Weber A, Schneider C, Grill E, Strobl R, Vetter-Kerkhoff C, Jauch K-W
Klinikum der Universität München - Großhadern, Chirurgische Klinik und Poliklinik, München, Deutschland.
Zentralbl Chir. 2011 Feb;136(1):66-73. doi: 10.1055/s-0030-1247469. Epub 2011 Feb 18.
Antibiotics are undeniably beneficial. However, inappropriate or incorrect use puts patients at risk for avoidable adverse drug reactions, promotes emergence of resistance and potentially increases overall health-care costs. The objective of this study was to assess the impact of pharmaceutical consulting on the quality and costs of antibiotic use in surgical wards.
From February 2007 to February 2008 a total of 638 patients were enrolled in the controlled intervention study. Within the control period (n = 317) the current pattern of anti-biotic use was monitored without intervening, in the intervention period (n = 321) the pharmacist gave advice with regard to optimised antibiotic therapy.
In 216 patients 331 antibiotic-related problems were identified; 232 interventions resulted in a modification of therapy (acceptance 70 %). The most common interventions were those regarding the duration of therapy and the choice of agent. The intervention with the greatest acceptance (91 %) was dosing recommendations. The pharmaceutical intervention resulted in a shorter duration of therapy (9.9 vs. 11.2 days, p < 0.001) and an increased adherence to the surgical department's guidelines (64 % vs. 71 %, p = 0.03). Intravenous therapy was switched to oral therapy earlier and more often (p = 0.006). As a result, the total cost for intravenous antibiotics decreased from € 96 500.- to € 81 600.- (p = 0.001). Dosage recommendations (e. g. in impaired organ function) or information on interaction and side effects increased drug -safety.
Using the example of antibiotic therapy we showed that pharmaceutical counselling on surgical wards influences various aspects of antibiotic therapy, increases drug safety and reduces cost by having an effect on duration of therapy and timely switch from intravenous to oral preparations.
抗生素的益处无可否认。然而，不当或错误使用会使患者面临可避免的药物不良反应风险，促使耐药性出现，并可能增加总体医疗费用。本研究的目的是评估药学咨询对外科病房抗生素使用质量和成本的影响。
2007年2月至2008年2月，共有638例患者纳入对照干预研究。在对照期（n = 317），监测抗生素使用的当前模式而不进行干预；在干预期（n = 321），药剂师就优化抗生素治疗提供建议。
在216例患者中识别出331个与抗生素相关的问题；232项干预措施导致治疗方案改变（接受率70%）。最常见的干预措施是关于治疗持续时间和药物选择。接受率最高的干预措施（91%）是给药建议。药学干预使治疗持续时间缩短（9.9天对11.2天，p < 0.001），并提高了对外科科室指南的依从性（64%对71%，p = 0.03）。静脉治疗更早且更频繁地转换为口服治疗（p = 0.006）。结果，静脉用抗生素的总成本从96500欧元降至81600欧元（p = 0.001）。给药建议（如在器官功能受损时）或关于相互作用和副作用的信息提高了用药安全性。
以抗生素治疗为例，我们表明外科病房的药学咨询会影响抗生素治疗的各个方面，通过影响治疗持续时间以及及时从静脉制剂转换为口服制剂来提高用药安全性并降低成本。
