Dupont C, Massé C, Auvert B, Page B, Heym B, Espinasse F, Hanslik T, Rouveix E
Service de médecine interne-2, CHU Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne cedex, France.
Rev Med Interne. 2008 Mar;29(3):195-9. doi: 10.1016/j.revmed.2007.11.011. Epub 2008 Jan 10.
Prospective study of amoxicillin-clavulanic acid (amox-clav) prescriptions in the medical departments of a teaching hospital that prescribes this antibiotic very often.
From April to May 2004, each patient treated by amox-clav was included. Data were collected (age, sex, past diseases, associated-diseases, reason for hospitalization, prior antibiotic therapy, date of amox-clav prescription, indication for amox-clav prescription, other associated antibiotics, nosocomial or community-acquired infection, site of infection, bacteriologic samples and bacterial identification, treatment duration and status of the physician). Data were analysed by a muldisciplinary group and compared with a referential used for antibiotic prescriptions in our hospital.
One hundred and two medical files were analysed. Seventy-one percent of amox-clav prescriptions were in adequation with the referential. Combination of three criteria (indication of antibiotic therapy, choice of amox-clav and of an antibiotic combination) showed that 58 (57%) was acceptable, 29 (28%) was debatable and 15 (15%) was unacceptable. Unacceptable prescriptions were often made by a junior. The majority of inadequate antibiotic prescriptions referred to acute pulmonary infections. Antibiotic combinations were often inadequate and treatment duration was too long. The quality of the prescription was more accurate when made by a senior.
An effort should be made in our teaching hospital to optimize antibiotic prescriptions.
对一家经常开具这种抗生素的教学医院内科部门的阿莫西林 - 克拉维酸（阿莫西林 - 克拉维）处方进行前瞻性研究。
2004年4月至5月，纳入每一位接受阿莫西林 - 克拉维治疗的患者。收集数据（年龄、性别、既往疾病、相关疾病、住院原因、先前的抗生素治疗、阿莫西林 - 克拉维处方日期、阿莫西林 - 克拉维处方指征、其他联合使用的抗生素、医院感染或社区获得性感染、感染部位、细菌学样本及细菌鉴定、治疗持续时间和医生状况）。数据由一个多学科小组进行分析，并与我院抗生素处方的参考标准进行比较。
分析了102份病历。71%的阿莫西林 - 克拉维处方符合参考标准。三项标准（抗生素治疗指征、阿莫西林 - 克拉维的选择及抗生素联合使用）综合起来显示，58份（57%）是可接受的，29份（28%）存在争议，15份（15%）不可接受。不可接受的处方通常由初级医生开具。大多数不恰当的抗生素处方涉及急性肺部感染。抗生素联合使用常常不恰当，且治疗持续时间过长。由资深医生开具的处方质量更准确。
我院应努力优化抗生素处方。
