Background: High antibiotic prescribing rates for adults with an asthma exacerbation have been reported in developed countries, but few studies have assessed the variation of antibiotic and adjunctive treatment in the routine care of children. Objective: We evaluated the trends in health resource utilization for children hospitalized for asthma exacerbation, ascertained the variations of practices across hospitals and geographic location, and classified these different patterns at hospital levels. Methods: Using data on Japanese children hospitalized for asthma exacerbation with no indication of bacterial infection during 2010–2018, we conducted a retrospective observational study to assess the trends in initial treatment patterns and their variations. Mixed-effect generalized linear models were used to investigate the treatment trends. Hierarchical cluster analyses were performed to classify the treatment variations across hospitals. Results: Overall, 54,981 children were eligible for the study. Proportions of antibiotic use decreased from 47.2% in 2010 to 26.9% in 2018. Similarly, utilization of antitussives, antihistamines, and methylxanthine showed decreasing trends over the period, whereas the use of mucolytics and ambroxol increased. These treatment variations were more considerable in hospital levels than in 47 prefecture levels. Hierarchical cluster analyses classified these patterns into 6 groups, mostly based on mediator release inhibitor, ambroxol, and antitussives. Conclusions: Wide variations in antibiotics and adjunctive treatments were observed across hospital levels. Our findings support the improvement in reducing inappropriate antibiotic use and highlight the need for comparative effectiveness research of the adjunctive treatments among children hospitalized for asthma.
Int Arch Allergy Immunol

中文翻译：

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日本因哮喘急性发作而住院的儿童的近期实践模式和变异

背景：在发达国家，成年人哮喘发作的抗生素处方率很高，但是很少有研究评估儿童常规护理中抗生素和辅助治疗的差异。目的：我们评估了因哮喘发作而住院的儿童的健康资源利用趋势，确定了不同医院和地理位置的做法差异，并在医院级别对这些不同模式进行了分类。方法：我们使用2010-2018年间因哮喘急性发作住院且无细菌感染迹象的日本儿童的数据，进行了一项回顾性观察性研究，以评估初始治疗模式及其变化的趋势。混合效应广义线性模型用于研究治疗趋势。进行了层次聚类分析以对各医院的治疗差异进行分类。结果：总共有54,981名儿童符合研究条件。抗生素的使用比例从2010年的47.2％下降到2018年的26.9％。同样，在此期间，使用镇咳药，抗组胺药和甲基黄嘌呤的趋势呈下降趋势，而使用粘液溶解剂和氨溴索的比例增加。与47个州的医院水平相比，这些治疗差异在医院水平上更为显着。层次聚类分析将这些模式分为6组，主要基于介质释放抑制剂，氨溴索和镇咳药。结论：在整个医院中，观察到抗生素和辅助治疗方法的广泛差异。我们的研究结果支持减少不当抗生素使用方面的改进，并强调需要对哮喘住院儿童的辅助治疗进行比较有效性研究。
Int Arch过敏免疫