某院儿科门急诊多西环素超说明用药的情况分析  

Analysis of Off-label Use of Doxycycline in Pediatric Outpatient and Emergency Departments of a Hospital

作　　者：劳楚瑜 王钰琦[1] 陈杰[1] LAO Chu-yu;WANG Yu-qi;CHEN Jie(Department of Pharmacy,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院药学部,广州510080

出　　处：《抗感染药学》2024年第10期1013-1018,共6页Anti-infection Pharmacy

基　　金：广东省基础与应用基础研究基金企业联合基金(编号:2021A1515220165);广东省药理学会触发器研究基金项目(编号:GDLY2021008);广东省钟南山医院基金会项目(编号:2.080.21.0)。

摘　　要：目的:分析医院儿科门急诊多西环素超说明用药的情况,为临床患儿多西环素的用药安全提供参考。方法:选取2023年11月―2024年6月中山大学附属第一医院儿科门急诊的68660张处方作为研究资料,采集处方所涉患者的年龄、性别、临床诊断、用药情况、实验室检查结果等信息,分析其中多西环素的超说明书用药特点和合理性。结果:68660张医院儿科门急诊处方中,使用了多西环素的处方有605张(占0.88%);605张多西环素处方中,所涉患儿的临床诊断分别为上呼吸道感染(373张,占61.65%)和下呼吸道感染(232张,占38.35%);超说明书用药的处方有287张(占47.44%),其中主要的类型为“超适用人群用药”(189例,占65.85%),其次为“超适应证用药”(99张,占34.49%);287张超说明书用药处方中有195张存在联合用药情况,其中以与抗感冒药联用为最多(145张,占50.52%),而与抗病毒药物和其他抗菌药物的联用处方分别有11张和12张;605张多西环素处方所涉患儿中,开展肺炎支原体检测的有533例,其阳性检出率为86.12%,而超说明书用药患儿和超适用人群用药患儿的阳性检出率分别为75.21%和93.82%;开展肺炎支原体耐药基因检测的有297例,其阳性检出率为86.53%,而超说明书用药患儿和超适用人群用药患儿的阳性检出率分别为83.46%和92.92%;此外,有395例(占65.29%)患儿在使用多西环素前的7 d内服用过大环内酯类药物,而多西环素超适用人群用药患儿中有157例(占83.07%)在7 d内服用过大环内酯类药物;循证分析结果显示,287张多西环素超说明书用药处方中有循证学证据支持的有266张(占92.68%)。结论:医院儿科多西环素存在较多的超说明书用药的情况,其中尤以超适用人群用药为多,虽然仅少数无循证学证据支持,但临床仍应加强超说明书用药的相关培训,以保障患儿的用药安全。Objective:To analyze the off-label use of doxycycline in pediatric outpatient and emergency departments of a hospital,and provide reference for the clinical safe use of doxycycline in children.Methods:68660 prescriptions from pediatric outpatient and emergency departments of the First Affiliated Hospital of Sun Yat-sen University from November 2023 to June 2024 were selected as research data.The information on the prescriptions such as patient age,gender,clinical diagnosis,medication and laboratory test results was collected to analyze the characteristics and rationality of off-label use of doxycycline.Results:Among 68660 prescriptions from pediatric outpatient and emergency departments,there were 605 prescriptions(0.88%)that contained doxycycline.Among 605 prescriptions containing doxycycline,the clinical diagnosis of involved children included upper respiratory tract infection(373 prescriptions,61.65%)and lower respiratory tract infection(232 prescriptions,38.35%).There were 287 prescriptions(47.44%)for off-label use,of which the main type was"use of drugs beyond the suitable groups"(189 prescriptions,65.85%),followed by"use of drugs beyond the indications"(99 prescriptions,34.49%).Among 287 prescriptions for off-label use,195 prescriptions contained drug combination,of which the most common was combined use with anti-cold drugs(145 prescriptions,50.52%),and there were 11 prescriptions for combined use with antiviral drugs and 12 prescriptions for combined use with other antibacterial drugs.Among the children involved in 605 prescriptions for doxycycline,533 cases were tested for Mycoplasma pneumoniae,with a positive detection rate of 86.12%,while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 75.21%and 93.82%respectively.There were 297 cases who received testing for Mycoplasma pneumoniae resistance genes,with a positive detection rate of 86.53%,while the positive detection rates of children with off-label use and those who used drugs beyond

关 键 词：多西环素 超说明书用药 儿科 合理用药 

分 类 号：R969.3[医药卫生—药理学] R978.14[医药卫生—药学]