上海市松江区21家医疗机构门诊处方合理用药国际指标调研

目的:了解上海市松江区21家医疗机构门诊合理用药状况。方法:采用合理用药国际调研主要指标,对松江区21家医疗机构2007年10月~2008年5月抽取的16 800张门诊处方进行调查。结果:松江区21家医疗机构门诊处方主要指标中平均每张处方用药品种数为2.5种,抗菌药物使用百分率为42%,注射剂使用百分率为20%,零差率基本药物使用百分率为43.97%。结论:21家医疗机构门诊用药基本合理,但部分医疗机构门诊的抗菌药物应用比例和注射剂应用比例均较高,合理用药水平还有待于进一步地提高。     

我院儿科急诊应用抗菌药物调查分析

目的评价我院儿科急诊处方中抗菌药的利用情况，为针对儿童的抗菌药应用和管理提供依据。方法对我院2007年10月儿科急诊处方中抗菌药的品种、应用率、联合用药情况等数据进行统计、分析。结果儿科急诊抗菌药应用率达53．03％，抗菌药联用率为4．02％，使用频率最高的是β-内酰胺类抗菌药。结论我院儿科急诊抗菌药应用率偏高，存在无指征用药现象。建议建立抗菌药分级管理制度，以促进抗菌药合理应用。     

门诊抗菌药物使用情况现状分析

目的了解门诊抗菌药物的使用情况现状和存在问题,促进门诊对抗菌药物的合理使用提供有效依据。方法进行随机抽取药房2010年1月～2012年1月门诊处方500张,对抗菌药物的使用情况做了统计分析。结果使用抗菌药物的门诊处方有309张,占抽取处方的61.80%。其中使用头孢类处方169张,占使用抗菌药物处方的54.69%;使用青霉素类处方75张,占使用抗菌药物处方的24.27%;使用大环内酯类处方35张,占使用抗菌药物处方的11.33%;使用其它类抗菌药物处方30张,占使用抗菌药物处方的9.71%。用一种抗菌药物处方170张,占抗菌药物处方的55.02%,用二联抗菌药物处方139张,占抗菌药物处方的44.98%,无三联使用抗菌药物者。结论抗菌药物使用率较高,还存在不合理用药等现象,应加强门诊使用抗菌药物的指导和监管,提出了合理使用抗菌药物的对策建议,以便更好的对抗菌药物进行合理应用。     

Utilization review of concomitant use of potentially interacting drugs in Thai patients using warfarin therapy

PURPOSE: In Thailand, there has been no study determining the concomitant use of medications, known to potentially interact with warfarin, in patients receiving warfarin therapy. This paper examined the frequency of which specific interacting drugs were concomitantly used in warfarin users. METHODS: We retrospectively examined the database of warfarin outpatient medical records from a regional 756-bed hospital located in the north of Thailand. All patients receiving warfarin from 10 June 1999 to 4 August 2004 were reviewed to identify all drugs possessing interaction potential with warfarin. The potential of significant interactions were divided into high, moderate and low, according to the extent of evidence documented in textbooks and literature. RESULTS: Among 1093 patients receiving warfarin therapy, 914 (84%) patients received at least one potentially interacting drug and half of them (457 patients) received at least one drug with high potential for interaction. The most frequently concomitant drug that increased INR was acetaminophen (63%, 316/457). Propylthiouracil was the most frequently concomitant drug that decreased INR response (4%, 19/457), while diclofenac was the most frequently concomitant drug that increased bleeding risk (16%, 73/457). CONCLUSIONS: About a half of patients receiving warfarin therapy was prescribed concomitant drug(s) that has a high potential of interactions with warfarin. These patients should be closely monitored and counselled to watch for signs and symptoms of bleeding and thrombosis to avoid adverse events associated with drug interactions.     

某院门诊抗菌药物合理应用分析

目的：了解某院门诊抗菌药物的使用情况,为监督和管理抗菌药物的合理使用提供依据。方法：随机抽取2009年3月门诊处方2435张。对其中的抗菌药物处方逐一审核,对其使用种类、注射剂使用情况、各种类处方所占比例、使用是否对症、联合使用、使用方法是否合适等情况进行分析。结果：某院门诊处方中抗菌药物使用比例为19.06％,使用频率排序前5位的分别是第3代头孢菌素、大环内酯类、硝基咪唑类、第1代头孢菌素和氟喹诺酮类。注射剂处方64张,占总抽检处方数的2.6％,其中使用频率排序前3位的分别为：头孢唑肟钠粉针、甲硝唑注射液和哌拉西林,舒巴坦粉针。不对症和联合不当处方共109张,占总抽检处方数的4.41％。使用方法不当处方共18张,占总抽检处方的0.73％。结论：该院门诊抗茵药物使用基本合理,但还需要进一步监督与管理。