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[人类医学中抗生素的合理处方]

[Rational prescription of antibiotics in human medicine].

作者信息

Kern Winfried V

机构信息

Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum und Medizinische Fakultät Freiburg, Albert-Ludwigs-Universität, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Deutschland.

出版信息

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 May;61(5):580-588. doi: 10.1007/s00103-018-2727-x.

Abstract

Rational prescription of antibiotics has become a priority in undergraduate and continued professional medical education and in quality management systems. Areas for optimization have been identified, above all, in critically establishing the indication for therapy, in increasing targeted therapy, and shortening treatment duration, and affect both outpatient and inpatient settings. They are partly related to deficiencies in clinical research, but aberrations in the development of the postgraduate training system, in the infrastructure, and in the reimbursement system of the various healthcare sectors in Germany contribute to problems in these areas. "Antibiotic stewardship" (ABS) programmes at different levels are capable of efficiently combining interventions to improve the quality of prescription. Progress has been made and experience gained in the professional training of physicians and pharmacists in antibiotic prescribing and with the hospital-wide establishment of ABS teams and specialist infectious disease consultation services. Close interaction and collaboration with diagnostic microbiology services are important and greatly enhance the impact of ABS programmes on the quality of prescription. Political support and investment are required for this new infrastructures to be sustainable and to further develop it for the cross-section between inpatients and outpatients, and for the outpatient setting.

摘要

抗生素的合理处方已成为本科及继续医学专业教育以及质量管理体系中的优先事项。已确定需要优化的领域,首先是在严格确定治疗指征、增加靶向治疗以及缩短治疗持续时间方面,这在门诊和住院环境中均有体现。这些问题部分与临床研究的不足有关,但德国研究生培训体系、基础设施以及各医疗保健部门报销体系发展中的偏差也导致了这些领域的问题。不同层面的“抗生素管理”(ABS)计划能够有效地结合各种干预措施以提高处方质量。在医生和药剂师抗生素处方的专业培训以及在全院范围内建立ABS团队和传染病专科咨询服务方面已取得进展并积累了经验。与诊断微生物学服务的密切互动与合作很重要,并且极大地增强了ABS计划对处方质量的影响。要使这种新的基础设施可持续发展,并进一步发展以适用于住院患者与门诊患者之间的交叉领域以及门诊环境,需要政治支持和投资。

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