基于不同指标评价儿童抗菌药物使用情况

The use of antibiotics in children was evaluated based on different indexes

目的:基于不同指标评价儿童抗菌药物使用,为临床合理用药评价提供参考。方法:采用回顾性分析方法,抽取郑州大学附属儿童医院2022年4—9月份出院病历5984份,提取患儿基本资料和抗菌药物使用情况,统计分析抗菌药物使用率、用药适应证、治疗天数、治疗时长及处方日剂量。结果:5984份病历中,抗菌药物使用率41.29%,其中,0~28 d患儿抗菌药物使用率为81.37%,住院时间超过30 d患儿抗菌药物使用率为92.43%;使用频次排名前3位的抗菌药物是第三代、第二代和第一代头孢菌素,使用率分别为42.78%、15.52%和10.95%。不同类别抗菌药物临床用药适应证有较大差别,第一代头孢菌素(327/335,97.61%)和第二代头孢菌素(220/475,46.32%)主要于围手术期预防使用,大环内酯类药物(176/187,94.16%)、青霉素类复方制剂(47/53,88.68%)和第三代头孢菌素(1119/1309,85.49%)主要用于社区获得性感染;抗菌药物每百人天治疗天数为48.16 DOTs,每百人天治疗时长为40.87 LOTs,DOT/LOT为1.18,每百人天治疗天数和每百人天治疗时长在不同年龄、住院时间和科室之间差异均存在统计学意义(P<0.01);处方日剂量随着年龄增长不断增加,>10岁儿童组处方日剂量接近于成人DDD,>10岁儿童组和0~28 d儿童组处方日剂量中位数比率因抗菌药物差异略有不同,最高为阿奇霉素(12),最低为头孢呋辛(6.82)。结论:除抗菌药物使用率评价指标之外,抗菌药物用药适应证、抗菌药物治疗天数和处方日剂量也可用于评价儿童抗菌药物使用。

OBJECTIVE To evaluate the use of antibiotics in children based on different indexes,in order to provide refer⁃ence for clinical rational drug use evaluation.METHODS A retrospective analysis was conducted to select 5984 medical records from the Children’s Hospital Affiliated to Zhengzhou University from April 2022 to September 2022.Basic data and the use of antibiotics were extracted,and the utilization rate,drug purpose,treatment days,treatment duration and daily prescription dose of antibiotics were statistically analyzed.RESULTS Among 5984 medical records,the utilization rate of antibiotics was 41.29%,among which,the utilization rate of antibiotics was 81.37%in children from 0 to 28 days,and 92.43%in children hospitalized for more than 30 days.The top three antibacterial drugs used frequently were the third generation,the second generation and the first generation cephalosporins,with utilization rates of 42.78%,15.52%and 10.95%,respectively.There were great differences in clinical indications of different types of antibiotics.The first generation of cephalosporins(327/335,97.61%)and the second gen⁃eration of cephalosporins(220/475,46.32%)were mainly used for perioperative prophylactic use.Macrolides(176/187,94.16%),penicillins(47/53,88.68%)and third-generation cephalosporins(1119/1309,85.49%)were mainly used for com⁃munity acquired infections.Treatment days per 100 person days were 48.16 DOTs,treatment duration per 100 person days was 40.87 LOTs,DOT/LOT was 1.18,treatment days per 100 person-days and treatment duration per 100 person days were signifi⁃cantly different among different ages,length of stay and departments(P<0.01);The prescription daily dose increased with age,The prescription daily dose of children older than 10 years was close to adult DDD.The ratio of prescription daily dose of children older than 10 years and children aged 0 to 28 days was slightly different due to the difference of antibiotics,with the highest value being azithromycin 12 and the lowest value being cefuroxime 6.82.CONCLUSIONS In addition to the evaluation index of the utilization rate of antibiotics,the indications of antibiotics,the number of days of antibiotics treatment and the prescribed daily dose of antibiotics can also be used to evaluate the use of antibiotics in children.