Samilski Jennifer A E, Lau Tim T Y, Elbe Dean H T, Aulakh Amneet K, Lun Eric M C
P T. 2012 May;37(5):291-9.
The use of moxifloxacin (Avelox) has increased at Vancouver General Hospital since its introduction onto the formulary in 2002. It is unclear, however, whether the use of the drug is optimal according to its indication. Hand-held electronic devices, such as personal digital assistants (PDAs), are novel tools that can be used during routine patient care to collect data for drug use evaluation (DUE) reviews.
We hypothesized that moxifloxacin was over-utilized and that opportunities existed to optimize its use. This study was designed to characterize moxifloxacin use in concordance with evidence-based assessment criteria. The feasibility of using a PDA device as a data-collection tool was also evaluated.
An observational DUE was conducted over a 4-week period (from February 17 to March 16, 2007) at Vancouver General Hospital, a 955-bed tertiary care hospital. Inpatients who received at least one dose of moxifloxacin were enrolled. Evidence-based assessment criteria were developed to evaluate the appropriateness of moxifloxacin use, and a PDA database was developed for data collection. The primary endpoint was the proportion of moxifloxacin use for approved first-line indications.
A total of 132 patients were included. Eighty-nine patients (67%) received moxifloxacin for first-line indications, including community-acquired pneumonia (57%) and acute exacerbation of chronic bronchitis (10%). Forty-three patients (33%) had alternative indications, primarily hospital-acquired pneumonia (25%). In 129 evaluable patients, approximately half (51%) of the clinical outcomes were successful; 37% were indeterminate; and 12% were failures. General medicine and respiratory service clinicians prescribed moxifloxacin more appropriately compared with surgical service personnel. Most of the pharmacists supported the use of PDAs as DUE data-collection tools.
Overall, moxifloxacin utilization at Vancouver General Hospital was appropriate according to evidence-based assessment criteria. Additional opportunities to improve its use exist through health care staff education. PDAs are ideal data-collection tools for DUEs, as they can be conveniently used during routine patient care.
自2002年莫西沙星（拜复乐）被列入温哥华总医院药品处方集以来，其使用量有所增加。然而，根据其适应证，该药物的使用是否最佳尚不清楚。手持电子设备，如个人数字助理（PDA），是新型工具，可在常规患者护理期间用于收集药物使用评估（DUE）审查的数据。
我们假设莫西沙星使用过度，且存在优化其使用的机会。本研究旨在根据循证评估标准描述莫西沙星的使用情况。还评估了使用PDA设备作为数据收集工具的可行性。
在拥有955张床位的三级护理医院温哥华总医院进行了为期4周（2007年2月17日至3月16日）的观察性DUE。纳入至少接受一剂莫西沙星的住院患者。制定循证评估标准以评估莫西沙星使用的合理性，并开发了一个PDA数据库用于数据收集。主要终点是莫西沙星用于批准的一线适应证的比例。
共纳入132例患者。89例患者（67%）接受莫西沙星用于一线适应证，包括社区获得性肺炎（57%）和慢性支气管炎急性加重（10%）。43例患者（33%）有其他适应证，主要是医院获得性肺炎（25%）。在129例可评估患者中，约一半（51%）的临床结局成功；37%不确定；12%失败。与外科服务人员相比，普通内科和呼吸科服务的临床医生更合理地开具莫西沙星。大多数药剂师支持使用PDA作为DUE数据收集工具。
总体而言，根据循证评估标准，温哥华总医院莫西沙星的使用是合理的。通过医护人员教育，仍有进一步改善其使用的机会。PDA是DUE理想的数据收集工具，因为它们可在常规患者护理期间方便地使用。
