药品的限定日剂量在抗菌药物利用评价中的应用

限定日剂量是世界卫生组织药物利用研究小组推荐的药物测量单位,为达到主要治疗目的的成人用药平均日剂量.解剖-治疗-化学的药物分类/限定日剂量现已成为药物利用研究的基本工具.本文通过文献检索,对利用ATC/ DDD系统开展抗菌药物应用研究的方法进行分析.探讨限定日剂量在监测抗菌药物应用研究中的地位,DDD值确定原则和方法.旨在利用ATC/DDD推动抗菌药物的合理使用.     

2005年我院住院患者氟喹诺酮类抗菌药物应用分析

目的:为了解我院氟喹诺酮类抗菌药物的使用情况,对2005年氟喹诺酮类抗菌药物的利用进行分析。方法:采用WHO推荐的ATC分类和约定日剂量DDD分析方法,用DDDs、抗菌药物使用密度、抗菌药物费用密度、抗菌药物平均日用金额来评价氟喹诺酮类抗菌药物在我院住院患者中的应用情况。结果:我院现有氟喹诺酮类注射剂11个品种,口服剂13个品种,使用金额占抗菌药物的12.7%,DDDs、抗菌药物使用密度158734.07DDD,366.18 DDD/(1000人天),抗菌药物费用密度11332.45元/(1000人天),平均日用费用为30.95元/DDD;各品种使用差异大。注射剂DDDs和使用密度是口服剂的1.53倍,抗菌药物费用密度注射剂是口服剂的61.66倍;平均日用金额注射剂是口服剂型约40倍。结论:本研究提示氟喹诺酮类抗菌药物在我院应用广泛,应加强应用规范化,注意调节某些药品的管理模式和应用频度,减缓细菌耐药的产生,确保患者用药安全、有效、经济、合理。     

Outpatient Use of Systemic Antibiotics in Croatia

Objective: The aim was to estimate the outpatient utilization of antibacterials for systemic use in Zagreb, Croatia, and to define the antibiotic utilization characteristics and consequences.Method: Using the WHO ATC/DDD methodology, the number of defined daily doses per 1000 inhabitants per day (DDDs/TID) was calculated for each individual antibiotic and ATC system levels were calculated from data collected on the number and size of packages prescribed and dispensed from pharmacies. The Drug Utilization 90% (DU90%) method was used to evaluate the quality of drug prescribing.Results: The total utilization of antibiotics was found to be extremely high, 55.0 DDDs/TID. The leading antibiotic was amoxicillin + clavulanic acid with 14.7 DDDs/TID. Penicillins accounted for the highest utilization (46.3%) expressed in DDDs/TID (25.4), followed by cephalosporins and macrolides 25 and 12.5% of utilization, respectively expressed in DDDs/TID), tetracyclines, quinolones, aminoglycosides and other agents. Nine of 27 antibiotics fell within the DU90% segment. The cost/DDD foldrugs within DU90% segment was 1.2 EUR, for drugs beyond DU90% segment was 1.4 EUR, and the average was 1.2 EUR.Conclusion: Irrational prescribing and preference to more expensive drugs have been reported in Zagreb. Therefore, the risk of resistance of microorganisms to beta-lactamase antibiotics, macrolides and quinolones could be expected. Prescribing patterns should be changed by introducing national guidelines on rational antibiotic prescribing, monitoring and evaluation of their implementation. Additional continuing education of physicians and pharmacists from independent sources should be organized and proper education should be provided to patients.     

Inpatient Drug Utilization in Europe: Nationwide Data Sources and a Review of Publications on a Selected Group of Medicines (PROTECT Project)

Drug utilization (DU) studies in inpatient settings at a national level are rarely conducted. The main objective of this study was to review the general information on hospital medicine management in Europe and to report on the availability and characteristics of nationwide administrative drug consumption databases. A secondary objective was to perform a review of published studies on hospital DU of a group of selected drugs, focusing on methodological characteristics (ATC/DDD). General information on hospital drug management was retrieved from several websites, nationwide administrative drug consumption databases and reports published by governmental organizations. A PubMed search was conducted using keywords related to the selected group of drugs AND ‘hospital drug utilization’. The data sources for hospital DU information varied widely and included 14 databases from 25 reviewed countries. Bulgaria, Croatia, Denmark, Estonia, Finland, France, Hungary, Iceland, Latvia, Norway and Sweden obtain information on inpatient DU at a national level from wholesalers/manufacturers. In Belgium, Italy and Portugal, drugs dispensed to patients in hospitals are registered at a national level. Data are freely available online only for Denmark and Iceland. From the PubMed search, of a total of 868 retrieved studies, only 13 studies used the ATC/DDD methodology. Although the number of DDD/100 bed‐days was used in four studies, other units of measure were also used. The type of information provided for the inpatient sector allowed primarily for conducting DU research at an aggregated data level. The existence of national administrative structures to monitor hospital DU would contribute to promoting the rational use of medicines and improving the safety and quality of prescribing.     

2008 年至 2010 年宿迁地区药物利用状况分 析简

目的 开发《宿迁地区药物利用分析系统》并对宿迁地区药物整体利用状况进行研究,为临床药物合理使用与政府对药品监管提供决策依据.方法 通过开发的药物分析软件收集宿迁地区二级甲等以上综合性医院的药品使用数据,利用药品的解剖学、治疗学、化学分类索引（ATC）的药物分类体系,并以限定日剂量（DDD）为药物的基本计量单位对ATC分类系统各类药物利用状况进行分析.结果 各类药物利用按用药频度（DDDs）排序,消化道和代谢类、血液和造血类、心血管类从2009年至2010年一直位列前3位;按金额排序抗感染类、消化道和代谢类、血液和造血药物2008年至2010一直列前3位;按日均费用额（DDDc）排序,其他类、抗感染类、抗肿瘤类3年来一直位列前3位.结论 系统运用ATC-DDD分析方法,比较客观地反映了该地区的药物利用真实状况和趋势.     

Importance of drug utilization studies as a pharmaceutical tool for the practice of evidence-based medicine

Application of the theory of the Evidence-based Medicine into the every day practice means critically appraising the evidence for validity and clinical usefulness. The real therapeutic value & place of different drugs could be determined only according to the internationally standardised drug statistics. The method for drug consumption analysis recommended by WHO is the ATC/DDD methodology. The basic features of this method will be summarised by the author as well as the usefulness of the data given by utilization researches especially regarding the validation of evidence-based practice and the basis of decision making processes.     

ATC/DDD体系指标用于质子泵抑制剂使用管理效果评价

目的为质子泵抑制剂(PPI)的临床规范使用提供参考。方法采用ATC/DDD体系的分类法查询并计算各PPI的限定日剂量(DDD)值,回顾性分析医院2015年至2017年使用PPI的品种、消耗数量、科室分布、用药频度(DDDs)、使用强度(AUD)及使用率等相关指标。结果医院PPI的DDDs、AUD及使用率,各科室PPI的DDDs、AUD及使用率排名相对稳定;住院患者PPI的DDDs呈上升趋势,PPI销售金额排前10名的科室波动不大,PPI使用率总体略有下降,但仍较高。结论以ATC/DDD评价系统为基础制订各临床科室PPI使用指标具有可行性,可为医疗机构规范PPI的临床应用提供参考。     

Patterns of systemic antibiotic use in a tertiary hospital in Israel in the years 1998-2000

OBJECTIVES: To investigate the pattern of antibiotic use in the hospital over a 3-year period according to individual drugs and hospital departments. SETTING: 335 adult beds of a tertiary hospital in Northern Israel during the years 1998-2000. An antibiotic control policy restricts the use of the most expensive antibiotics and those with broad spectrum of activity and a major impact on bacterial resistance. METHODS: The ATC/DDD and DU 90% methodologies were used. The use of antibiotics was expressed as the number of defined daily doses (DDD) per 100 bed-days. RESULTS: The total antibiotic use varied during the study period from 93.7-101.0 DDD/100 bed-days (p < 0.1). Thirteen drugs accounted for 90% of the total volume. The use of broad spectrum penicillins was the highest of all drugs followed by cephalosporins and oral quinolones. The highest rates of antibiotic use were found in the departments of ENT, urology, gynecology and orthopedics and in the intensive care unit (ICU). The total restricted antibiotics use was 7.2 DDD/100 bed-days and was the highest in the ICU. CONCLUSIONS: The ATC/DDD methodology provided delineation and interpretation of antibiotic usage patterns in the hospital. Although the overall use is higher then that found in several reports from European hospitals, stratification by individual drugs and by hospital department yielded similar trends.     

Problems in collecting comparable national drug use data in Europe: the example of antibacterials

OBJECTIVE: To describe the methodological problems in collecting retrospectively comparable data on drug use and to compare the use of antibacterials in some European countries. METHODS: A spreadsheet was distributed in 2000 through the European Drug Utilisation Research Group (EuroDURG) network, requesting 1994-1999 data on use of antibacterials for systemic use (ATC group J01), from ambulatory, hospital, or total care, aggregated at ATC 4th level, and presented in defined daily doses per 1000 inhabitants per day (in the 1999 ATC/DDD version or specified other version). RESULTS: The network was able to provide national utilization data for two or more years in the requested period from 16 countries (4 only from primary care, 3 both from primary care and total use, and 9 only total use data). The main methodological problems identified were: use of divergent ATC/DDD versions, divergent assignment of DDDs for combination products and the use of unofficial or national DDDs. It was possible to correct for the different ATC/DDD versions to some extent, except for the cephalosporin group (not included in the analysis), as the collection of data at the ATC 4th level precluded recalculation of DDDs. In the seven countries with primary care data the total J01 antibacterials use varied by a factor of 2.5 (Belgium 23.4 and The Netherlands 9.5 DDDs per 1000inhabitants per day). The use of J01A tetracyclines varied fourfold, and the use of J01C penicillins and J01F macrolides and lincosamides approximately threefold. Significant reduction over time was seen in J01A and an increase in J01F. CONCLUSIONS: In the scientific and regulatory community it is still difficult to perform a valid and comprehensive cross-national collection of utilization data on antibacterials. White spots on the European map persist for ambulatory care data, and data are missing for the hospital sector in most countries. For a thorough explanation of the considerable intercountry variability (especially in antibacterial subgroups and time trends analysis) a sustained and concerted effort is necessary to implement a validation process of the ATC/DDD use in the various countries and to adopt a common methodological approach to the collection of utilization data at the substance level (ATC 5th level).     

我院麻醉性镇痛药应用情况分析

目的对医院2002年门诊麻醉性镇痛药使用情况进行统计分析,以加强麻醉性镇痛药的合理使用,最大限度地减轻患者的痛苦。方法以WHO推荐的限定日剂量（DDD）、药物利用指数（DUI）为指标评价麻醉性镇痛药的应用是否合理。结果哌替啶（度冷丁）在用于癌症止痛时DUI=1．181,其他麻醉性镇痛药应用基本合理。结论度冷丁在用于癌症止痛时存在不合理现象,应严格按照WHO推荐的三阶梯用药方案来治疗癌症疼痛。     

我院2010-2012年门诊药房麻醉药品利用及处方书写合理性分析

目的:了解我院麻醉药品的使用情况,评价临床用药的合理性,为合理用药提供参考。方法:采用世界卫生组织(WHO)推荐的限定日剂量(DDD)和药物利用指数(DUI)等作为药物利用的评价指标,对我院2010-2012年开具的门诊麻醉药品名称、剂量、规格、用法用量等进行统计和分析。结果:麻醉药品的使用频率排前2位的是吗啡缓释片和芬太尼透皮贴剂;吗啡注射液、吗啡缓释片、芬太尼透皮贴剂、羟考酮缓释片、可待因片的DUI<1,哌替啶的DUI=1。结论:该院麻醉药品的使用基本合理但仍存在一定不合理用药行为,需进一步加强宣传和管理。     

Analysis of antibiotic consumption of five different clinical departments,especially considering the features of hematology departments

The importance of antibiotic consumption and bacterial resistance analysis is unquestionable. Although the WHO has been recommending the use of ATC/DDD method for the analysis of drug utilization for about 20 years, only limited numbers of publications are available considering the antibiotic consumption of in-patients. In the present study--with the help of the mentioned method--we analysed the utilization of antibiotics in 5 clinical departments. We also investigated the connection between antibiotic consumption, bacterial resistance and enterococcal sepsis at the haematologic department. We could follow the successful impact of the implementation of the new guideline.     

住院患者第二类精神药品处方调查和分析

目的:了解第二类精神药品在我院的使用情况,为精神药品的合理使用提供指导,促进合理用药。方法:采用WHO推荐的限定日剂量(defined daily dose,DDD)作为药物使用研究的测量单位,以药物利用指数(drug utilization index,DUI)作为对各种药品处方用量进行分析的指标。DUI>1.0,说明处方剂量>DDD,表明用药存在不合理;反之则说明处方剂量相似文献   

北京市和平里医院门诊抗菌药物应用分析

目的:了解我院门诊抗菌药物应用现状,为合理使用抗菌药物提供依据。方法:随机抽取我院2010年1—12月每月1天的门诊处方,共计13 162张,统计处方的用药品种、销售金额等,并统计抗菌药物处方中抗菌药物种类、名称、每日剂量、用药天数、给药途径、联合用药情况及抗菌药物分类使用情况等。以世界卫生组织(WHO)建议的限定日剂量(DDD)及药物利用指数(DUI)作为判断是否合理用药的标准。结果:抗菌药物使用率为27.98%,其销售金额占药品总销售金额的12.5%,单一抗菌药物使用率为87.48%,处方平均金额为233.87元。口服抗菌药物DUI排序前10位中有7种药品的DUI>1,注射用抗菌药物DUI排序前10位中有2种药品的DUI>1,其中6种口服药、1种注射用药是由于临床用药日剂量基本符合我国药品说明书规定日剂量但高于WHO的DDD所致。结论:我院门诊抗菌药物处方各项指标基本符合要求,除个别药品外,抗菌药物的应用基本符合我国药品说明书要求。     

北京地区2002年～2004年抗抑郁药应用分析

目的:本文旨在利用《全国医药经济信息网》北京地区的2002年~2004年有关抗抑郁药利用参数,对抗抑郁药的利用度进行分析。方法:采用世界卫生组织推荐的限定日剂量、应用频度为指标,分析抗抑郁药的利用度。结论:应用抗抑郁药人数增加较快,销售金额增加明显,主要以进口与合资药品销售为主,5-羟色胺再摄取抑制剂等新型抗抑郁药已成为临床应用的一线药物,三环类药应用减少。