依据抗菌药物PK/PD理论对我院门诊药房抗菌药物不合理处方的点评及案例解析

Analysis of irrational antibacterials prescriptions based on the PK/PD theory of antibacterial drugs in the outpatient dispensary of our hospital

目的:依据抗菌药物PK/PD理论,对我院门诊药房抗菌药物不合理处方进行点评与分析,以期优化临床给药方案。方法:基于4例出现频数较高的不合理抗菌药物处方,结合抗菌药物PK/PD理论,明确药师在抗菌药物应用的适应证、用法用量、给药频次等问题的处方点评策略。结果:β-内酰胺类抗菌药物为时间依赖性抗菌药物,为取得较好临床疗效,β-内酰胺类抗菌药物的T>MIC需要超过给药间歇的40%;阿奇霉素片为大环内酯类抗菌药物,属于时间依赖性且PAE较长的抗菌药物,推荐给药频次为qd;氟喹诺酮类药物属于浓度依赖性抗菌药物,其有较高的组织浓度,AUC0-24 h/MIC≥100和/或C max/MIC>8时可发挥良好的疗效。结论:在处方点评过程中,药师应评估患者的综合情况,以抗菌药物PK/PD理论为指导,开展有效地处方点评工作,对不合理处方积极干预,以促进临床合理用药。

Objective：On the basis of PK/PD theory for antibacterials, the irrational prescriptions of antimicrobials were analyzed in the outpatient dispensary of our hospital in order to optimize clinical dosing regimens. Methods：Based on 4 cases of irrational antibacterial prescriptions with higher frequency, combined with PK/PD theory, the evaluating strategies were clariifed, such as the application of antibacterials indications, usage, dosage, drug frequency and so on. Results： β-lactam antibacterials were time-dependent antibacterials, T〉MIC of which must be more than 40%interval time of administration for good antibacterial effect. Azithromycin tablet was macrolide antibacterials with time-dependent and long PAE, the dosing frequency of azithromycin was recommended as once a day. Fluoroquinolones were concentration-dependent antibacterials with higher tissue concentration, whose AUC0-24 h/MIC≥100 and/or Cmax/MIC〉8 were necessary for good antibacterial effect. Conclusion：During the process of prescription analysis, pharmacists should evaluate the comprehensive conditions of patients, carry out effective prescription comment with the guidance of the PK/PD theory of antibacterials and actively provide effective intervention in order to promote clinical rational drug use.