我院2004年～2006年6月抗感染药物应用分析

目的 了解我院2004年～2006年6月抗感染药物的应用情况，分析抗感染药物使用的特点和趋势。为其合理应用和科学管理提供依据。方法 对我院2004年～2006年6月抗感染药的销售金额排序。并采用WHO药物统计合作中心设定的限定日剂量（defined daily dose，DDD）方法计算我院抗茵药物的用药频度。结果 我院临床较常用的抗感染药物为头孢菌素类、青霉素类、大环内酯类、喹诺酮类；2004年～2006年6月我院抗感染药物消耗金额，在年度药品消耗总金额中，都排在临床用药第1位：但比例逐年下降；大部分抗感染药物日均费用逐年递减。结论 2004年-2006年6月我院抗感染药物使用基本合理．新上市的抗感染药物以及药品价格昂贵的抗感染药物使用较少。     

Biomedical applications of prokaryotic carbonic anhydrases

Introduction: The hydration/dehydration of CO₂ catalyzed by carbonic anhydrases (CAs, EC 4.2.1.1) is a crucial physiological reaction for the survival of all living organisms because it is connected with numerous biosynthetic and biochemical pathways requiring CO₂ or HCO₃^?, such as respiration, photosynthesis, carboxylation reactions, pH homeostasis, secretion of electrolytes, transport of CO₂, bicarbonate, etc.

Areas covered: The bacterial genome encodes CAs belonging to the α-, β-, and γ-CA classes able to ensure the survival and/or satisfying the metabolic needs of the bacteria, as demonstrated by in vivo and in vitro experiments. The discovery of new anti-infectives that target new bacterial pathways, such as those involving CAs, may lead to effective therapies against diseases subject to the antibiotic resistance. This aspect is important in pharmaceutical and biomedical research but received little attention till recently.

Expert opinion: An overview of the potential use of CAs in biomedical applications, as drug targets, bioindicators, and within artificial organs is presented. The discovery of thermostable bacterial CAs allowed the use of CAs in biotechnological applications, but patents related to the use of bacterial CAs in the development of pharmacological agents are scarce.     

Structural pharmacogenomics,drug resistance and the design of anti-infective super-drugs

Large-scale comparative analysis of drug-target polymorphism structures enables the rational design of next generation ‘super drugs’ – drugs that are less prone to development of drug resistance or that work for the largest possible fraction of the patient population. Furthermore, knowledge of the drug-target-shape repertoire that exists within the patient population enables predictions of likely clinical trial outcomes and response rates for drug efficacy. This gives information on the optimal drug candidates before the initiation of clinical trials. The economic impact of incorporating pharmacogenomics insights early on in the drug discovery process will be substantial and will afford significant competitive advantages to companies that successfully incorporate this technology.     

Liposomes in the treatment of infectious diseases

Phospholipids and other polar lipids can form liposomes and similar colloidal particles that can be used as drug carrier systems. The potential of liposomal delivery systems to increase the therapeutic index (efficacy to safety ratio) of clinically important drugs has been realised with the recent approval of liposomal oncologic and antifungal drugs. The application of liposomes to the treatment of infectious diseases initially focused on intracellular pathogens, based on the natural targeting of liposomes to phagocytic cells and on the antifungal drug amphotericin B, based on its unique affinity for lipids. Recent studies with small, low-clearance liposomes have shown that more specialised formulations may provide benefits over simpler ‘first generation’ liposomes for the treatment of infectious diseases, including prolonged residence in plasma, increased tissue exposure and targeting to sites of infection. These improved biopharmaceutical properties have been associated with both curative and prophylactic activity against a range of non-intracellular pathogens, including Staphylococcus and Klebsiella. These and other highly engineered liposome formulations may provide effective delivery systems for specific antibacterial, antifungal and antiviral indications in the future. Adequate patent protection will be crucial in fully exploiting these advanced liposome technologies and in maintaining market share for liposomal products. This review discusses some of the patent issues related to liposomes and their use in the treatment of infectious diseases.     

中西药临床应用不良反应300例分析

[目的]总结分析我院近3年中、西药临床应用中药物不良反应(ADR)的发生情况,促进临床合理用药。[方法]对300例ADR报表进行回顾性分类统计分析。[结果]ADR涉及的药品种类繁多,其中以抗感染药居首位,中药制剂次之;ADR以皮肤及其附件损害最为常见;静脉给药方式占多数。[结论]加强ADR监测工作,重视ADR,合理用药,减少或避免ADR的发生,提高临床用药的安全性。     

Clinical Impact of an Antibiotic Time Out Initiative at an Academic Medical Center

Background: Various strategies aimed at limiting inappropriate antimicrobial use including antibiotic time out (ATO) have been proposed to combat the development of antimicrobial resistance, yet there are limited studies that have assessed the impact of ATO on clinical outcomes. Methods: This single-center retrospective study reviewed the effect of a passive ATO strategy by comparing 100 adult patients with an ATO matched by infection type to 100 antibiotic-treated adult patients lacking an ATO note. Results: No difference in clinical outcomes was observed, however, ATO did result in improved optimization of antibiotic selection and duration, and reduction of piperacillin/tazobactam and vancomycin use. Conclusion: Further studies are warranted to evaluate the impact of ATO on clinical outcomes of a larger homogenous population with specified infectious diagnoses and clinical characteristics.     

抗感染药物利用分析

目的评价抗感染药物的应用现状及趋势。方法对我院2005-2007年抗感染药物的销售金额、用药频度（DDDs）等进行回顾性分析。结果我院抗感染药物销售金额2007年有所增长,但其占西药总销售金额的比例呈下降趋势。各年度头孢菌素类销售金额在抗感染药中所占比例均列第1位,平均为49．16％,β-内酰胺类（包括头孢菌素类、青霉素类和其他β-内酰胺类）在抗感染药销售金额中比重最大,占抗感染药总销售额的平均比例为58．83％。DDDs排序前4位的分别是头孢菌素类、大环内酯类、氟喹诺酮类、四环素类,其DDDs之和占年度抗感染药DDDs总和的75．25％、80．27％、80．76％;在DDDs排序前10位药品中,销售金额排序与DDDs排序比〉1的占99．97％。结论安全、有效、价格低廉的抗感染药物占主导地位,临床用药合理。     

2002年度我院151例抗感染药ADR报告分析

目的 了解我院抗感染药物发生的ADR情况及其给患造成的危害。方法 对我院2002年度151例ADR病例报告进行分类统计和分析评价。结果 涉及ADR的药物共有31个品种，其中以喹诺酮类居首位，其次为头孢菌素类。合并用药占58．3％，用药途径以静脉注射为主。主要的ADR类型为皮肤损害，其次是胃肠系统损害。重度ADR13例(8．6％)。结论 应继续加强抗感染药物ADR监测，尤其加强不易观察的不良反应及慢性ADR的监测。     

我院2003年7月～2006年6月抗感染药应用分析

目的:分析掌握我院各类抗感染药的使用情况,为临床合理应用抗生素及科学制定采购计划提供依据。方法:根据我院“医院药品库存管理系统”的原始数据资料,采用限定日剂量法和销售金额排序法进行分析。结果:我院抗感染药品种数从2003年至2005年有所增加,但增幅不大,头孢菌素类品种数最多。抗感染药销售金额平均占西药销售金额的32.36%,低于国内其他医院。β-内酰胺类销售金额遥遥领先,平均占抗感染药销售金额的50.99%。青霉素类、头孢菌素类、大环内酯类、氟喹诺酮类和硝基咪唑类药物是使用频度最高的5大类,这5类药的DDDs之和平均占各年度占抗感染药物DDDs总和的85.29%。在DDDs排序前20位中,口服制剂占2/3,注射制剂占1/3;排序比>1的占75%,<1者,占25%,表明安全有效、价格低廉的抗感染药物占主导地位,临床用药基本合理。结论:掌握医院抗感染药物的应用情况,对于促进合理用药具有重要意义。