2015—2019年西安市第一医院β-内酰胺酶抑制剂复方制剂临床应用合理性分析

Evaluation of the rationality of clinical application ofβ-lactamase inhibitors compound in the First Hospital of Xi’an during 2015—2019 period

目的对西安市第一医院β-内酰胺类抗生素/β-内酰胺酶抑制剂复方制剂(简称β-内酰胺酶抑制剂复方制剂)的临床应用情况、用药趋势及合理性进行分析,为其规范化管理和临床合理用药提供参考。方法对2015—2019年西安市第一医院β-内酰胺酶抑制剂复方制剂的销售金额、用药频度(DDDs)、日均费用(DDC)、药品排序比(B/A)和科室分布等进行统计和分析,并抽取β-内酰胺酶抑制剂复方制剂住院病例500份,对其合理性进行评价。结果β-内酰胺酶抑制剂复方制剂销售金额和DDDs总体呈增长趋势,其中注射用美洛西林钠舒巴坦钠和注射用头孢哌酮钠舒巴坦钠位居前2位。DDC从2017年起有不同程度的下降,各品种间DDC差异较大。注射用美洛西林钠舒巴坦钠和注射用头孢哌酮钠舒巴坦钠B/A为1.00,同步性较好;注射用哌拉西林钠舒巴坦钠和注射用哌拉西林钠他唑巴坦钠B/A小于1.00,使用成本较高;注射用阿莫西林钠克拉维酸钾和阿莫西林克拉维酸钾分散片B/A大于1.00,使用成本较低。β-内酰胺酶抑制剂复方制剂科室分布于呼吸内科、泌尿外科、肾脏内分泌科、神经内科、神经外科、重症医学科、心血管内科、干部病房、康复医学科、儿科等,临床应用较广泛。抽取的500份应用β-内酰胺酶抑制剂复合制剂住院病例,有53例存在用药不合理的情况,其中适应症不适宜45例(9%),用药疗程不适宜4例(0.8%),用法用量不适宜3例(0.6%),联合用药不适宜1例(0.2%)。结论西安市第一医院β-内酰胺酶抑制剂复方制剂临床应用基本合理,但仍存在选择抗菌药物价格高和起点高的问题,今后应进一步加强对β-内酰胺酶抑制剂复方制剂的管理。

Objective To analyze the clinical application and trend ofβ-lactamase inhibitors compound in the hospital,and to provide reference for standardized management and rational clinical use of drug.Methods The data of utilization ofβ-lactamase inhibitors compound in the First Hospital of Xi’an from 2015 to 2019 were collected and analyzed statistically,and consumption sums,frequency of drug use(DDDs),defined daily cost(DDC),drug sequence ratio(B/A)and department distribution were calculated and analyzed.A retrospective analysis was made of 500 medical records of the patients usingβ-lactamase inhibitors compound,and the medication rationality ofβ-lactamase inhibitors compound was evaluated.Results The consumption sums and DDDs ofβ-lactamase inhibitor compound showed an overall growth trend,among which meloxicillin sodium sulbactam sodium for injection and cefoperazone sodium sulbactam sodium for injection were the top two.Since 2017,DDC has decreased to different degrees,and there was a big difference in DDC among varieties.B/A values of meroxicillin sodium sulbactam sodium for injection and cefoperazone sodium sulbactam sodium for injection were 1,indicating good synchronization.B/A values of piperacillin sodium sulbactam sodium for injection and piperacillin sodium tazobactam sodium for injection were less than 1,the use cost was higher;B/A values of amoxicillin sodium potassium clavulanate for injection and amoxicillin potassium clavulanate dispersible tablets were more than 1.Theβ-lactamase inhibitor compound was widely used in respiratory medicine,urology,kidney endocrinology,neurology,neurosurgery,intensive medicine,cardiovascular medicine,cadre ward,rehabilitation medicine,pediatrics,etc.There were 53 cases of irrational use records,in which,improper indications(9%),appropriate course of treatmen(0.8%),irrational dosage(0.6%)and improper drugCombination(0.2%)were the major problems.Conclusion The clinical application ofβ-lactamase inhibitor compounds is basically reasonable in the hospital,but there are still problems of high price and high starting point for the selection of antibiotics,so the management ofβ-lactamase inhibitor compounds should be further strengthened in the future.