Potocki M, Goette J, Szucs T D, Nadal D
Division of Infectious Diseases, University Children's Hospital of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
Infection. 2003 Dec;31(6):398-403. doi: 10.1007/s15010-003-4130-1.
The rise in the use of antibiotics has resulted in increasing health care costs and the emergence of resistant bacteria. Little is known about the general misuse of antibiotics in hospitalized children. We evaluated the utilization of antibiotics in a pediatric teaching hospital aiming to identify targets for improvement of prescription.
Clinical, radiological, laboratory and treatment data of patients hospitalized in a pediatric medical and a pediatric surgery ward were prospectively collected during a 6-week period. A subsequent review of the collected data by a pediatric infectious diseases specialist, taking into consideration existing in-house treatment guidelines, was carried out.
A total of 125 (36%) of 349 patients was prescribed 246 antibiotics. The median length of hospital stay for children prescribed antibiotics was 5 days (range, 2-30 days) and for those not prescribed 3 days (1-32 days; p < 0.001). Of 154 patients in the medical ward, 64 (42%) received antibiotics, compared to 61 (31%) of 195 patients in the surgical ward (p < 0.05). Empirical prescriptions were more frequent than prophylactic ones, which were more frequent than therapeutic prescriptions (136 [55%] vs 94 [38%] vs 16 [7%]; p < 0.001). Overall, 85% of the prescriptions were considered justified. The rates of inappropriate prescriptions were similar in the medical and surgical ward, and higher for therapeutic (19%) or prophylactic treatment (18%) than for empirical treatment (12%). Higher inappropriate prescription rates were noted for macrolides than for co-trimoxazole and beta-lactams (50% vs 18% and 15%, respectively; p < 0.05).
Efforts need to be undertaken towards continuous education of medical staff on judicious antibiotic use, as well as ensuring compliance with existing guidelines. Improvement in the availability of rapid diagnostic methods to discern viral from bacterial infections may help reduce the numbers of empiric therapies in favor of pathogen-targeted therapeutic treatments.
抗生素使用的增加导致医疗保健成本上升以及耐药菌的出现。对于住院儿童抗生素的普遍滥用情况知之甚少。我们评估了一家儿科教学医院抗生素的使用情况，旨在确定改进处方的目标。
在为期6周的时间里，前瞻性收集了儿科内科和儿科外科病房住院患者的临床、放射学、实验室及治疗数据。随后，由一名儿科传染病专家根据现有的内部治疗指南对收集的数据进行了审查。
349例患者中有125例（36%）使用了246种抗生素。使用抗生素的儿童中位住院时间为5天（范围2 - 30天），未使用抗生素的儿童为3天（1 - 32天；p < 0.001）。在内科病房的154例患者中，64例（42%）接受了抗生素治疗，相比之下，外科病房195例患者中有61例（31%）接受了抗生素治疗（p < 0.05）。经验性处方比预防性处方更常见，预防性处方又比治疗性处方更常见（136例[55%]对94例[38%]对16例[7%]；p < 0.001）。总体而言，85%的处方被认为是合理的。内科和外科病房不适当处方的比例相似，治疗性（19%）或预防性治疗（18%）的不适当处方比例高于经验性治疗（12%）。大环内酯类药物的不适当处方率高于复方新诺明和β-内酰胺类药物（分别为50%对18%和15%；p < 0.05）。
需要努力持续对医务人员进行合理使用抗生素的教育，并确保遵守现有指南。提高快速诊断方法的可用性以区分病毒感染和细菌感染，可能有助于减少经验性治疗的数量，转而采用针对病原体的治疗方法。
