Service évaluation pharmaceutique et bon usage, agence générale des équipements et produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, Paris, France.
Service évaluation pharmaceutique et bon usage, agence générale des équipements et produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, Paris, France.
Med Mal Infect. 2017 Feb;47(1):42-49. doi: 10.1016/j.medmal.2016.09.003. Epub 2016 Oct 17.
We aimed to document amoxicillin-clavulanic acid prescription to improve the proper use of antibiotics in hospital settings. We used three criteria: quality of medical charts, adequacy of indications, and adequacy of treatment duration.
This study was designed as a one-day point prevalence survey carried out by antibiotic lead specialists.
We included 387 prescriptions from 32 hospitals. Immunodeficiency was recorded as a risk factor in 30% of patients. Computerized prescriptions were observed in 79% of cases. The indication was mentioned in 73% of cases and a 48/78-hour re-assessment of the antibiotic therapy was performed in 54% of cases. The antibiotic indication was primarily for pneumonia and was deemed appropriate in 75% of patients. Adult mean treatment duration was 11.1 days. Use of dual combination therapy and/or treatment duration exceeding two weeks accounted for the main reasons for an inappropriate use of antibiotics. Prescriptions recorded as having been made by senior physicians were of the shortest treatment duration (P=0.0163).
Medical charts should be better filled in. Reinforcing the role of senior physicians in supervising antibiotic prescriptions is likely to result in a better control of treatment duration and ultimately in a reduced antibiotic consumption. By reinforcing the collaboration between pharmacists and antibiotic lead specialists, the improvement of computerized prescriptions at hospital level should help better detect the "at risk" prescriptions, namely those exceeding seven days or those combining antibiotics.
我们旨在记录阿莫西林-克拉维酸处方，以改善医院环境中抗生素的合理使用。我们使用了三个标准：病历质量、适应证充分性和治疗持续时间充分性。
这项研究设计为抗生素专家进行的为期一天的现况调查。
我们纳入了来自 32 家医院的 387 份处方。30%的患者记录有免疫功能低下的风险因素。79%的病例为计算机开具的处方。73%的病例中提到了适应证，54%的病例对抗生素治疗进行了 48/78 小时的重新评估。抗生素适应证主要为肺炎，75%的患者认为适应证合适。成人平均治疗时间为 11.1 天。联合使用双重药物治疗和/或治疗时间超过两周是抗生素不合理使用的主要原因。记录为由资深医生开具的处方的治疗持续时间最短（P=0.0163）。
病历应填写得更好。强化资深医生在监督抗生素处方方面的作用，可能有助于更好地控制治疗持续时间，最终减少抗生素的使用。通过加强药剂师和抗生素专家之间的合作，提高医院层面的计算机化处方，有助于更好地发现“高危”处方，即那些超过 7 天或联合使用抗生素的处方。
