van der Meer J W, Gyssens I C
Department of General Internal Medicine, University Medical Center St Radboud, Nijmegen, The Netherlands.
Clin Microbiol Infect. 2001;7 Suppl 6:12-5. doi: 10.1046/j.1469-0691.2001.00079.x.
There is worldwide concern about the development of antimicrobial resistance [1]. Selective pressure by antimicrobial drugs is by far the most important driving force for the development of resistance. Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. In developed countries, some 30% of the hospitalized patients will be treated with these drugs. It is generally accepted that antimicrobial prescribing is often suboptimal, even in a country like the Netherlands, where both antibiotic consumption and microbial resistance rates are low [2,3]. The major problem with inappropriate prescribing is because of insufficient education in infectious diseases and antimicrobial therapy. Often, the prescription of these drugs with little toxicity is unjustified because of insecurity about the diagnosis of the clinician; 'drugs of fear' [4]. In our surveys, some 15% of the antibiotic prescriptions in surgical and internal medicine wards were considered unjustified [5,6]. Many prescribers are not yet fully aware that their justified or unjustified prescription adds to the resistance problem. In this paper, aspects of the quality of antimicrobial prescribing in the hospital setting will be discussed.
全球对抗菌药物耐药性的发展都极为关注[1]。抗菌药物产生的选择压力是耐药性发展的最重要驱动力。抗菌药物是医院里最常开具的药物之一。在发达国家，约30%的住院患者会接受这些药物的治疗。普遍认为，即使在抗生素消耗量和微生物耐药率都较低的荷兰这样的国家，抗菌药物的处方开具往往也并不理想[2,3]。不合理处方的主要问题在于传染病和抗菌治疗方面的教育不足。通常，由于临床医生对诊断缺乏信心，这些毒性较小的药物的处方开具是不合理的，即“恐惧用药”[4]。在我们的调查中，外科和内科病房约15%的抗生素处方被认为是不合理的[5,6]。许多开处方者尚未充分意识到，无论其处方合理与否，都会加剧耐药问题。本文将讨论医院环境中抗菌药物处方开具的质量问题。
