Khan A K Afzal, P V Mirshad, Rashed Mohammed Rafiuddin, Banu Gausia
Associate Professor, Department of Pharmacology, M.E.S Medical College , Kerala-679338, India .
J Clin Diagn Res. 2013 Apr;7(4):671-4. doi: 10.7860/JCDR/2013/5323.2878. Epub 2013 Feb 27.
Inappropriate antimicrobial use increases the incidence of drug resistance, drug toxicity and superinfections, thereby increasing the healthcare costs. Various approaches for rationalizing the antimicrobial therapy, have been suggested. Collection of baseline data on the pattern of the antimicrobial use is usually suggested as the first step in this direction, which will help in identifying the problem areas, which demand our attention.
To study the usage pattern of prophylactic antimicrobials in surgical patients, in order to detect any inappropriateness concerning the selection, timing, redosing and the duration of antimicrobial administration.
A retrospective review of the randomly selected medical records of general surgical cases over an 8 month period in a tertiary care teaching hospital.
The medical records of 258 patients who had undergone surgical procedures were verified for the appropriateness of the antimicrobial prophylaxis, with respect to the choice of the antimicrobial agent, the time of its administration, the intraoperative dosing, and the duration of the postoperative use. The obtained data was analyzed and conclusions were drawn with the help of descriptive statistics.
Third generation cephalosporins were used preoperatively in all the 258(100%) patients through the intravenous route. In addition, 77(30%) patients received metronidazole or amikacin. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given. The duration of the postoperative prophylaxis was extended to 36 hours or more in 248(96%) of the cases.
The timing of administration of the preoperative dose was appropriate and well delegated to the operating room nurse. The intra operative dose was appropriately omitted. The main concern was the increasing use of the third generation cephalosporins and the unnecessary prolonged duration of the postoperative prophylaxis, which needed to be addressed.
抗菌药物的不当使用会增加耐药性、药物毒性和二重感染的发生率，从而增加医疗成本。人们已经提出了各种使抗菌治疗合理化的方法。收集抗菌药物使用模式的基线数据通常被认为是朝着这个方向迈出的第一步，这将有助于识别需要我们关注的问题领域。
研究外科手术患者预防性抗菌药物的使用模式，以检测抗菌药物给药在选择、时机、再次给药和持续时间方面是否存在不当之处。
对一家三级护理教学医院8个月期间随机抽取的普通外科病例的病历进行回顾性研究。
对258例接受外科手术的患者的病历进行核查，以确定抗菌药物预防在抗菌药物选择、给药时间、术中给药和术后使用持续时间方面是否恰当。对获得的数据进行分析，并借助描述性统计得出结论。
所有258例（100%）患者术前均通过静脉途径使用第三代头孢菌素。此外，77例（30%）患者接受了甲硝唑或阿米卡星。抗菌药物在手术前半小时至一小时给药。术中未进行再次给药。248例（96%）患者术后预防用药时间延长至36小时或更长。
术前剂量的给药时间恰当，且很好地委托给了手术室护士。术中剂量适当省略。主要问题是第三代头孢菌素的使用增加以及术后预防用药时间不必要的延长，这需要加以解决。
