Jewesson P J, Bachand R L, Bell G A, Ensom R J, Chow A W
Can Med Assoc J. 1985 Apr 1;132(7):785-9.
The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital. Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied. Appropriateness of therapy was assessed on the basis of published indications. Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections. It was used as frequently for prophylaxis as for therapy. Surgical services accounted for 95% of the treatment courses. Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%). Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery. Written justification for use and automatic stop orders are recommended to improve the cost effectiveness of both prophylactic and therapeutic use of selected antimicrobial agents.
近期胃肠外给药甲硝唑的发布、相对较高的成本及潜在不良反应促使一家拥有1000张床位的教学医院进行了使用质量审核。在6周期间对81名住院患者的92个疗程治疗进行了研究。根据已发表的适应症评估治疗的适宜性。胃肠外给药甲硝唑主要用于厌氧和厌氧-需氧感染。其用于预防和治疗的频率相同。外科服务占治疗疗程的95%。在27个（29%）疗程中发现了不恰当使用情况：12个（13%）疗程表明应使用胃肠外给药甲硝唑以外的药物，而15个（16%）疗程的治疗剂量、给药间隔或持续时间欠佳。如果在择期结直肠手术的围手术期预防中用口服或直肠甲硝唑治疗替代静脉治疗，将实现大幅节省。建议使用书面理由说明和自动停药医嘱，以提高所选抗菌药物预防和治疗使用的成本效益。
