美国门诊抗生素处方（2010-2011年）中约30%是不必要的——每年约4,700万张处方，大多用于病毒感染。
原始表述
قدّرت دراسة Fleming-Dutra في JAMA عام 2016 أن نحو 30% من وصفات المضادات الحيوية في عيادات الرعاية الإسعافية الأمريكية غير ضرورية، أي ما يقارب 47 مليون وصفة سنوياً
按来源为原话. 译文由本项目提供；以阿拉伯语原文为准。
译文
美国门诊抗生素处方（2010-2011年）中约30%是不必要的——每年约4,700万张处方，大多用于病毒感染。
出处
- 来源状态
- 档案网站编辑
- 归属
- Archive editors (eltayebat.com)
- 出处
- https://eltayebat.com/rule/antibiotic-overuse/
- 归属的不确定性
- Archive editorial narrative and featured-study cards, written by the archive operators; study selection is the archive's, not necessarily Elawady's.
- 所声称的机制
Overprescribing.
- 所声称的健康影响
Unnecessary exposure, resistance.
- 涉及人群
US outpatients
- Elawady 设定的地域限制
none found
科学评估
正确 – 该说法有可靠证据支持。
证据确定性: 中 – 进一步研究仍可能影响该评估。
1. 说法是什么？
A large share of outpatient antibiotics is unnecessary.
2. 哪些内容可证实是正确的？
From the abstract: 506 prescriptions per 1000 population per year, of which 353 were estimated appropriate (30.2% not appropriate); acute respiratory conditions: 221 per 1000, only 111 appropriate (A-ABX-19). CDC: 'At least 30 percent of antibiotics prescribed in the United States are unnecessary'; 'most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses'; '47 million excess prescriptions each year' (I-ABX-129). A later US claims analysis (2016) found 23.2% of fills inappropriate and 28.5% without a recent diagnosis (I-ABX-130).
3. 哪些内容是错误或夸大的？
Nothing material. 'Mostly for viral infections' matches the CDC wording ('most'), not 'all'. The 30% is an estimate ('at least 30 percent'), not a count.
4. 哪些内容仍不明确？
The exact share depends on the assumptions used to define appropriate prescribing.
5. 哪些研究支持该说法？
A-ABX-19, A-ABX-20, I-ABX-129 (CDC: at least 30%, 47 million), I-ABX-130 (2016: 23.2% inappropriate), I-ABX-131 (Egypt: antibiotics in 81.2% of infection consultations).
6. 哪些研究与该说法相矛盾？
None against the estimate. Later US data with a different method give 23.2% clearly inappropriate plus 35.5% potentially appropriate (I-ABX-130), which is consistent in magnitude.
7. 对德国和欧洲而言情况如何？
Overprescribing is also a concern in Europe; no EU figure was verified here.
8. 关于埃及的已知情况是什么？
In private primary care in Egypt (2017-2021), antibiotics were prescribed in 81.2% of infection-related consultations and 52.9% of prescriptions were WHO 'Watch' antibiotics (I-ABX-131); overuse is therefore also a problem in Egypt.
9. 合理的实际结论是什么？
这支持的是抗生素的合理管理使用——而不是拒绝使用抗生素。
评估详情
- 证据确定性的依据
National survey data (NAMCS/NHAMCS) with guideline-based estimates of appropriateness; the 30% follows from the abstract (506 vs 353 per 1000, i.e. 30.2%). The 47 million figure and the statement that most unnecessary prescriptions were for viral respiratory conditions are confirmed by the CDC statement on the study (I-ABX-129). Certainty is moderate because appropriateness is estimated from diagnosis codes and assumed appropriate rates.
- 来源质量
High-quality national survey analysis.
- 地区可推广性
US data; prescribing rates differ in Europe and Egypt.
- 个体例外情况
Not applicable.
- 说法的地域范围
- 未说明
- 最近审核
- 2026年10月26日 初步
科学证据详解
有充分科学证据支持 – 该说法与一致的高质量证据相符。
研究问题: In US ambulatory care in 2010-2011, what share of antibiotic prescriptions was unnecessary, how many prescriptions per year did this represent, and were they mostly for viral infections?
研究问题详解 (PECO)
- 人群
- US outpatients (doctors' offices and emergency departments), 2010-2011
- 干预或暴露
- Antibiotic prescriptions
- 对照
- Guideline-based estimate of appropriate prescribing
- 地域范围
- US data; prescribing patterns differ by country
- 结局指标
- Share and number of unnecessary prescriptions
- Conditions involved
研究结果按作者报告呈现。我们的评估见下文。
哪些证据支持该说法？
Unnecessary antibiotic prescriptions in the US
National survey analysis of US ambulatory visits.
- 实际结果
- 506 prescriptions/1000/year, 353 appropriate (30.2% not appropriate); acute respiratory conditions 221/1000, 111 appropriate.
- 方法学质量
- high (national representative survey)
- 相关性
- direct: the source of the claim
- 局限
- Appropriateness inferred from diagnoses and guidelines.
CDC: 1 in 3 US outpatient antibiotic prescriptions unnecessary
Centers for Disease Control and Prevention. CDC Online Newsroom (archived) 2016 指南 / 立场声明已核查摘要新增CDC press release on the same study.
- 实际结果
- 'At least 30 percent' unnecessary; '47 million excess prescriptions each year'; most for viral respiratory conditions.
- 方法学质量
- agency statement
- 相关性
- direct: verifies the 47 million figure and 'mostly viral'
- 局限
- Press release, not peer-reviewed.
About a quarter of US antibiotic fills were inappropriate in 2016
Later US claims analysis with a different method.
- 实际结果
- 2016: 23.2% inappropriate, 35.5% potentially appropriate, 28.5% without a recent diagnosis.
- 方法学质量
- moderate-high (19.2 million enrollees)
- 相关性
- indirect (different year, population and method)
- 局限
- Coding-based classification.
哪些证据不支持该说法？
未发现反对该说法的高质量证据。
总体证据说明了什么？
基于上述研究的编辑评估——其本身并非研究结果。
哪种观点有更好的证据支持？
The claim is correctly reproduced: about 30% (at least 30%) of US outpatient antibiotic prescriptions in 2010-2011 were unnecessary, about 47 million per year, most for viral respiratory conditions.
为什么有些研究权重更大
The primary study and the CDC statement are direct; later data (Chua 2019) and Egyptian data (Nguyen 2026) show the problem persists and is not limited to the US.
因果关系是否已确立？ 不适用 Descriptive estimate, not a causal question.
仍存在的不确定性
The estimate depends on assumptions about appropriate prescribing rates; it may be conservative ('at least').
合理的结论
Correct as reported.
为什么研究结果看起来互相矛盾？
No real conflict: Chua 2019 (23.2% inappropriate) uses another population, year and classification; adding fills without any diagnosis code would increase the share.
这是否取决于国家？
- 一般生物学效应
- Not a biological question.
- 饮食习惯
- Not applicable (medicine use, not diet).
- 法律规则
- Prescription-only status of antibiotics differs; non-prescription dispensing is common in many LMICs.
- 实际监测数据
- Egypt: antibiotics were prescribed in 81.2% of infection-related private primary-care consultations, 52.9% from the WHO Watch group (I-ABX-131).
地区差异有可靠数据支持。
统计复核
- Share not appropriate from reported rates – (506-353)/506 = 30.2%; acute respiratory conditions account for 110 of the 153 excess per 1000 (72%). 已重新计算
- Plausibility of 47 million – 153 excess per 1000 implies about 307 million people, consistent with the US population in 2010-2011. 已重新计算
- Proportions – Inappropriate 23.2%, potentially appropriate 35.5% (recomputed from counts). 已重新计算
总体证据的确定性（GRADE，简化版）
- 主要结局
- Share of unnecessary outpatient antibiotic prescriptions (US 2010-2011)
- 起始等级
- 低（观察性研究）
- 降级理由
- none (descriptive national survey; observational start)
- 升级理由
- Consistent with later independent data
- 结果
- 中
由单名审查者参照 GRADE 方法进行的简化评估；并非正式的 GRADE 专家组评估。GRADE 评价的是针对某一结局的整体证据，而非单项研究。
已核查的临床指南和官方声明
- CDC: CDC: 1 in 3 antibiotic prescriptions unnecessary (press release, 3 May 2016) (2016) · 原始文献
At least 30% of US outpatient antibiotics are unnecessary; 47 million excess prescriptions per year; most for viral respiratory conditions. - CDC: Core Elements of Outpatient Antibiotic Stewardship (2016) · 原始文献 无法获取；内容未采用
- WHO: The WHO AWaRe (Access, Watch, Reserve) antibiotic book (2022) · 原始文献
Inappropriate use and overuse of antibiotics drive AMR; the book gives evidence-based guidance on antibiotic choice, dose, route and duration for over 30 common infections in children and adults.
检索策略
本次审查的文献检索记录（检索式采用原数据库语法）。
| 数据库 | 日期 | 检索式 | 检索目标 | 命中数 | 纳入数 |
|---|---|---|---|---|---|
| Europe PMC | 2026年10月26日 | TITLE:"Appropriateness of outpatient antibiotic prescribing among privately insured US patients" | 支持性证据 | 1 | |
| Europe PMC | 2026年10月26日 | (Egypt OR Egyptian) AND (antibiotic) AND (prescribing OR prescriptions OR "self-medication" OR "without prescription") AND (inappropriate OR unnecessary OR "primary care" OR pharmacies) AND PUB_YEAR:[2018 TO 2026] | 双向 | 1396 | |
| Web (curl, archive.cdc.gov) | 2026年10月26日 | https://archive.cdc.gov/www_cdc_gov/media/releases/2016/p0503-unnecessary-prescriptions.html | 指南 | 1 | |
| Web (curl, cdc.gov) | 2026年10月26日 | https://www.cdc.gov/antibiotic-use/hcp/core-elements/outpatient-antibiotic-stewardship.html | 指南 | 1 |
待解决的问题
Current US and Egyptian figures for unnecessary prescribing by diagnosis.
核查深度如何？
5 项相关研究：0 项核查了全文（其中 0 项进行了结构化偏倚风险评估），5 项基于摘要核查，0 项仅核查了文献信息。 尚未进行由两名独立审查者完成的正式评估，也尚未进行独立的人类专家审核。
最近一次科学审核: 2026年10月26日
评定结论的变更历史
- 2026年10月25日 · 第 1 阶段 · 初始评估: 基本正确 (中)
- 2026年10月26日 · 第 4 阶段（系统证据审查） · 评定结论已更改: 基本正确 (中) → 正确 (中)
The only unverified elements (the 47 million figure and 'mostly for viral infections') are now verified in the CDC statement on the study (I-ABX-129). The archive's figures and wording match the source.
新来源: I-ABX-129 I-ABX-130 I-ABX-131
通俗解释
一项由CDC牵头的美国研究估计，2010-2011年的门诊抗生素处方中，每10张至少有3张是不需要的——每年约4,700万张——大多用于感冒、咽喉痛、支气管炎以及其他由病毒引起的呼吸道感染。后来的美国数据和来自埃及的数据表明，过度使用的情况仍在持续。解决办法是只在需要时才使用抗生素。
与该说法相关的研究
支持该说法的研究 (5)
-
Unnecessary antibiotic prescriptions in the US
Fleming-Dutra KE et al.. JAMA 2016 · PMID 27139059 · DOI 10.1001/jama.2016.4151横断面研究被 Tayebat 档案网站引用已核查摘要★ 关键研究About 30% of outpatient antibiotic prescriptions were judged unnecessary.
该研究是否支持这一具体说法？ 是 · 方法学质量: 高 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Estimate inappropriate use.
- 研究是如何开展的？
Survey analysis.
- 研究了多少人、动物或样本？
184,032 visits.
- 实际发现了什么？
30% inappropriate.
- 观察到的效应有多大？
506 vs 353/1000.
- 研究结果对日常生活意味着什么？
Overuse is common.
- 该研究有哪些局限？
Estimated appropriateness.
- 它对 Elawady 的具体说法说明了什么？
Supports.
- 研究结果是否适用于德国和欧洲？
Low.
- 从该研究中明确不能得出什么结论？
That antibiotics are never needed.
-
Antibiotics and resistance in the individual
Costelloe C et al.. BMJ 2010 · PMID 20483949 · DOI 10.1136/bmj.c2096Meta分析被 Tayebat 档案网站引用已核查摘要After an antibiotic, resistant bacteria are more common for months.
该研究是否支持这一具体说法？ 是 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Review.
- 研究是如何开展的？
Meta-analysis.
- 研究了多少人、动物或样本？
24 studies.
- 实际发现了什么？
Resistance rises.
- 观察到的效应有多大？
OR 2.5.
- 研究结果对日常生活意味着什么？
Each course matters.
- 该研究有哪些局限？
Observational.
- 它对 Elawady 的具体说法说明了什么？
Supports.
- 研究结果是否适用于德国和欧洲？
High.
-
CDC: 1 in 3 US outpatient antibiotic prescriptions unnecessary
Centers for Disease Control and Prevention. CDC Online Newsroom (archived) 2016指南 / 立场声明独立交叉核查已核查摘要CDC estimated 47 million unnecessary prescriptions a year, mostly for viral respiratory illnesses.
Confirms 'at least 30 percent' and '47 million excess prescriptions each year', mostly for viral respiratory conditions
该研究是否支持这一具体说法？ 是 · 方法学质量: 高 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Announce US overprescribing estimate
- 研究是如何开展的？
Press release on national survey study
- 研究了多少人、动物或样本？
Not applicable
- 实际发现了什么？
At least 30% unnecessary; 47 million per year
- 观察到的效应有多大？
47 million
- 研究结果对日常生活意味着什么？
Antibiotics are often given when they cannot help
- 该研究有哪些局限？
US 2010-2011 only
- 它对 Elawady 的具体说法说明了什么？
Confirms the claim
- 研究结果是否适用于德国和欧洲？
Low
- 从该研究中明确不能得出什么结论？
Rates in Europe or Egypt
-
About a quarter of US antibiotic fills were inappropriate in 2016
Chua KP et al.. BMJ 2019 · PMID 30651273 · DOI 10.1136/bmj.k5092横断面研究独立交叉核查已核查摘要23% of outpatient antibiotic fills had no diagnosis justifying them.
2016: 23.2% inappropriate plus 28.5% without diagnosis
该研究是否支持这一具体说法？ 是 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Measure inappropriate antibiotic prescribing
- 研究是如何开展的？
Insurance claims analysis
- 研究了多少人、动物或样本？
19.2 million people
- 实际发现了什么？
23.2% inappropriate
- 观察到的效应有多大？
23.2%
- 研究结果对日常生活意味着什么？
Overprescribing persists
- 该研究有哪些局限？
Coding-based
- 它对 Elawady 的具体说法说明了什么？
Supports the claim's general point
- 研究结果是否适用于德国和欧洲？
Low
- 从该研究中明确不能得出什么结论？
Rates outside the US
-
Egyptian private clinics prescribe antibiotics in 4 of 5 infection visits
Nguyen N et al.. BMJ Glob Health 2026 · PMID 42097706 · DOI 10.1136/bmjgh-2025-021139横断面研究独立交叉核查已核查摘要In Egypt, 81% of infection consultations ended with an antibiotic, half from the 'Watch' group.
Egypt: antibiotics in 81.2% of infection consultations; 52.9% Watch
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Measure antibiotic prescribing in private primary care
- 研究是如何开展的？
Prescriber survey analysis
- 研究了多少人、动物或样本？
384,975 consultations
- 实际发现了什么？
Very high prescribing
- 观察到的效应有多大？
Egypt 81.2%
- 研究结果对日常生活意味着什么？
Overuse is common in Egypt too
- 该研究有哪些局限？
Survey data; private sector
- 它对 Elawady 的具体说法说明了什么？
Supports the overuse message regionally
- 研究结果是否适用于德国和欧洲？
Egypt-specific
- 从该研究中明确不能得出什么结论？
What share was unnecessary
该组中没有被标记为关键研究的研究。
与该说法相矛盾或限制该说法的研究 (0)
该组中没有研究。
结果不一或不明确的研究 (0)
该组中没有研究。
地区背景
德国 / 欧盟
Overprescribing is also a concern in Europe; no EU figure was verified here.
埃及
In private primary care in Egypt (2017-2021), antibiotics were prescribed in 81.2% of infection-related consultations and 52.9% of prescriptions were WHO 'Watch' antibiotics (I-ABX-131); overuse is therefore also a problem in Egypt.
在我的国家适用什么？
一般科学评估
正确 正确：2010-2011年美国门诊抗生素处方中至少有30%是不必要的，每年约4,700万张，大多用于病毒性呼吸道感染。
该说法涉及生物学或医学关系。上述科学评估不论在哪个国家都适用；各国食品数据不会改变这一评估。
参考文献
- Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.. Fleming-Dutra KE et al.. JAMA 2016 · PMID 27139059 · DOI 10.1001/jama.2016.4151
- Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis.. Costelloe C et al.. BMJ 2010 · PMID 20483949 · DOI 10.1136/bmj.c2096
- CDC: 1 in 3 antibiotic prescriptions unnecessary (press release, 3 May 2016).. Centers for Disease Control and Prevention. CDC Online Newsroom (archived) 2016
- Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.. Chua KP et al.. BMJ 2019 · PMID 30651273 · DOI 10.1136/bmj.k5092
- AWaRe antibiotic prescribing for common acute infections in private primary care in low-middle-income countries: a patient-level analysis using IQVIA prescriber surveys from Pakistan, Egypt and Indonesia.. Nguyen N et al.. BMJ Glob Health 2026 · PMID 42097706 · DOI 10.1136/bmjgh-2025-021139