Measurement of Adult Antimicrobial Drug Use in Tertiary Care Hospital Using Defined Daily Dose and Days of Therapy

Widespread overuse and inappropriate use of antimicrobial drugs continues to fuel an increase in antimicrobial resistance and leads to consequent treatment complications and increased healthcare costs. In the present study we aimed to describe antimicrobial drug consumption and predictors and to identify potential targets for antimicrobial stewardship. This was a prospective observational study conducted at adult medicine wards of tertiary care teaching hospital over the period of five months. Antimicrobial drug consumption was measured using days of therapy per 1000 patient days and defined daily dose per 1000 patient days. Additionally, predictors of multiple antimicrobial prescribing were also analyzed. Seven hundred thirty patients were screened and 550 enrolled, receiving 1,512 courses of antimicrobial therapy, mainly intravenously (66%). Most frequently prescribed agents were artesunate (13%), ceftriaxone (11%) and metronidazole (10.5%). Overall consumption was 1,533 days of therapy per 1000 patient days and was mainly attributed to antibiotics (98.3%) for empirical therapy (50%). Median days of antimicrobial drugs prescribing were 3 (inter quartile range 2-5). Most commonly consumed antimicrobials were ceftriaxone (31%, 248.8 g) and artesunate (26%, 29 g). Antimicrobials contributed to 72.5% expense of the total incurred. Multivariate analysis reveals that younger patients (≥45 years) (odds ratio: 1.59, 95% CI 1.14-2.21) were more likely and absence of comorbidities (odds ratio: 0.58, 95% CI 0.42-0.79) and shorter hospital stay (≥6 days)(odds ratio: 0.44, 95% CI 0.32-0.60) were associated with less likelihood of prescribing multiple antimicrobial drugs. Estimating antimicrobial drugs use by defined daily dose method will remain open to criticism because the prescribed dosage is not often in agreement with the “usual” daily dose, which depends on location of and susceptibility of pathogenic organisms and metabolic status of the patient.     

我院抗骨质疏松药物用药趋势分析及合理应用评价

目的分析我院抗骨质疏松药的利用情况,为临床合理使用提供参考。方法根据抗骨质疏松药的结构及作用机制不同进行分类,采用WHO推荐的限定日剂量(Defined Daily Dose,DDD)频度分析法,对我院2006年8月-2009年7月抗骨质疏松药的销售金额、用药频度及日均费用等进行回顾性分析。结果我院抗骨质疏松药中,碳酸钙片用药频度最高,双膦酸盐类增长迅速;日均费用唑来磷酸注射液最高。结论抗骨质疏松药物应用情况调查对促进抗骨质疏松药的合理应用及临床用药监护具有重要意义。     

Drug utilization in paediatrics: Non-medical factors affecting decision making by prescribers

Summary The study was done to show that in certain areas of paediatric pharmacotherapy unexpected discrepancies may arise between accepted therapeutic principles and the actual behaviour of a prescribing doctor. The first example was of a great reduction in penicillin use in a university teaching hospital after certain therapeutic accidents: in one year, there were 2 fatal cases of rhabdomyolysis due to use of procaine benzyl-penicillin. Other antimicrobial drugs inferior to penicillin, such as lincomycin and sulphonamides, replaced penicillins. The second example showed the inverse relationship between the use of antitussives and other drugs in symptomatic treatment of respiratory diseases in outpatients and inpatients; the pressure of unduly optimistic expectations of therapy imposes a high prescribing rate of these drugs in the outpatient population, in contrast to hospitalized patients, whose doctors, being spared such pressure, prescribe antitussives far less often. The third example demonstrates the possibility of inadequate education in the use of antimicrobial drugs. Although doctors from regional hospitals receive their training at an university hospital, they tend to prescribe chloramphenicol ten times more per bed-day than their colleagues in an university hospital. In terms of the cost/effectiveness ratio, a high prescribing rate of cephalosporins is not economically favourable in a university teaching hospital. It is also shown that studies of drug utilization in children are feasible if age — appropriate adaptation of the statistical value expressed as the defined daily dose is performed. The adaptation was evaluated by comparing pharmacy-based drug consumption data expressed in paediatric defined daily doses, with actual days of treatment with particular drugs, i.e. data from patient records for 244 beds in the University Teaching Hospital.     

2007—2010年北京积水潭医院门诊抗骨质疏松药应用分析

目的:了解我院抗骨质疏松药的应用现状及趋势。方法:根据抗骨质疏松药的结构及作用机制不同进行分类,采用WHO推荐的限定日剂量(DDD)频度分析法,对我院2007—2010年抗骨质疏松药的销售金额、用药频度(DDDs)及限定日费用(DDC)等进行回顾性分析。结果:我院抗骨质疏松药的销售金额呈逐年上升趋势,降钙素类抗骨质疏松药销售金额占总销售金额的40%,碳酸钙D3片(钙尔奇D 600片)及骨化三醇胶丸(盖三淳胶丸)DDDs排序前2位,鲑鱼降钙素注射液(密盖息注射液)DDC排序居第1位。结论:我院抗骨质疏松药使用基本合理,随着我国人口的老龄化和民众保健意识增强,抗骨质疏松药市场潜力巨大。     

我院门诊抗高血压药处方分析

目的:评价我院抗高血压药的使用情况。方法:采用世界卫生组织推荐的限定日剂量方法,对我院2006年1月门诊处方抗高血压药的使用情况进行统计、分析。结果:各年龄组间的高血压患病率存在显著性差异,其随年龄的增长而显著增加。钙离子通道拮抗药、β-受体阻滞药、血管紧张素转换酶抑制剂(ACEI)的使用频率最高。联合用药占全部处方的38.68%,其中以二联用药为主。结论:我院抗高血压药应用基本符合2005年版《中国高血压防治指南》。单药治疗以第3代钙通道拮抗药和长效ACEI为主,新型高选择性β-受体阻滞药也占重要地位。大部分联合用药方案较合理,但也存在一些重复用药行为,须引起重视。     

某院门诊处方合理用药国际指标调研分析

目的:了解某院2007年的门诊处方情况。方法:随机抽取该院2007年门诊处方5 029张,采用合理用药调研指标和限定日剂量方法,以Excel表单完成统计、分析。结果:5 029张处方中,以自费患者为主(占60.83%),患者年龄平均46.9a。每次就诊人均用药2.63种,抗菌药物和注射剂应用比例分别为21.79%和10.44%,通用名处方率达50.47%,喹诺酮类、头孢菌素类、大环内酯类列用药频度和用药金额的前3位,头孢菌素类和青霉素类药物利用指数偏大。抗菌药物联用率达23.72%,单药应用率为76.28%,二联用药率为20.07%,三联及以上全部为抗结核治疗。处方内容修改后医师签名率为60.19%,内服药与外用药分开书写率为32.88%。结论:该院门诊处方基本合理,但仍需加大管理力度,增强医师合理用药意识,减少不合理用药。     

2008—2010年天门市第一人民医院抗高血压药应用分析

目的:分析我院抗高血压药的应用情况,为临床合理用药提供参考。方法:采用世界卫生组织(WHO)推荐的限定日剂量(DDD)方法,对我院2008—2010年抗高血压药使用情况进行统计分析。结果:我院抗高血压药销售金额呈逐年上升趋势,销售金额最大的是缬沙坦,用药频率最大的是硝苯地平,药物利用指数(DUI)>1的品种占51.85%,限定日费用(DDC)从0.47到9.25,相差19.68倍。结论:我院抗高血压药的应用基本符合安全、有效、经济的用药原则,兼顾不同层次需要。     

野外驻训门诊用药量情况分析

目的 了解部队驻训期间门诊用药的结构特点及趋势,以利更好地开展外训药材保障工作.方法 对2008年至2010年野外驻训期间门诊处方8 091张,采用以用药频度(DDDs)、限定日费用(DDDs)、药物利用指数(DUI)为指标进行分析.结果 野外驻训期间常用药为抗感染类、呼吸系统类、解热镇痛类、五官皮肤类及消化系统类药物,常用药物的用药频度呈逐年下降趋势,大多数药物的药物利用指数在1.00左右.结论 应结合任务特点,加强外训期间重点药物的供应管理,并初步建立模块化保障体系,同时应进一步促进药物的合理应用.     

2007—2012年天津医科大学第二医院口服镇静催眠药应用分析

了解2007-2012年我院口服镇静催眠药的使用情况及用药趋势,为临床合理用药提供依据。方法：根据我院医院信息系统（CHIS）中2007-2012年口服镇静催眠药的原始数据资料,采用世界卫生组织（WHO）推荐的限定日剂量（DDD）分析法,对各年口服镇静催眠药的销售金额、用药频度（DDDs）、限定日费用（DDC）等进行比较分析。结果：2007-2012年我院口服镇静催眠药的销售金额和DDDs基本呈增长趋势,DDC稳中有降。艾司唑仑、劳拉西泮、氯硝西泮等苯二氮蕈类药的DDDs均较高,以唑吡坦为代表的新型非苯二氮革类药用量增长迅速。结论：我院口服镇静催眠药应用基本合理,其中苯二氮革类药占主导地位,新型非苯二氮革类药用量也有逐年上升趋势,前景广阔。进一步加强精神药品的监督管理仍是今后工作的重点。     

Drug use profile in a Nigerian city hospital

The newly introduced WHO Drug Use Indicators enable the delineation of drug use patterns, identification of inappropriate use and evaluation of interventional strategies. This study highlights the drug use pattern in a city hospital and further identifies areas of inappropriate use that need to be addressed. Records of 614 patient encounters (January-December 1993) were obtained by systematic random sampling at the Central Hospital, Benin City. The WHO prescribing indicators were calculated and detailed review in various therapeutic categories was carried out. The average number of drugs per encounter was 3.7. The percentage of encounters with injection and antibiotics were 37.0% and 54.2% respectively. Forty-eight per cent of drugs were prescribed by generic name and 94.4% of all prescribed products were in the National Essential Drug List. Drugs were not prescribed in 2.8% of encounters. Of injections, 74.1% were for treatment of febrile illness, usually presumed to be malaria. Analgesics/antipyretics, mainly paracetamol, were prescribed in 72.3% of encounters. In 57.8% of encounters vitamin preparations were prescribed. Certain differences were observed between children and adults with children receiving more vitamins and antimalarials. These findings suggest some inappropriate use of drugs which may in turn reflect current practice throughout Nigeria. Proper case management of febrile illness is likely to promote more rational use of drugs.     

某院门诊抗菌药物使用情况分析

目的了解本院2013年门诊抗菌药物的使用情况,为抗菌药物的合理应用提供参考。方法以限定日剂量（DDD）的方法,采用Excel 2003对本院2013年门诊抗菌药物使用情况,包括抗菌药物使用率、用药频度（DDDs）、门诊抗菌药物使用强度（DDD）、平均治疗日数（ATD）、日均费用（DDDc）等进行分类统计和综合分析。结果本院2013年门诊抗菌药物使用率为10.21%,门诊抗菌药物使用强度为33.64,平均治疗日数（ATD）为3.30。DDDs排前3名的抗菌药物类别分别是第二代头孢菌素、大环内酯类、第三代头孢菌素。DDDs排前3名的抗菌药物品种分别是头孢呋辛、克拉霉素、奥硝唑口服制剂。结论本院门诊抗菌药物临床应用总体基本合理,但仍存在用药档次较高、头孢菌素类使用过于集中等问题,应引起重视并持续改进。     

2013年12月我院门诊抗高血压药用药调查

目的分析医院门诊抗高血压药的应用现状,旨在为合理用药提供参考。方法采用世界卫生组织推荐的限定日剂量法,对医院门诊抗高血压药物使用情况进行统计分析。结果使用频率前四位的抗高血压药依次为钙通道阻滞剂（CCB）、血管紧张素Ⅱ受体阻滞剂（ARB）、固定配比复方制剂、β受体阻滞剂。联合用药占调查处方的32.07%,以二联用药为主,其中CCB与ARB联用处方最多。结论医院抗高血压药的应用状况基本合理。     

Discrepancies between prescribed daily doses and WHO defined daily doses of antibacterials at a university hospital

AIMS: The defined daily doses (DDD) defined by the WHO are widely used as an indicator to measure antibiotic use in the hospital setting. However, discrepancies exist between countries in terms of antibiotic dosage. The aim of the present study was to compare, for each antibacterial agent available at our university hospital, the prescribed daily doses (PDD) with the DDD. METHODS: Data were extracted from the pharmacy computer system. Antibiotic use was expressed in DDD per 1000 patient days. We also calculated the ratio of number of DDD:number of treatment-days and estimated the average PDD for each antibiotic and route of administration. RESULTS: The average PDD did not correspond to the DDD for many classes of antibiotics. If fluoroquinolones and cephalosporins were prescribed at a dosage close to the DDD, other antimicrobial classes such as penicillins, aminoglycosides or macrolides were not. Overall, the number of DDD overestimated the number of treatment days by 40%. For the most consumed antibiotic at our hospital, i.e. oral amoxicillin-clavulanic acid, the PDD was three times the DDD. CONCLUSIONS: Our study shows that, except for the fluoroquinolones and the cephalosporins, the number of DDD did not correctly reflect the number of antibiotic treatment days at our hospital. This does not invalidate the systematic approach of the WHO and hospitals should use the DDDs to make national and international comparisons of their antibiotic use. However, each hospital should define and validate its own indicators to describe the local exposures to antibiotics and to study the relationship with resistance.     

Drug utilisation in Dutch nursing homes

Objective: To quantify and evaluate drug utilisation in a sample of Dutch nursing homes. Methods: A retrospective analysis of computerised medication data of 2355 residents aged 65 years and over from six nursing homes in the Netherlands was performed. For each therapeutic drug group, the number of users was determined. The ten therapeutic groups used most frequently were investigated further. For these, patient characteristics, use of therapeutic subgroups, the average daily dosages and the chronicity of drug use were determined. Chronicity was expressed as the percentage of treatment days divided by the number of residents' days in the nursing home. Results: During the study period, 89%, 77% and 56% of the study population used a drug from the anatomical therapeutic chemical (ATC) main group N (nervous system), A (alimentary tract and metabolism) and C (cardiovascular system), respectively. Eight of the ten therapeutic drug groups prescribed most frequently were used for more than 50% of the time. In particular, psycholeptic drugs, diuretics and laxatives were used chronically (83%, 81%, and 80% of the nursing home stay, respectively). Except for a few drug groups, such as laxatives and diuretics, the prescribed daily dosages were relatively low. Twenty-eight percent of the residents received loop diuretics; these were prescribed in relatively high dosages. Conclusion: Drug utilisation in the nursing homes was high and many drugs were used chronically. In view of the risk of possible adverse effects and drug–drug interactions, the prescribing and dosage of psycholeptic drugs, laxatives, loop diuretics and ulcer-healing drugs should be re-evaluated, carefully. Received: 11 March 1999 / Accepted in revised form: 19 September 1999     

2006～2008年我院门诊抗菌药物应用分析

目的：调查我院门诊2006～2008年抗菌药物使用情况,为临床合理用药提供依据。方法：利用本院网络系统,统计药品消耗数据,采用WHO推荐的限定日剂量（Defined daily dose,DDD）和销售金额排序法进行统计分析。结果：2006～2008年门诊抗菌药物使用率较高的为头孢菌素类、氟喹诺酮类、大环内酯类、青霉素类、硝基咪唑类等。结论：我院抗菌药物临床应用基本合理。     

某院2017~2018年门诊口服H1受体拮抗剂使用情况分析

目的了解我院2017~2018年两年门诊口服组胺H₁受体拮抗剂使用情况并加以分析,指导临床合理用药。方法对我院2017~2018年门诊口服组胺H₁受体拮抗剂相关信息,包括药物规格、销售金额、用药频度等指标进行统计分析。结果左西替利嗪连续两年销售金额最高,其次为依巴斯汀和非索非那定;DDDs排名前4位分别为左西替利嗪、西替利嗪、非索非那定和依巴斯汀,DDC中奥洛他定最贵,西替利嗪最便宜。结论我院门诊口服组胺H₁受体拮抗剂使用基本合理,总体呈增长趋势。     

湖北省第三人民医院住院患者抗新型冠状病毒肺炎（COVID-19）药物的使用情况分析

目的分析湖北省第三人民医院住院患者抗新型冠状病毒肺炎(COVID-19)药物的使用情况。方法收集2020年1月24日-2020年2月19日湖北省第三人民医院已出院的110例COVID-19确诊患者的临床资料,采用世界卫生组织推荐的限定日剂量(DDD)法对药物总金额、用药频度(DDDs)、限定日费用(DDC)和排序比(B/A)进行统计分析。结果药物总金额排序居前3位的药物类别分别为免疫增强药、喹诺酮类和碳青霉烯类,排序居前3位的药品依次为人免疫球蛋白、莫西沙星和美罗培南。DDDs排序居前3位的药物类别分别为免疫增强药、糖皮质激素类及质子泵抑制药,排序居前3位的药品依次为人免疫球蛋白、甲泼尼龙和莫西沙星。DDC较高的有药品有美罗培南、莫西沙星和哌拉西林钠/舒巴坦钠;B/A较高的有甲泼尼龙、蒙脱石散、奥司他韦,B/A较低的有美罗培南、头孢哌酮钠舒巴坦钠和头孢哌酮钠/他唑巴坦钠。结论湖北省第三人民医院COVID-19药物的使用基本合理,但仍然存在不足,需进一步加强管理,其中抗菌药物的同步性较差,临床应用合理性有待考证。     

山西博爱医院2007年—2010年调脂药物分析

目的:了解山西博爱医院调脂药物的应用现状与发展趋势,为临床合理用药提供参考。方法:采用WHO推荐的限定日剂量(DDD)法,对山西博爱医院2007年—2010年调脂药物的使用情况,包括药品品种、销售金额、用药频度(DDD s)、日均费用(DDD c)等进行统计分析。结果:4年中阿托伐他汀的销售始终位列第一,调脂药物的销售金额逐年上升。新品种他汀类的药物不断引进,普伐他汀钠、瑞舒伐他汀先后进入山西博爱医院且增长之势迅猛,大有替代阿托伐他汀之势。他汀类药物占据了调脂药物应用的主要部分。结论:他汀类调脂药物是临床治疗高脂血症的一线药物,占据主导地位。调脂药物的临床应用应符合发展趋势。建议医师在临床实践中,单用他汀类治疗不能达到满意疗效时应考虑联合用药。