Dixit Diksha, Ranka Rajat, Panda Prasan Kumar
Medical School, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.
Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.
JAC Antimicrob Resist. 2021 Sep 15;3(3):dlab135. doi: 10.1093/jacamr/dlab135. eCollection 2021 Sep.
Antimicrobial stewardship describes the practice of promoting the selection of the right drug, dosage, delivery and duration of antimicrobial therapy (the 4Ds) in order to curtail the emergence of resistant organisms. It is important to quantify the inappropriate use of antimicrobials in terms of percentage adherence to each of the 4Ds mentioned.
We undertook a prospective review of medical records of patients admitted to the medical wards of a tertiary care centre in North India. All patients on antimicrobials were included and their records reviewed for indication, drug, dose, delivery and duration (or by asking the treating physician if not documented). Adherence to the 4Ds was determined by referring to updated literature-based standard treatment guidelines (STGs) for each specific disease.
Of 304 patients, drugs were appropriate and matched STGs in 218 (72%) patients, with adherence to the right dose in 210 (69%), route of delivery in 216 (71%) and duration in 197 (65%). Full adherence to the 4Ds was observed in 196 (64.5%). Maximum adherence was observed in treating skin and soft tissue infections (100%), while minimum adherence was observed in administering medical prophylaxis (40%). WHO Access, Watch and Reserve categories comprised 29%, 63% and 8.5% of all prescribed antibiotics, respectively.
The right drug, dose, delivery and duration of therapy are prescribed in 72%, 69%, 71%, and 65% of patients, respectively. In order to increase the adherence to 100%, bedside stewardship practices in the form of prospective audits and feedback must be improved. There is a need to integrate WHO AWaRe classification of antibiotics into treatment guidelines.
抗菌药物管理描述的是促进选择正确的抗菌治疗药物、剂量、给药方式和疗程（即4个D）的实践，以减少耐药菌的出现。按照上述4个D的每项依从性百分比来量化抗菌药物的不当使用情况很重要。
我们对印度北部一家三级医疗中心内科病房收治患者的病历进行了前瞻性回顾。纳入所有使用抗菌药物的患者，并审查其病历以确定用药指征、药物、剂量、给药方式和疗程（若未记录则询问主治医生）。参照针对每种特定疾病的最新循证标准治疗指南（STG）来确定对4个D的依从性。
在304例患者中，218例（72%）患者使用的药物恰当且符合STG，210例（69%）患者剂量正确，216例（71%）患者给药途径正确，197例（65%）患者疗程正确。196例（64.5%）患者完全符合4个D。治疗皮肤和软组织感染时依从性最高（100%），而进行医学预防时依从性最低（40%）。世界卫生组织的“准入”“观察”和“储备”类抗生素分别占所有处方抗生素的29%、63%和8.5%。
分别有72%、69%、71%和65%的患者接受了正确的药物、剂量、给药方式和疗程治疗。为了将依从性提高到100%，必须改进以前瞻性审核和反馈形式的床边管理措施。有必要将世界卫生组织的抗生素“AWaRe”分类纳入治疗指南。
