del Rey Calero Juan
An R Acad Nac Med (Madr). 2003;120(1):97-113; discussion 113-9.
The development of antibiotics resistance is reaching epidemic proportions. Due to increased transportation of persons and goods across continents, some bacterial clones have disseminated over several countries. To increase benefits and reduce risk, and therefore improve quality of prescription, the rational use of antibiotics should be promoted. To do so, patterns of use and prescription rates expressed in DDD per 1,000 hospital beds should be examined. Hospitalised patients received 25-40% of all systemic doses, in many cases inappropriately. In community studies reference estimates are made per 1,000 inhabitants-day (DHD). Over the last years, consumption has levelled-of around 20 DHD in 2000, showing remarkable differences between regions in Spain. Antibiotic consumption is approximately 270 Tons (in 1997), with an increase of only 10% in the last decade. The URANO study estimated that 19% of patients receive chemotherapy, although 42% do not comply with treatment and 29% are self-medicated. Among the chemotherapeutic agents mostly used are penicillins (11.4 DHD), macrolides (3.6 DHD), Quinolones (2.2 DHD) and Cephalosporins (1.9 DHD). We recommend surveillance of antibiotics resistance and improvement in the training of health professionals and in health information for patients about risks of self-medication; we also propose a better control of antibiotics administered to farm animals.
抗生素耐药性的发展正达到流行程度。由于人员和货物跨大陆运输的增加，一些细菌克隆已传播到多个国家。为了增加益处并降低风险，从而提高处方质量，应推广抗生素的合理使用。为此，应检查以每1000张医院床位的限定日剂量（DDD）表示的使用模式和处方率。住院患者接受了所有全身剂量的25%至40%，在许多情况下是不适当的。在社区研究中，参考估计是按每1000居民日（DHD）进行的。在过去几年中，消费量趋于平稳，2000年约为20 DHD，西班牙各地区之间存在显著差异。抗生素消费量约为270吨（1997年），在过去十年中仅增加了10%。URANO研究估计，19%的患者接受化疗，尽管42%的患者未遵医嘱治疗，29%的患者自行用药。最常用的化疗药物包括青霉素（11.4 DHD）、大环内酯类（3.6 DHD）、喹诺酮类（2.2 DHD）和头孢菌素类（1.9 DHD）。我们建议对抗生素耐药性进行监测，改善卫生专业人员的培训以及向患者提供有关自行用药风险的健康信息；我们还提议更好地控制给农场动物使用的抗生素。
