Rodríguez-Baño J, Paño-Pardo J R, Alvarez-Rocha L, Asensio Á, Calbo E, Cercenado E, Cisneros J M, Cobo J, Delgado O, Garnacho-Montero J, Grau S, Horcajada J P, Hornero A, Murillas-Angoiti J, Oliver A, Padilla B, Pasquau J, Pujol M, Ruiz-Garbajosa P, San Juan R, Sierra R
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, España.
Farm Hosp. 2012 Jan-Feb;36(1):33.e1-30. doi: 10.1016/j.farma.2011.10.001. Epub 2011 Dec 1.
The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures.
抗菌药物因其几个原因而成为独特的药物。首先，就降低发病率和死亡率而言，它们的疗效高于其他药物。此外，抗生素是唯一与生态效应相关的药物类别，因为其使用可能会促使微生物耐药性的出现和传播。最后，几乎所有医学专科都会使用它们。由于传染病管理方面的重大进展以及抗生素耐药性的传播，抗菌药物的合理使用非常复杂。因此，有必要在医院实施优化抗生素使用的项目（本文件中称为PROA）。这份共识文件明确了PROA的目标（即改善感染患者的临床疗效，尽量减少与抗菌药物使用相关的不良事件，包括抗生素耐药性的出现和传播，并确保使用最具成本效益的治疗方法），并为在西班牙医院实施这些项目提供了建议。这些建议的关键要点如下。应在感染委员会的支持下组建多学科抗生素团队。PROA应被视为机构项目和医院战略目标的一部分。PROA应包括基于可衡量指标的具体目标，以及旨在改善抗菌药物使用的活动，主要通过教育活动以及更多基于针对开处方者的培训活动而非仅仅是限制性措施的干预来实现。
