常用抗生素的临床合理用药

目的：探讨分析常用抗生素的临床合理用药,改善抗生素的不合理使用。方法回顾分析2013年1月_2014年1月1986例临床使用抗生素的病例的临床资料对抗生素的使用情况。结果经探讨分析发现,医院临床上抗生素的用药情况逐年趋向合理、谨慎,但有常用抗生素临床用药不合理现象。结论临床上滥用抗生素现象已经得到极大改善,政府卫生部门应加强对抗生素滥用的监督力度和宣传力度,使临床医师更加合理有效应用抗生素。     

常用抗生素的临床合理应用

目的:针对几种常见抗生素临床实际应用的探讨,总结出抗生素的临床合理应用准则。方法:通过文献分析和作者多年临床经验,主要讨论了青霉素类、头孢菌素类、四环素类、氨基糖苷类等常用抗生素的适应症、用药剂量及时机、禁忌症以及不良反应等关键要素,总结了抗生素使用原则。结果:医务人员在日常的工作中,掌握各类主要抗生素的适应症、用药剂量及时机、禁忌症以及不良反应等,对于患者的疾病治疗具有重要意义,是医务工作者的基本技能要求。结论:合理使用抗生素,尽量避免其危害,使之为人类所用,从而达到最好的治疗效果。     

临床抗生素的合理使用

<正>合理使用抗生素是指在明确的指征下,选用适宜的抗生素并采用适当的剂量与疗程,以达到杀灭致病微生物和控制感染的目的,同时又要防止各种不良反应的发生。目前,由细菌、病毒、支原体、衣原体等多种病原微生物所致的感染性疾病遍布临床各科,其中细菌性感染最为常见,因此抗菌药物也就成为临床最广泛应用的药物之一。     

论临床合理使用抗生素

药品是防病治病的物质基础,既有治疗疾病的一面,也有产生不良反应的一面,在用药过程中,由于用药不当而导致一些与治疗无关的不良反应,本文分析目前医院盲目使用抗生素,导致临床抗生素无效浪费原因,提出合理使用抗生素使用方法和建议。     

浅谈抗生素的临床合理使用

抗生素在临床上使用极为广泛。据国内某些大医院的调查，门诊病人使用者占全部门诊处方的26％-32％左右，住院患者高达40％以上。基层医院使用更为普遍。笔者调查了10余处基层医院及本院用药情况，使用抗生素人数占处方的50％以上。抗生素的广泛使用对控制某些疾病起了重要作用，但随之也产生了一系列问题。主要是细菌的耐药菌株增多，     

常用抗生素的合理应用

<正> 临床常用的抗生素主要有青霉素类,头孢菌素类、氨基糖甙类、大环内酯类、喹诺酮类、临床医生首先要掌握抗生素的作用机理,主要抗菌谱,抗菌作用特点,药动学,剂量大小,不良反应,毒副作用以及药物相互间配伍禁忌等基本知识。     

合理使用抗生素

青霉素的临床应用始于1941年,迄今已经历了半个世纪,它作为抗微生物感染药物,曾挽救了千百万人的生命,为人类的医疗保健事业作出巨大的贡献。     

合理使用抗生素

细菌感染是疾病发生的主要原因之一。为充分发挥抗生素的治疗作用 ,使毒副反应减至最低程度 ,又不致于使细菌发生耐药 ,必须合理使用。1　抗生素的选择抗生素品种繁多 ,选用适当药物极为重要。最好尽一切努力找到病原菌 ,根据药敏试验 ,选用病原菌高度敏感的抗生素。在未得到培养结果前 ,可以根据患者病史、病情、感染来源以及临床经验开始抗生素治疗 ,以免延误治疗 ,以后按培养和药敏结果加以调整。1 1　选用杀菌的抗生素　抗生素对细菌有选择性毒性 ,对宿主细胞及组织无或很少毒性。了解抗生素对细菌作用的不同 ,对临床治疗有重要意义。抗…     

合理使用抗生素

抗生素的发展与乱用、滥用抗生素，预防性使用抗生素，造成细菌耐药的矛盾已经日益突出，成为我国医疗事业的一个严峻问题。为此，本文对不合理使用抗生素的严重后果以及如何正确使用抗生素作一概述。     

Evaluation of rational antibiotic use

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.     

从微生物、机体、抗菌药三者间关系探讨合理使用抗菌药

本文对微生物、机体、抗菌药物三者之间的相互关系转化进行了一些探讨,提出了抗菌素在临床上应用中需注意的若干问题。     

探讨临床药师在动静脉内瘘术中规范化使用抗菌药物的作用

目的 探讨临床药师在实施单病种动静脉内瘘术临床路径中的作用,摸索在有限的卫生资源条件下,通过规范化诊疗过程、标准化用药行为,来降低抗菌药物的使用率,减少耐药菌的产生,降低医疗费用,最终达到改善医疗质量,使患者的临床用药能够做到安全、有效、经济.方法 根据研究项目的需要自行设计点评表,对实施临床路径前后应用抗菌药物情况进行对比分析研究.结果 实施临床路径后,抗菌药物的不合理使用率由路径前的98.51％下降至路径后的5.3％ （P ＜0.001）,预防用抗菌药物的平均金额由443元降至5.01元（P ＜0.001）,预防用抗菌药物总费用占总住院费用比例由4.1％降至0.093％（P＜0.001）,平均用药天数由4d降至0.06 d（P ＜0.001）.西药总费用占总住院费用比例由36.57％降至15.89％（P＜0.001）.结论 临床药师在肾内科动静脉内瘘术临床路径实施中对抗菌药物使用的干预是行之有效的,应进一步在该院推广.     

机械通气患者下呼吸道感染抗生素治疗的临床观察

目的：探讨机械通气患者并发下呼吸道感染菌群变化规律，方法：将机械通气患者49例，且通气时间48h以上者，每日查痰培养，隔日照X线胸片，记录痰培养致病菌出现时间规则使用抗生素，直至脱机时的变化规律。结果：以革兰阴性杆菌致病几率为最高，其次为革兰阳性菌、金黄色葡萄球菌及肠球杆菌。发病至气管吸痰细菌培养阳性的时间表明，机械通气〈4d，痰培养阳性率为15％（3例／20例）；5～6d者达50％（4例／8例）；超过7d者，痰培养阳性率100％（n=21）。结论：本观察表明机械通气患者并发下呼吸道感染的防治中，加强呼吸道管理，防止交互感染，合理使用抗生素，对患者的预后是不可忽视的。     

Analysis of antibiotic usage]

Economic analysis is founded on the assumption that resources are limited and that should be used in a way that maximizes the benefits gained. Pharmacoeconomics extends these assumptions to drug treatment. Therefore, a full pharmacoeconomic analysis must consider two or more alternative treatments and should be founded on measurement of incremental cost, incremental efficacy, and the value of successful outcome. Antibiotic policy based only on administrative restrictions is failed, instead of it disease formularies and infectologist consultation system are needed. Equally important are various programmes that encourage the cost-conscious use of the antibiotics chosen. Some of the methods evaluated in the literature include: streamlining from combination therapy to a single agent, early switching from parenteral to oral therapy, initiating treatment with oral agents, administering parenteral antibiotic at home from outset of therapy, and antibiotic streamlining programmes that are partnered with infectious disease physicians. The solution is the rational and adequate use of antibiotics, based on the modern theory and practice of antibiotic policy and infection control, that cannot be carried out without the activities of experts in this field.     

浅谈临床护士与小儿安全合理用药

患者入院经医生诊断,以处方或医嘱形式,针对患者所患疾病,根据其症状、体征及临床多方面相关检查信息资料,经综合分析判断后,拟出针对性的治疗方案,涉及治疗药物部分,则经药学服务部门的审核,将所用药品配发至临床,最后一环,则是经护士按临床医嘱,对患者实施药物治疗.     

Clinical decision support systems and antibiotic use

Aim To review and appraise randomised controlled trials (RCT) and ‘before and after' studies published on clinical decision support systems (CDSS) used to support the use of antibiotics. Methods A literature search was carried out in October 2006 using MEDLINE including Medical Subject Heading (MeSH) terms (1966–2006), EMBASE (Excerpta Medica, 1980–2006) and International Pharmaceutical Abstracts (IPA, 1970–2006) using the combinations of the following terms: (Decision support systems) or (CDSS) AND (antibiotics) or (anti-infectives) or (antibacterials) or (antimicrobials). Only English language papers were selected. Editorials, letters and case reports/series were excluded. The reference sections of all retrieved articles were also searched for any further relevant articles. Results Forty articles were identified. Five RCT and six ‘before and after' studies were retrieved. In the RCTs, three studies used computer-based CDSS, one paper-based CDSS and one a combination of both. Two studies were conducted in primary care and three within secondary care. The primary outcomes for each study were different and only three studies were significant in the favour of the use of CDSS. ‘Before and after' studies were used where RCT were not feasible. One ‘before and after' study was excluded because it did not include any control group. The remaining five included historical control groups and evaluated the use of computer-based CDSS within secondary care. Their primary outcomes also varied but all concluded significant benefits of CDSS. Only three of ten studies were conducted outside the USA; one in Switzerland and two in Australia. Conclusion CDSS could be a powerful tool to improve clinical care and patient outcomes. It presents a promising future for optimising antibiotic use. However, it is difficult to generalise as most studies were conducted in the United States. Although RCT are the ‘gold standard' in research, they may not be feasible to conduct. Realising that different study designs answer different questions would allow researchers to choose the most appropriate study design to evaluate CDSS in a specified setting.     

米卡芬净临床不良反应及合理用药

目的分析并探讨米卡芬净不良反应(ADR)发生的类型及特点,为临床安全、合理用药提供参考。方法检索国内外有关米卡芬净不良反应的病例报道,对其不良反应发生类型及特点进行分析和总结。结果米卡芬净的不良反应以皮疹、胃肠道反应及肝损害最为多见,另外可见心血管疾病、溶血及过敏反应等。结论鉴于米卡芬净可造成患者多个器官和系统的不良反应,医药人员在临床治疗过程中应加强不良反应的监测,减少和防止ADR的发生率,以确保患者的用药安全。     

抗感染治疗导致的免疫性损伤机制及其合理使用抗生素

在治疗重症反复感染中发现,抗生素对免疫系统有影响;在感染过程中,免疫病理损伤与临床抗生素的疗效有重要的相关性。在临床中发现,临床医师在治疗重症反复感染中,抗生素不断的轮番置换,并没有达到治疗的目的。究其原因,就是忽视抗生素与免疫系统之间的相互影响。为此本文对参加数年以来的重症、反复感染患者的会诊经验进行总结,并对以上2者之间的关系提出一定的见解,以便在临床合理用药时提供一定的参考。     

静脉滴注丙种球蛋白、地塞米松佐治新生儿缺氧缺血性脑病临床观察

目的 :探讨静脉滴注丙种球蛋白 (IVIG)和地塞米松 (DEX)对新生儿缺氧缺血性脑病 (HIE)的治疗效果。方法 :治疗组在对照组治疗基础上 ,加用 IVIG,DEX治疗 ,观察两组临床症状消失时间、住院时间及治愈率。结果 :与对照组比较 ,治疗组患儿临床症状消失时间、住院时间明显缩短 (P<0 .0 1) ,治愈率明显提高 (P<0 .0 5 )。结论 :IVIG,DEX能减轻缺氧缺血引起脑的免疫损伤