比阿培南临床合理使用评价标准的建立与应用

Establishment and application of evaluation criteria on reasonable use of biapenem

目的建立新碳青霉烯类抗菌药物比阿培南药物利用评价(DUE)标准,并进行回顾性应用调查分析,为临床合理使用比阿培南提供参考依据。方法参考世界卫生组织及美国、加拿大等发达国家DUE操作指南,构建DUE标准基本框架,结合《抗菌药物临床应用指导原则》及比阿培南药品说明书等,组织专家讨论建立比阿培南DUE标准;设计患者使用比阿培南调查表,评价某三甲医院比阿培南使用情况。结果建立的比阿培南DUE标准包括用药指征、用药过程、用药结果3个部分;通过回顾性分析DUE标准应用,发现某三甲医院比阿培南在临床应用过程中在患者治疗前后体温监测、血常规检查、药物使用剂量和给药途径、溶媒选用和滴注时间、药物相互作用等方面符合标准率均为100.0%;在用药指征和禁忌证把握、病原学检查、用药疗程、抗菌药物联合应用等方面存在不合理现象,其中用药指征符合标准率为70.0%,8.3%有用药禁忌证、第1次使用前<72h进行细菌培养和药敏试验的占60.0%、用药疗程符合标准率为58.3%、抗菌药物联合应用符合标准为40.0%。结论建立的比阿培南DUE标准具有较好的实用性,在临床实践应用中可发现临床用药过程中存在的问题或不足,对促进临床合理用药具有重要指导意义。

OBJECTIVE To establish and retrospectively apply the drug use evaluation criterion on biapenem so as to provide basis for the reasonable clinical use of biapenem. METHODS Referring to the expert advice and guideline of clinical application of biapenem of WHO and the developed countries such as the United States and Canada, the drug use evaluation criteria on biapenem was established, and the data form was designed to collect the information of biapenem-use and to assess the drug use in a 3A hospital. RESULTS The drug use evaluation criterion on biap- enem consisted of drug indications, drug use process and the results. Through the retrospective DUE application, we found that the qualified rates of some reasonable use of biapenem in a 3A hospital including temperature moni- toring in patients before and after treatment, routine blood test, medication doses and administration way, solvent selection and drip time, and drug interaction were 100.0%; there were also some unreasonable use of biapenem such as lax grasping indications and contraindieations, less pathogeny detecting, unreasonable antibacterial drugs combined application, long or short course of treatment in clinic, among which the qualified rate of the medication indication was 70.0%, 8.3% were medication contraindications, 60.0% were performed the bacterial culture and drug susceptibility testing within 72 hours before the first application; the accordant rate of the criteria of medica- tion course was 58.3%, the combined use of antibiotics was 40.0%. CONCLUSION The DUE criterion has very strong practicability, and some problems and insufficiencies can be found in the clinical medication of biapenem, the DUE criterion possesses great significance in promotion of reasonable use of antibiotics.