Drug prescribing in children in a North Indian referral hospital

Ojective — Pattern of drug use in an ambulatory paediatric patients in a tertiary care hospital in Northern India was studied. Methods — Prescribing patterns were studied prospectively, using drug use indicators developed by WHO/International Network for Rational Utilization of Drugs (INRUD). Results — The most frequent diagnosis was seizure disorder (26.9%) and antiepileptics were the most often prescribed drugs (24.6); followed by vitamin and mineral supplements (20.1%), and cough/cold preparations (16%). Use of vitamin and mineral supplements was disproportionately high (20.1%) when compared to the number of cases of anaemia (2.3% and malnutrition (2.6%). The average number of drugs per encounter (1.32), percentage of encounters with an antibiotic (6.1%) or injection (0.2%) prescribed, were all within the acceptable range. The percentage of drugs prescribed by generic name was too low, at 11.2%. Conclusion — Barring the frequent use of supplements and low rate of generic prescribing, prescribing trends were found to be rational in other aspects in the study population. Copyright © 2000 John Wiley & Sons, Ltd.     

Drug use in pregnancy: an overview of epidemiological (drug utilization) studies

Summary The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960–1988.The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids.However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy.The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.This study was supported in part by the National Research Council (CNR, Rome, Italy), Convenzione Farmacologia Clinica     

我院2002-2004年肾移植患者住院用药情况分析

目的：分析我院肾移植手术患者住院期间的用药情况及变化趋势，促进临床合理用药。方法：查阅我院2002～2004年肾移植患者的住院病历及相关资料，对住院期间用药情况进行分析，以用药金额排序法和限定日剂量法对用药情况进行评估。结果：我院2002～2004年肾移植患者均次总药费、日均药费、用药总金额呈逐年上升趋势。金额排序前20位药品主要为抗排斥药、抗感染药、胃肠溃疡治疗药及抗栓塞药等，各类药物DUI≤1。结论：我院肾移植患者用药情况基本合理，但也存在如抗感染药起点高，费用大等不合理现象。     

Drug utilization review in a teaching hospital: experience with vancomycin

Summary A prospective, two-phase, drug utilization review (DUR) was performed at the Royal Adelaide Hospital (RAH) to determine the extent and pattern of vancomycin use. For all patients commencing oral or parenteral vancomycin, treatment indication, route of administration, duration of therapy, results of culture and sensitivity tests, adverse drug reactions and results of therapeutic drug level monitoring were recorded. Vancomycin courses were classified as being for therapy or prophylaxis and compared with predetermined audit criteria to assess appropriateness of use.During the 8 week initial phase, data on 62 treatment courses in 59 patients were recorded, 50% for therapy and 50% for prophylaxis. Sixty four percent were classified as inappropriate, occurring in 32% of therapeutic courses and 97% of those for prophylaxis. During the 10 week re-evaluation, conducted 10 months later, data for 43 treatment courses in 43 patients were reviewed, 42% for therapy and 58% for prophylaxis. Sixty five percent were inappropriate occuring in 17% of therapeutic courses and 100% of the prophylactic courses.When compared with the initial phase, the re-evaluation demonstrated a decrease in the empirical use of vancomycin in the combination treatment of neutropaenic fever and also in the duration of vancomycin use for surgical prophylaxis. During both study phases, criteria contraventions were mostly due to inappropriate indication or duration of therapy. The cost of inappropriate vancomycin use was reduced by over 50% between survey phases, from $Aus11,500 or 55% of total vancomycin cost during the initial phase to $Aus3,600 or 25.7% during the re-evaluation.The most effective of the remedial strategies implemented after the initial phase was direct consultation with prescriber groups. The effectiveness of this DUR has provided the basis for an ongoing DUR programme at the RAH which has been met with general acceptance by hospital clinicians and administrators.     

解放军175医院特殊使用类抗菌药物的应用分析及管理

目的分析笔者所在医院特殊使用类抗菌药物的应用及管理情况,为合理用药提供参考。方法收集医院信息系统中2011年度特殊使用类抗菌药物的用药信息,采用限定日剂量（DDD）,对限定日剂量数（DDDs）、日用药费用（DDC）、B/A值等指标进行统计分析。结果我院使用的特殊使用类抗菌药物品种占72.22%,以注射剂型为主。不同类别特殊使用类抗菌药物的DDDs及所占比例、DDC等指标变化各不相同,B/A值介于0.29~9.00之间。结论抗菌药物分级管理制度落实不到位。从严引进特殊使用类抗菌药物,加强特殊使用类抗菌药物的用药教育,严格落实抗菌药物分级管理制度。     

注射用左氧氟沙星的药物利用评价

目的：从横断面角度了解某院注射用左氧氟沙星的临床应用情况,为加强左氧氟沙星的临床应用管理和优化给药方案提供依据。方法：采用连续多点横断面法对某院2014年8月至2015年3月每月13日注射用左氧氟沙星的使用情况进行统计和分析,结合浓度依赖性抗菌药物PK/PD理论、左氧氟沙星特点和抗菌药物临床应用指导原则,分别从用药目的、用药剂量、感染部位和联合用药等方面评判其用药合理性。结果：一日一次给药方案为224例（43.41%）,一日两次给药方案为292例（56.59%）;日剂量0.6 g为251例（48.64%）,日剂量0.4 g为78例（15.12%）,日剂量0.3 g为162例（31.40%）,日剂量0.2 g为25例（4.84%）;患者肌酐清除率在20~49 mL·min^-1区间的药物利用指数为1.61,肌酐清除率在10~19 mL·min^-1区间的药物利用指数为1.67,大于65岁老年患者药物利用指数为1.56;无适应证用药73例（14.15%）,其中非手术无适应证用药17例（3.29%）;手术预防用药56例（10.85%）;未考虑患者年龄、肾功能和感染部位,给药剂量过高39例（7.56%）,给药剂量过低69例（13.37%）;中枢神经系统感染用药17例（3.29%）;同类药物联合用药10例（1.94%）,无指征三/四联用药31例（6.01%）。210例患者用药存在问题,总的不合理使用率40.70%。结论：左氧氟沙星PK/PD理论适用于其临床应用评价,判断其临床应用的合理性还需综合考虑患者肾功能、感染部位和手术部位。     

某院非住院患者合理用药监护系统的应用与分析

目的：分析非住院患者合理用药监护系统在某院的应用与实践，促进非住院患者合理用药。方法：介绍非住院患者合理用药监护系统的相关功能，并对其应用成效进行评价。结果：该系统具有个性用药交代、慢病管理与随访以及便捷的药品信息查询等功能。与应用传统咨询系统相比，非住院患者合理用药监护系统提高了慢病患者的用药依从性，降低了患者不良反应发生率；显著提高了药师对患者进行用药交代、解答用药疑问以及制订随访方案等工作的效率（P<0.01）；患者的满意度由90%提升至96%；纳入该系统的患者稳步上升。结论：借助该系统实现了合理用药服务由院内到院外的延伸，监护了非住院患者合理用药，扩展了服务途径，提升了药学服务价值。