46例感染患儿使用夫西地酸合理性分析  

Rationality analysis of sodium fusidate in 46 pediatric patients with infections

作　　者：张杨[1] 傅亚青 汪震[1] 刘东[1] 杜光[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院药学部,湖北武汉430030

出　　处：《中国医院药学杂志》2016年第4期318-322,共5页Chinese Journal of Hospital Pharmacy

摘　　要：目的:夫西地酸钠的药理作用特殊,对革兰性耐药菌敏感性高,耐受性好。但由于其高耐药风险被列为特殊级管理的抗菌药物。本研究从超说明书用药的角度分析某院儿科住院部夫西地酸钠的使用情况,旨在为儿童感染患者合理使用该抗菌药物提供借鉴。方法:调取儿科3个月内使用夫西地酸钠的46名住院患儿病例,对其在各病区的使用情况、使用方法、疗效和安全性进行分析。结果:夫西地酸钠治疗革兰阳性球菌的效果和安全性得到进一步证实,对检出革兰阳性球菌感染的患儿有效率为100%,总有效率为65.2%;仅发现1例由于输液速度过快导致的静脉痉挛。然而,超说明书用药现象严重,使用方法和使用时机存在诱发耐药菌的风险。46名患儿中,35.3%为超适应证用药(上呼吸道感染、支气管炎、泌尿系统感染);使用频率91.3%与说明书要求不符;34.8%的患儿出现感染后,在没有药敏结果指导的前提下首先选用窄谱的夫西地酸钠治疗;41.4%的夫西地酸钠未与其他抗菌药物联合使用。结论:夫西地酸钠超说明书用药与疗效、安全性和耐药菌的产生密切相关。某些情况下超说明书用药存在合理性,但不合理用药应积极避免。ORJECTIVE To analyze off-label use of sodium fusidate in pediatric inpatients to rationalize use of narrow-spec- trum antibiotics in this special population. METHODS A total of 46 patients received sodium fusidate treatment in our pediatric department from July to September, 2013. Drug use distribution in different wards, method of use, efficacy and safety were analyzed. RESULTS Safety of sodium fusidate was confirmed in pediatric patients with Gram-positive infections. Sodium fusi- date was effective in 100% patients infected with Gram-positive rods, but total effective rate was only 65.2%. One case of ve- nous spasm was reported due to inappropriately high infusion rate. Incorrect use method and time might increase risk of drug resistance. Out of 46 cases, 35. 3 M used sodium fusidate for off-labeled indications, including upper respiratory tract infection, bronchitis, and urinary tract infection. Use frequency was different from drug label in 91.3% patients. Sodium fusidate was used as the first line antibiotics in 34. 8% pediatric patients without guidance from the antimicrobial susceptibility test. It was used as mono-therapy in 41.4% cases. CONCLUSION Off-label use of sodium fusidate is related to its efficacy, safety, and drug resistance. Although some off-label uses are rationalized by patient＇s specific conditions, others are not evidence supported and therefore should be avoided.

关 键 词：夫西地酸钠 儿科 超说明书用药 疗效 安全性 

分 类 号：R969[医药卫生—药理学]