提高台湾台北市抗结核药物给药的一致性。

Improved consistency in dosing anti-tuberculosis drugs in Taipei, Taiwan.

机构信息

International Union Against Tuberculosis and Lung Disease, Paris, France.

出版信息

PLoS One. 2012;7(8):e44133. doi: 10.1371/journal.pone.0044133. Epub 2012 Aug 27.

DOI:10.1371/journal.pone.0044133

PMID:22952900

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3428337/

Abstract

BACKGROUND

It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007-2010 were investigated to assess whether interventions on dosing were effective.

METHODOLOGY/PRINCIPAL FINDINGS: Lists of all notified culture positive TB cases in 2007-2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007-2010 (p<0.001). The proportion of patients treated with consistent dosing of a 3-drug fixed-dose combination (FDC) increased from 73.9% in 2003 to 87.7% in 2007-2010 (p<0.001), and that for 2-drug FDC from 76.0% to 86.1% (p = 0.024), for rifampicin (RMP) from 62.8% to 85.5% (p<0.001), and for isoniazid from 87.8% to 95.3% (p<0.001). In 2007-2010, among 2917 patients treated with either FDCs or RMP in single-drug preparation, the dosage of RMP was adequate (8-12 mg/kg) in 2571(88.1%) patients, too high in 282(9.7%), too low in 64(2.2%). In multinomial logistic regression models, factors significantly associated with adequate dosage of RMP were body weight and preparations of RMP. Patients weighting <40 kg (relative risk ratio (rrr) 6010.5, 95% CI 781.1-46249.7) and patients weighting 40-49 kg (rrr 1495.3, 95% CI 200.6-11144.6) were more likely to receive higher-than-recommended dose of RMP.

CONCLUSIONS/SIGNIFICANCE: Prescribing practice in the treatment of TB in Taipei City has remarkably improved after health authorities implemented a series of interventions.

摘要

背景

据报道，2003 年台北市报告的结核病（TB）病例中有 35.5% 没有记录治疗前体重，而在有记录的病例中，抗 TB 药物剂量不规范的情况很常见。台湾疾病控制中心（CDC）已采取行动加强基层医生对抗 TB 药物的剂量规范。本研究旨在评估对基层医生进行剂量规范干预的效果，调查 2007-2010 年台北市抗 TB 药物的处方情况。

方法/主要发现：从台湾疾病控制中心国家 TB 登记处获得 2007-2010 年所有报告的培养阳性 TB 病例清单。对 TB 病例管理档案进行医疗审核，以收集治疗开始时的治疗前体重和开具的治疗方案。所开剂量与推荐剂量进行比较。2003 年有记录治疗前体重的患者比例为 64.5%，2007-2010 年增加到 96.5%（p<0.001）。用 3 种固定剂量组合（FDC）药物进行规范剂量治疗的患者比例从 2003 年的 73.9%增加到 2007-2010 年的 87.7%（p<0.001），用 2 种 FDC 的比例从 76.0%增加到 86.1%（p=0.024），利福平（RMP）的比例从 62.8%增加到 85.5%（p<0.001），异烟肼的比例从 87.8%增加到 95.3%（p<0.001）。2007-2010 年，在 2917 例接受 FDC 或 RMP 单药治疗的患者中，2571 例（88.1%）RMP 剂量充足（8-12mg/kg），282 例（9.7%）剂量过高，64 例（2.2%）剂量过低。在多项逻辑回归模型中，与 RMP 剂量充足显著相关的因素是体重和 RMP 的制剂。体重<40kg（相对风险比（rrr）6010.5，95%CI 781.1-46249.7）和体重 40-49kg（rrr 1495.3，95%CI 200.6-11144.6）的患者更有可能接受高于推荐剂量的 RMP。

结论/意义：在卫生部门实施了一系列干预措施后，台北市结核病治疗的处方实践有了显著改善。