Thuong M, Shortgen F, Zazempa V, Girou E, Soussy C J, Brun-Buisson C
Medical Intensive Care, Hospital Pharmacy, Clinical Microbiology Laboratory and Infection Control Unit, Hôpital Henri Mondor, Créteil, France.
J Antimicrob Chemother. 2000 Sep;46(3):501-8. doi: 10.1093/jac/46.3.501.
We evaluated the appropriateness of use of restricted antimicrobial agents in the context of a newly implemented order form and delivery system for restricted antimicrobial agents, using sequential prospective audits of prescriptions. Four antimicrobial agents were selected: glycopeptides (61 prescriptions), ciprofloxacin (42), piperacillin-tazobactam (42) and imipenem- cilastatin (47). The justification and adequacy of the antibiotic or combination used, reassessment of therapy and duration of treatment were appraised with reference to the clinical situation and hospital's guidelines. Of the 192 prescriptions, 30 (16%) were empirical therapy, 95 (49%) empirical and secondarily documented and 67 (35%) initially documented therapy. Overall, 73% of prescriptions conformed to guidelines, but the adequacy varied from 93% for vancomycin to only 38% for ciprofloxacin. Of 83/157 initially inadequate prescriptions, 42 (51%) were switched according to guidelines, but only 14% of ciprofloxacin prescriptions were adapted later. An intervention audit with counselling on ciprofloxacin usage increased this rate to 75%. Although implementation of the guidelines resulted in a marked reduction in overall antimicrobial costs, inappropriate antibiotic usage may persist for some drugs despite restricted access. These results emphasize the need for combined interventions using education and expert counselling, targeted to classes of antibiotic for which inappropriate usage is most common.
我们通过对处方进行序贯前瞻性审核，评估了在新实施的限制使用抗菌药物订购单和配送系统背景下，限制使用抗菌药物的使用合理性。选择了四种抗菌药物：糖肽类（61张处方）、环丙沙星（42张）、哌拉西林-他唑巴坦（42张）和亚胺培南-西司他丁（47张）。参照临床情况和医院指南，对抗生素或联合用药的合理性及充分性、治疗的重新评估和治疗持续时间进行了评估。在192张处方中，30张（16%）为经验性治疗，95张（49%）为经验性治疗且有二次记录，67张（35%）为初始记录治疗。总体而言，73%的处方符合指南，但充分性各不相同，万古霉素为93%，环丙沙星仅为38%。在157张初始不充分的处方中，83张中有42张（51%）根据指南进行了调整，但环丙沙星处方中只有14%后来进行了调整。一项关于环丙沙星使用的干预审核并提供咨询后，这一比例提高到了75%。尽管实施指南使总体抗菌药物成本显著降低，但尽管限制了获取途径，某些药物的不适当抗生素使用可能仍然存在。这些结果强调了需要采用教育和专家咨询相结合的干预措施，针对最常出现不适当使用情况的抗生素类别。
