日接收日期：2024年9月5日发布日期：2024年9月30日OI：https://doi.org/10.1038/s41598-024-72349-4Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsAntibiotics PrescriptionPediatric PatientsWHO AWaRe classificationMozambique

关键词抗生素处方儿科患者谁知道分类莫桑比克

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