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2011-2015 年中国某结核病专科医院住院患者抗结核药物处方分析。

Antituberculosis drug prescribing for inpatients in a national tuberculosis hospital in China, 2011-2015.

机构信息

Beijing Chest Hospital, Capital Medical University, Beijing, China; Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China; Administration Office, Clinical Center on Tuberculosis, Chinese Center for Disease Control and Prevention (CDC), Beijing, China.

Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

出版信息

J Glob Antimicrob Resist. 2018 Sep;14:17-22. doi: 10.1016/j.jgar.2018.02.008. Epub 2018 Feb 21.

Abstract

OBJECTIVES

This study aimed to describe trends in antituberculosis drug prescribing for inpatients from 2011-2015 in a Chinese national tuberculosis (TB) hospital.

METHODS

This retrospective study, performed in March 2016, reviewed the medical records of all inpatients from Beijing Chest Hospital diagnosed with TB between 2011-2015. Medication used for TB treatment during the inpatient period was recorded.

RESULTS

A total of 11465 inpatients were enrolled in the study. The most frequently prescribed drug for inpatients was isoniazid (71.2%; 8164/11465), followed by ethambutol (67.5%; 7738/11465), pyrazinamide (59.7%; 6839/11465) and rifampicin (40.0%; 4589/11465). In addition, amikacin (16.5%; 1889/11465), levofloxacin (33.0%; 3789/11465), para-aminosalicylic acid (12.4%; 1422/11465) and clarithromycin (3.5%; 406/11465) were the most common drugs used in the treatment of inpatients for Group II, III, IV and V drugs, respectively. A significant increasing trend in prescribing was found for rifampicin, pyrazinamide, capreomycin, moxifloxacin, prothionamide, para-aminosalicylic acid, cycloserine, clofazimine and linezolid, respectively, whilst there was a significant decreasing trend in the rate of prescribing of ethambutol, amikacin, levofloxacin, amoxicillin/clavulanic acid and clarithromycin during the 5-year study period (P<0.01).

CONCLUSIONS

These data demonstrate that prescription of anti-TB drugs varied greatly across clinical diagnostic categories, treatment history and drug susceptibility profiles of TB patients. The World Health Organization (WHO)-endorsed standard regimen should be more extensively employed under conditions where drug susceptibility testing is unavailable in order to guide clinicians to formulate a suitable treatment regimen for TB patients.

摘要

目的

本研究旨在描述 2011 年至 2015 年间中国某结核病(TB)医院住院患者抗结核药物的应用趋势。

方法

本回顾性研究于 2016 年 3 月进行,分析了 2011 年至 2015 年间在首都医科大学附属北京胸科医院确诊为结核病的所有住院患者的病历。记录住院期间用于结核病治疗的药物。

结果

本研究共纳入 11465 例住院患者。住院患者最常使用的药物为异烟肼(71.2%,8164/11465),其次为乙胺丁醇(67.5%,7738/11465)、吡嗪酰胺(59.7%,6839/11465)和利福平(40.0%,4589/11465)。此外,阿米卡星(16.5%,1889/11465)、左氧氟沙星(33.0%,3789/11465)、对氨基水杨酸(12.4%,1422/11465)和克拉霉素(3.5%,406/11465)分别为二线、三线、四线和五线药物治疗住院患者时最常使用的药物。利福平、吡嗪酰胺、卷曲霉素、莫西沙星、丙硫异烟胺、对氨基水杨酸、环丝氨酸、氯法齐明和利奈唑胺的处方使用率呈显著上升趋势,而乙胺丁醇、阿米卡星、左氧氟沙星、阿莫西林/克拉维酸和克拉霉素的处方使用率在 5 年研究期间呈显著下降趋势(P<0.01)。

结论

这些数据表明,抗结核药物的处方在临床诊断类别、治疗史和结核病患者的药物敏感性方面存在较大差异。在无法进行药物敏感性检测的情况下,应更广泛地使用世界卫生组织(WHO)推荐的标准方案,以指导临床医生为结核病患者制定合适的治疗方案。

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