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2018年至2022年中国妊娠合并尿路感染的真实世界药物治疗模式:横断面分析

Real world drug treatment models for pregnancy complicated with urinary tract infection in China from 2018 to 2022: a cross-section analysis.

作者信息

Jin Jing, Li Changyan, He Yuqing, Pan Jiaqian, Zhu JiaLei, Tang Jing

机构信息

Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.

出版信息

Front Pharmacol. 2024 Jan 29;15:1349121. doi: 10.3389/fphar.2024.1349121. eCollection 2024.

DOI:10.3389/fphar.2024.1349121
PMID:38348394
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10859756/
Abstract

Urinary tract infection (UTI) is common in pregnant women. The selection of anti-infection plans during pregnancy must take into account the dual factors of patient pregnancy status and urinary tract infection anti-infection treatment, as well as the efficacy, cost, risk, and potential adverse reactions associated with each method applied to individual patients. Consequently, there are numerous drugs from which to choose; presently, there is no unified conclusion regarding the choice of drug therapy, and there is a lack of long-term drug treatment for UTI during pregnancy. Our objective is to investigate the actual drug treatment patterns of UTI patients during pregnancy in China over the past 5 years, with a particular emphasis on the trend and rationality of antibiotic use in these patients over the past 5 years. We conducted a cross-sectional analysis of data from a China Medical Association-supervised hospital prescription analysis cooperation initiative. From January 2018 to December 2022, the information is extracted from prescriptions/medical orders of patients with UTI during pregnancy. Using a primary anatomical therapeutic chemistry (ATC) classification code and the US Food and Drug Administration (FDA) classification, we quantified the frequency of drug use and drug types. We also calculated the prevalence of the most frequently prescribed antibacterial medications and assessed the efficacy of anti-infection plans based on drug labels and guidelines. Among the 563 patients included in this research, Chengdu (36.59%), Guangzhou (27.72%), and Shanghai (8.70%) were the top three cities. Over the course of 5 years, the average age was 29.60% ± 6.59 years, with approximately 60.21% of women between the ages of 25 and 34. Each patient's primary anti-infection medications were statistically analyzed. Cephalosporins (403, 71.58%), enzyme inhibitors (66, 11.72%), and penicillins (34, 6.04%) were the first few categories, followed by the most commonly used cephalosporins. Cefuroxime, ceftriaxone, and cefdinib, rounded out the top five. Cefoxitin and cefaclor. According to the 5-year change in dosage, cephalosporins have always ranked first. Three of the top five most expensive drugs are cephalosporins, carbapenems, and enzyme inhibitors. Teicoplanin, tigecycline, nifurtel, linezolid, and quinolones ranked among the top five in terms of per-patient drug costs for patients receiving comprehensive treatment drugs. In the 5 years of research, the average age of patients who visit a doctor has not increased substantially, but the opportunity cost of female fertility has increased, which has severely impeded the fulfillment of fertility desires. The selection of medications is generally reasonable, and the dosage of the first-line cephalosporins recommended by the guidelines is relatively high in this study. The dosage of furantoin and fosfomycin, which are more prevalent in urinary tract infections, is however relatively low. In addition, some expensive pharmaceuticals may increase patients' financial burden. On the premise of meeting clinical needs, future research will focus on how to further improve the level of rational drug use in outpatient clinics, attain economical, safe, and effective drug use, and thus reduce the economic burden on patients.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4394/10859756/ab40fbd39879/fphar-15-1349121-g006.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4394/10859756/20dc897a055b/fphar-15-1349121-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4394/10859756/ab40fbd39879/fphar-15-1349121-g006.jpg
摘要

尿路感染(UTI)在孕妇中很常见。孕期抗感染方案的选择必须兼顾患者妊娠状态和尿路感染抗感染治疗这两个因素,以及应用于个体患者的每种方法的疗效、成本、风险和潜在不良反应。因此,可供选择的药物众多;目前,关于药物治疗的选择尚无统一结论,且孕期UTI缺乏长期药物治疗。我们的目的是调查过去5年中国孕期UTI患者的实际药物治疗模式,特别关注这些患者过去5年抗生素使用的趋势和合理性。我们对一项由中华医学会监督的医院处方分析合作倡议的数据进行了横断面分析。从2018年1月至2022年12月,从孕期UTI患者的处方/医嘱中提取信息。使用主要解剖学治疗化学(ATC)分类代码和美国食品药品监督管理局(FDA)分类,我们对药物使用频率和药物类型进行了量化。我们还计算了最常用抗菌药物的患病率,并根据药物标签和指南评估了抗感染方案的疗效。本研究纳入的563例患者中,成都(36.59%)、广州(27.72%)和上海(8.70%)位列前三。在5年期间,平均年龄为29.60%±6.59岁,约有60.21%的女性年龄在25至34岁之间。对每位患者的主要抗感染药物进行了统计分析。头孢菌素(403例,71.58%)、酶抑制剂(66例,11.72%)和青霉素(34例,6.04%)位列前几类,其次是最常用的头孢菌素。头孢呋辛、头孢曲松和头孢地尼位列前五。头孢西丁和头孢克洛。根据5年的剂量变化,头孢菌素一直排名第一。最昂贵的五种药物中有三种是头孢菌素、碳青霉烯类和酶抑制剂。替考拉宁、替加环素、硝呋太尔、利奈唑胺和喹诺酮类在接受综合治疗药物的患者人均药物成本方面位列前五。在5年的研究中,就诊患者的平均年龄没有大幅增加,但女性生育的机会成本增加,这严重阻碍了生育愿望的实现。药物选择总体合理,本研究中指南推荐的一线头孢菌素剂量相对较高。然而,在尿路感染中更常见的呋喃妥因和磷霉素的剂量相对较低。此外,一些昂贵的药物可能会增加患者的经济负担。在满足临床需求的前提下,未来的研究将侧重于如何进一步提高门诊合理用药水平,实现经济、安全、有效的用药,从而减轻患者的经济负担。

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