674张儿科门诊抗菌药物处方点评与分析

Comment and Analysis on 674 Prescriptions of Antibiotics in Pediatric Outpatient

目的:了解郴州市妇幼保健院(以下简称"我院")儿科门诊抗菌药物处方中存在的问题,为临床合理应用和医院科学管理抗菌药物提供依据。方法:随机抽取2016年我院儿科门诊抗菌药物处方674张,依据药品说明书、公开发表的国内外文献与指南、教材书、《处方管理办法》《抗菌药物临床应用管理办法》《抗菌药物临床应用指导原则》及《中华人民共和国药典·临床用药须知》(2010年版)等对处方进行回顾性分析。结果:674张处方涉及33种疾病的临床诊断,抗菌药物处方数排序居前5位的病种分别为支气管炎、咽炎、扁桃体炎、支气管肺炎和胃炎;涉及27种抗菌药物(不包括局部使用制剂和外用制剂),共使用798例次,排序居前5位的抗菌药物分别为头孢克肟干混悬剂、注射用头孢他啶、注射用头孢哌酮舒巴坦、注射用阿奇霉素和注射用哌拉西林舒巴坦。674张处方中,不合理处方343张(占50.9%),主要类型包括临床诊断书写不全、未按照抗菌药物管理规定开具抗菌药物、适应证不适宜、遴选药品不适宜、用法与用量不适宜、无指征用药、重复给药和有不良药物相互作用。结论:我院儿科门诊抗菌药物存在不合理应用现象,应加强对抗菌药物的管理,积极发挥临床药师作用,加强医、药合作,促进临床合理用药。

OBJECTIVE ： To investigate problems in prescriptions of antibiotics in pediatric outpatient in Maternal and Child Health Hospital of Chenzhou （hereinafter referred to as ＂our hospital＂） , so as to provide references for clinical rational application and scientific management of antibiotics. METHODS： 674 prescriptions of antibiotics in pediatric outpatients in our hospital were randomly extracted and retrospectively analyzed according to dispensatories, literatures and handbooks published home and abroad, textbooks, Prescription Administration Policy, Administration Policy for Clinical Application of Antibiotics, Guiding Principles for Clinical Application of Antibiotics, Chinese Pharmacopoeia-Clinical Medication Instructions （2010 Version）. RESULTS： Clinical diagnoses of 33 kinds of diseases were involved in the 674 prescriptions, the top 5 diseases ranked in the number of prescriptions were respectively bronchitis, pharyngitis, amygdalitis, bronchopneumonia and gastritis; 27 kinds of antibiotics were involved （not including those for local application and external use ）, with 798 times of using in total, the top 5 antibiotics were respectively cefixime for suspension, ceftazidime for injection, eefoperazone-sulbactam for injection, azithromycin for injection and piperacillin-sulbactam for injection. Of the 674 prescriptions, there were 343 irrational prescriptions （50. 9% ）, mainly including the types of incomplete writing of clinical diagnosis, not prescribe under the administration policy of antibiotics, inappropriate indications, inappropriate drug selection, improper usage and dosage, non-indication medication, repetitive medication, adverse drug interactions. CONCLUSIONS ： Irrational application of antibiotics in pediatric outpatient in our hospital is still exist, which needs to be reinforced on its administration and gives full play of clinical pharmacists, clinicians-pharmacists collaboration needs to be enhanced so as to promote clinical rational medication.