从处方分析探讨“全国抗菌药物临床应用专项整治活动”的必要性  

Discussion on the Necessity of "Special Rectification Activities of Clinical Application of Antibacterials in China" through Prescription Analysis

作　　者：郭澄[1] 张剑萍[1] 华雪蔚[2] 郭丽娜[2] 万丽丽[1] 

机构地区：[1]上海交通大学附属第六人民医院药剂科,上海200233 [2]中国医药工业信息中心,上海200040

出　　处：《中国药房》2012年第2期97-101,共5页China Pharmacy

摘　　要：目的:探讨开展"全国抗菌药物临床应用专项整治活动"的必要性。方法:收集上海市9家综合性三级医院2008-2010年含抗菌药物在内的原始电子处方,采用Excel对各项处方数据进行汇总,计算用药频度(DDDs)、年均增长率(CAGR)及抗菌药物使用强度(AUD)等,并进行分析。结果:3年来,9家样本医院抗菌药物处方数及处方金额呈逐年上升趋势,但其在总处方数和总处方金额中所占比例保持稳定。DDDs排序列前10位的药品类别中,第2代头孢菌素类药稳居首位,且DDDs上升的CAGR也最高。DDDs排序列前10位的药品中,属头孢菌素类的有4个,上升最快的是头孢呋辛(片剂),CAGR达17.3%。限制使用类药在抗菌药物中所占比例最高,超过50%;非限制使用类药所占比例次之,并呈逐年下降趋势;特殊使用类药虽然所占比例最小,但3年来呈极明显的逐年上升趋势。样本医院A的住院患者抗菌药物应用率3年来一直在65%以上,5个重点科室的抗菌药物AUD为40.37～198.43DDD/100人/天,与本次专项整治活动的标准均存在不小的差距。结论:虽然近年来临床抗菌药物的应用管理力度加强,但滥用现象仍较普遍,需要加强监控。OBJECTIVE： To investigate the necessity of ＂Special Rectification Activities of Clinical Application of Antibacterials in China＂. METHODS： The original electronic prescriptions including antibiotics were collected from 9 comprehensive Grade Three hospitals in Shanghai between 2008 and 2010. Excel software was used to summarize all the prescription data, calculating DDDs, compound annual growth rate（CAGR） and antibiotics use density （AUD）, etc. RESULTS： The number of antimicrobial agents＇ prescriptions and the amount of prescriptions showed a rising trend year by year in the recent 3 years. However, its proportion in the total number and total amount of prescriptions remained stable. Among treatment categories of top 10 drugs in the list of DDDs, the second generation cephalosporins ranked first place and the rising CAGR of DDDs in the 3 years was also the highest. Among the top 10 drugs in the list of DDDs, cephalosporin had four. Cefuroxime （tablets） rose fastest with CAGR of 17.3%. Drugs of restricted use took up the highest proportion of antimicrobials, which was more than 50%; followed by drugs of non-restricted use with a declining trend year by year. Although the drugs of special use accounted for the smallest, they showed a very obvious increasing trend year by year in the three years. The utilization ratio of antimicrobials in hospitalized patients in hospital A among sample hospitals had been above 65% in three years. The AUD of antimicrobials in five key departments were 40.37- 198.43 DDD/100 persons/ day. There was a large gap with the standard in this special campaigns activity. CONCLUSION： Although the clinical use of antimicrobials has been limited in recent years, antimicrobials abuse remains serious. It needs further efforts of health administrative departments and all levels of medical institutions.

关 键 词：抗菌药物 合理应用 分级管理 抗菌药物使用强度 必要性 处方分析 

分 类 号：R969.3[医药卫生—药理学] R287[医药卫生—药学]