Current Practices on Prescribing and Deprescribing for Patients on Long-Term Antibiotic Treatment for Chronic Pulmonary Conditions: An Umbrella Review by the European Society of Clinical Pharmacy (ESCP)

Chronic pulmonary conditions require complex treatment strategies involving long-term antibiotic treatment, which carries the highest risk of antimicrobial resistance and adverse drug events (ADE). Specific guidance on prescribing and deprescribing can help reduce these risks and improve therapy effectiveness. The aim of the study was to determine prescribing and deprescribing practices for long-term antibiotic treatment (≥30 days) in preventing exacerbations of stable chronic pulmonary conditions in adult patients across all healthcare settings. This umbrella review was part of a larger registered study (PROSPERO, CRD42022381268) including systematic reviews and meta-analyses retrieved from PubMed, Cochrane Library, and PsycInfo. Outcomes of interest included condition, antibiotic, dose, duration, (de-) prescribing advice. Standardized methodological tools were used to assess methodological quality of the selected publications (ROBIS), facilitate data extraction (EPOC), and guide narrative summary of findings (PRIOR). In total, <i>n</i> = 14 publications were analyzed. (De-)prescribing advice is summarized for treatment (≥30 days) of chronic obstructive pulmonary disease, asthma, non-cystic fibrosis bronchiectasis, cystic fibrosis, and bronchiolitis obliterans syndrome. Macrolides are the most commonly recommended antibiotic for stable chronic pulmonary conditions. ADEs are the main reason for antibiotic discontinuation. Little consideration is given to emergence of antibiotic resistance. There is a significant paucity of literature providing specific (de-)prescribing advice for clinical practice. More precise recommendations are required in view of patient safety.

慢性肺部疾病需采用包含长期抗生素治疗在内的复杂治疗策略，而此类治疗的抗菌药物耐药(antimicrobial resistance)与药物不良反应事件(adverse drug events, ADE)风险最高。针对处方开具与停药的专项指导，可有效降低上述风险并提升治疗有效性。本研究旨在明确各类医疗场景下，成年慢性稳定性肺部疾病患者中，用于预防疾病急性加重的长期抗生素治疗（疗程≥30天）的处方开具与停药实践。本伞状综述(umbrella review)隶属于一项更大规模的注册研究（PROSPERO注册号：CRD42022381268），该研究纳入了从PubMed、Cochrane Library及PsycInfo数据库中检索得到的系统评价与荟萃分析。本研究关注的结局指标包括疾病类型、抗生素种类、给药剂量、疗程以及（退）处方建议。研究采用标准化方法学工具对纳入文献的方法学质量进行评估（ROBIS）、辅助数据提取（EPOC）并指导研究结果的叙述性总结（PRIOR）。最终共分析了n=14篇文献。本文针对慢性阻塞性肺疾病、哮喘、非囊性纤维化支气管扩张症、囊性纤维化以及闭塞性细支气管炎综合征的疗程≥30天的治疗，总结了相应的（退）处方建议。大环内酯类药物是慢性稳定性肺部疾病最常被推荐的治疗用抗生素。药物不良反应事件是抗生素停药的主要诱因。目前对抗菌药物耐药性产生的考量却极为有限。当前针对临床实践提供专项（退）处方建议的相关文献极为匮乏。基于患者安全考量，亟需更为精准的相关推荐意见。