Urquhart J
University of Limburg, Maastricht, The Netherlands.
Postgrad Med J. 1992;68 Suppl 3:S49-58; discussion S59.
Compliance with outpatient antibiotic regimens can now be measured by electronically monitoring the time history of dosing. This new approach reveals that many patients comply only partially with prescribed regimens in randomized, controlled, outpatient trials. Omitted or delayed doses and early cessation of dosing are commonly observed. Partial compliance converts a fixed-dose trial into a set of natural experiments in dose ranging, presenting a variety of patterns of dose timing that can be correlated with clinical outcomes for an estimate of minimum compliance needed for satisfactory outcome. Reliable measures indicate little difference in compliance between once- and twice-daily regimens, but considerably higher rates of omitted doses with three-times-daily or four-times-daily dosing. A key practical issue is to ensure continuity of drug action in the face of the most common compliance errors. Continuity of action is more likely when the prescribed interval between doses is considerably shorter, preferably half or less, than the drug's duration of action, allowing doses occasionally to be delayed or omitted without a gap in drug action. Thus, a twice-daily regimen may be expected to maintain crucial continuity of drug action better than a once-daily regimen, even if a few more doses are missed. Errors to avoid in compliance with outpatient antibiotic regimens are prolonged intervals between doses and early cessation of treatment.
现在可以通过电子监测给药时间记录来衡量门诊抗生素治疗方案的依从性。这种新方法表明，在随机对照门诊试验中，许多患者仅部分依从规定的治疗方案。漏服或延迟服药以及提前停药的情况很常见。部分依从性将固定剂量试验转变为一系列剂量范围的自然实验，呈现出各种剂量给药时间模式，这些模式可以与临床结果相关联，以估计获得满意结果所需的最低依从性。可靠的测量结果表明，每日一次和每日两次治疗方案在依从性方面差异不大，但每日三次或四次给药时漏服剂量的发生率要高得多。一个关键的实际问题是，面对最常见的依从性错误时要确保药物作用的连续性。当规定的给药间隔明显短于药物的作用持续时间，最好是其一半或更短，这样即使偶尔延迟或漏服一剂，也能在药物作用上无间断，此时更有可能保持作用的连续性。因此，即使错过几剂，每日两次的治疗方案可能比每日一次的治疗方案更能维持关键的药物作用连续性。在依从门诊抗生素治疗方案时要避免的错误是给药间隔延长和提前停止治疗。
