门诊患儿就诊前抗生素使用现状的单中心调查

Single Center Investigation of Application of Antibiotics before Outpatient Visit in Pediatrics

目的:调查我院儿科2018年3-4月门诊患儿就诊前抗生素使用现状。方法:由医师发放调查表,家属自愿如实填写。收集患儿年龄、性别、症状、就诊前是否服用抗生素、首剂抗生素与症状出现时段、服用时长、抗生素种类及来源等相关信息进行统计学分析。结果:入选的患儿共187例,使用抗生素者155例,占82. 89%;未使用者32例,占17. 11%。抗生素使用率细菌组与病毒组分别为81. 43%、84. 07%(P>0. 05);幼儿组、学龄前期组及学龄期组患儿抗生素使用率分别为88. 46%、86. 42%、84. 61%,高于婴儿组(P<0. 05);单独使用者占85. 16%,联合应用占14. 84%。单独使用率由高到低分别为头孢菌素类58. 71%、青霉素类21. 93%、大环内酯类4. 52%(P<0. 05)。抗生素来源分别为药店购买(28. 38%)、社区医师处方(27. 10%)、家里储备(20. 65%)、上次生病所剩(23. 87%) 4个途径(P>0. 05)。首剂抗生素应用时限<12 h组应用率44. 52%,明显高于12~24 h组的29. 68%和>24 h组的25. 81%(P <0. 05)。结论:儿科患者就诊前抗生素应用存在滥用、不规范、不合理现象,应加强宣教及监管。

Objective: To investigate the application status of antibiotics before outpatient visit in pediatrics of our hospital from Mar. to Apr. 2018. Methods: The questionnaire was issued by the clinicians,and the family members voluntarily filled in the truth. Statistical analysis was conducted on children’s age,gender,symptoms,administration of antibiotics before visit,duration of the first dose of antibiotics and the onset of symptoms,duration of the treatment,categories and source of antibiotics. Results: A total of 187 children were enrolled,155 cases( 82. 89%) were given antibiotics,and 32 cases( 17. 11%) received no antibiotics. The application rates of antibiotics in the bacterial group and viral group were respectively 81. 43% and 84. 07%( P>0. 05). The application rates of antibiotics in the toddler,preschool and school-age group were respectively 88. 46%,86. 42% and 84. 61%,higher than those in the infant group( P<0. 05). The proportion of single application of antibiotics accounted for 85. 16% and drug combination accounted for 14. 84%. The single application rate of antibiotics were 58. 71% for cephalosporins,21. 93% for penicillins and 4. 52% for macrolide( P<0. 05). The sources of antibiotics were respectively pharmacy purchases( 28. 38%),prescriptions by community clinicians( 27. 10%),home reserves( 20. 65%),and the remaining drugs( 23. 87%,P > 0. 05). The application rate of the first dose of antibiotics in the < 12 h group was 44. 52%,significantly higher than that in the 12 to 24 h group( 29. 68%) and the > 24 h group( 25. 81%,P < 0. 05).Conclusion: The application of antibiotics in children before outpatient visit is abusive,non-standard and irrational. Therefore,the propaganda,education and supervision should be strengthened.