Appleby D H, John J F
South Med J. 1980 Nov;73(11):1473-5. doi: 10.1097/00007611-198011000-00016.
We reviewed total usage of parenteral cephalosporins at a county hospital during 1978 with regard to appropriateness, pattern of use, and cost. In addition, we determined the impact of replacing cephalothin with cephapirin in the hospital formulary. During the 12-month study 366 patients received 409 courses of parenteral cephalosporins: 167 received cefazolin, 160 received cephapirin, and 35 received a combination of cefazolin and cephapirin. The surgical service prescribed 87% of the cephapirin and 92% of the cefazolin. Parenteral cephalosporins were used 62% of the time for prophylaxis and 38% of the time for therapy. Usage was judged inappropriate in 47% of all courses based on our criteria; 25% of the therapeutic courses were judged inappropriate, compared to 60% of the prophylactic courses. Pharmacy costs of cefazolin used as prophylaxis were more than twice the cost for cephapirin. Cost of a mean therapeutic course for cefazolin was 43% higher than for cephapirin. Antibiotic audits and continued education combined with judicial substitution of therapeutic equivalents should limit the inappropriate use and expense of parenteral cephalosporins for large as well as small hospitals.
我们回顾了1978年一家县医院肠胃外头孢菌素的总体使用情况，涉及适用性、使用模式和成本。此外，我们还确定了在医院配方中用头孢匹林替代头孢噻吩的影响。在为期12个月的研究中，366名患者接受了409个疗程的肠胃外头孢菌素治疗：167人接受头孢唑林，160人接受头孢匹林，35人接受头孢唑林和头孢匹林的联合治疗。外科服务部门开出了87%的头孢匹林和92%的头孢唑林。肠胃外头孢菌素62%的时间用于预防，38%的时间用于治疗。根据我们的标准，47%的疗程使用不当；25%的治疗疗程被判定为不当，而预防疗程的这一比例为60%。用作预防的头孢唑林的药房成本是头孢匹林的两倍多。头孢唑林平均治疗疗程的成本比头孢匹林高43%。抗生素审计和持续教育，再加上合理替换治疗等效物，应能限制大医院和小医院肠胃外头孢菌素的不当使用和费用。
