儿科患者万古霉素临床用药合理性调查分析

Investigation and analysis about the Reasonable usage of Vancomycin in Pediatric Patients

目的了解我院儿科患者万古霉素的临床应用情况,对其合理性做出分析评价。方法回顾性分析我院2014年1月~2015年12月使用万古霉素进行治疗的儿科住院患者共168例,以《抗菌药物临床应用指导原则》、《万古霉素临床应用中国专家共识》为依据,通过用药指征、用法用量、病原学检查等方面来分析评价万古霉素用药的合理性。结果 168例患儿平均年龄为25.6±7.2月,疾病分布中肺炎＋败血症50例（29.8%）比例最高,160例（95.2%）进行了病原学送检,但病原菌培养阳性仅105例（65.6%）,仅23.8%患儿依据病原学结果用药,平均用药10.1±2.2天,49%未按推荐剂量使用,32%用药天数不合理,经验用药占40.5%,用药不合理率为51.2%。结论我院在万古霉素的应用中存在诸多不合理情况,应进一步规范万古霉素的使用,控制用药指征,减少经验用药,提高合理用药的水平。

Objective To investigate the clinical usage of vancomycin in pediatric patients and analyze the rationality of its clinical medication. Methods A total of 168 patients hospitalized in department of pediatrics from January 2014 to December 2014 were collected, and vancomycin usage were analyzed retrospectively. According to ＂clinical application of antibacterial drugs guiding principles＂ and ＂vancomycin clinical application of Chinese expert consensus ＂, indications, usage, dosage and etiology examination of vancomycin were analyzed to estimate the rationality of vancomycin usage. Results Among 168 children, mean age were 25.6±7.2 months. There were 50 cases whose disease were sepsis combined with pneumonia, which accounted for the highest proportion of 29.8%,. There were 160cases（amount to 95.2%） being given pathogenic detection, only 105 cases（amount to 65.6%） of them were positive. But there were only23.8% children being treated according to the results of pathogenic detection. In all children, average medication time was 10.1 ± 2.2days, 49% of all children were not treated according to recommended dose. There were 32% children being given unreasonable medication days. Furthermore, drug usage by experience accounted for 40.5%. Irrational medication usage account for 51.2%. Conclusion There are still some deficiencies about usage of vancomycin in our hospital. Some restrictive measures should be established about the use of special antibacterial.The management of antibiotics should be strengthened to advance the reasonable use of this drug and improve its therapeutic effect.