抗菌药物合理应用的基本思路

卫生部颁布的<抗菌药物临床应用指导原则>(以下简称<指导原则>)正在全国各地贯彻实施,这为抗菌药物临床应用提供了规范,对提高我国感染性疾病的抗菌治疗水平,减缓细菌耐药性加重,降低医药费用将起深远的影响.     

抗菌药合理应用的原则及常用品种定位

2004年10月由中华医学会、中华医院管理学会药事管理专委会、中国药学会医院药学专委会编写的《抗菌药物临床应用指导原则》在全国颁布实施，这对提高我国感染性疾病的抗菌治疗水平，减缓细菌耐药性发展，降低医药费用将起深远影响。     

抗菌药合理应用的基本思路

2004年10月由中华医学会、中华医院管理学会药事管理专业委员会、中国药学会医院药学专业委员会编写的《抗菌药物临床应用指导原则》(以下简称《指导原则》)在全国颁布实施,这对提高我国感染性疾病的抗菌治疗水平,减缓细菌耐药性发展,降低医药费用将起着深远影响。     

儿科合理应用抗菌药的基本原则

根据卫生部颁布的<抗菌药物临床应用指导原则>(以下简称<指导原则>)所强调的基本原则,对于儿科领域应着重注意以下几项[1].     

抗菌药抗菌作用评估的参数及其临床应用

我国医学教育体制下培养的临床医师在校期间很少接受系统的药物及其药物治疗学方面的培训，因此对各种药物包括抗菌药物的了解较肤浅，这给以后几十年的临床工作带来了弊病，即规范用药、合理用药的水平有限，甚至出现不少随意用药、错误用药的现象，由此影响疗效、增加药物的不良反应，对抗菌药物而言还可能促使细菌耐药性的产生。     

抗菌药物不合理用药分析

抗菌药物是治疗和控制各种感染性疾病的一类重要药物,被广泛应用于临床.但近年来,抗菌药物从广泛使用演变成过量使用甚至滥用,不合理用药的不良后果是导致不良反应增多、细菌耐药性增长、治疗失败等,给患者健康和生命造成重大影响.本研究对近年来国内公开发表的药学或医学期刊报道的302例抗菌药物的不合理用药采用文献计量学方法进行统计分析,总结抗菌药物不合理应用的特点,指导临床合理用药.     

妇产科围手术期抗菌药合理应用评价

目的有效控制感染的同时防止宿主体内茵群失衡,减少患者用药过敏或其他不良反应和细菌耐药性的产生.方法医师使用抗菌药必须掌握适应证并遵循安全、有效、经济的原则.结果及结论妇产科围手术期抗茵药的合理应用体现在用药品种、剂量、时间、途径、患者、疗程及治疗目标均是适宜的.医疗机构应有严格管理措施,促进和保证抗菌药合理应用.     

我院抗菌药物使用情况评价简

抗菌药物是治疗感染性疾病的重要药物,是临床广泛使用的药物之一.正确合理应用抗生素是提高疗效、降低不良反应发生率以及延缓细菌耐药性发生的关键.原卫生部于2012 年8 月1 日起实施〈抗菌药物临床应用管理办法〉,更加促进抗菌药物的规范合理使用.为了解我院抗菌药物应用情况,对2011 年7 月至2012 年9 月我院抗生素使用情况进行回顾性分析,为临床合理用药、医疗水平的提高及新药的研究方向提供有利的信息和依据.     

儿科抗菌药物的临床合理应用

由于抗菌药物的滥用,导致细菌耐药性的产生,药源性疾病的出现,因此抗菌药物的合理应用已经是临床上亟待解决的问题。儿童作为一类特殊的用药群体,新陈代谢旺盛,对药物排泄较快,但是肝、肾功能、中枢神经系统以及某些酶系统发育尚未成熟,对药物代谢及解毒功能较差。     

预防用药不能替代无菌操作

前不久,卫生部下发通知,要求进一步加强外科围术期的抗菌药物预防用药管理,纠正当前过度依赖抗菌药物预防手术感染的现象,并逐步建立抗菌药物临床应用预警机制。本文作者就此采访了上海华山医院抗生素研究所汪复教授、     

PBPK模型在抗感染药物研发及临床评价中的应用

摘要：生理药动学( physiologically based pharmacokinetic,PBPK) 模型是一种模拟药物在人或动物体内吸收、分布、代谢和排泄过程的数学模型,集成了药物的理化和系统(生理)信息,能描述药物在靶组织器官中的经时变化,用于药物研究的各个阶段。本文将综述PBPK模型在抗感染药物研发及临床评价中的应用,为抗感染药物研发及临床合理应用提供参考。     

2007～2009年我院抗感染药物使用情况分析

目的:了解我院2007～2009年抗感染药物的使用情况,分析抗感染药物使用特点及变化规律,为临床合理用药提供依据。方法:根据我院计算机管理系统,对我院2007～2009年抗感染药物的品种数、销售金额等进行统计及分析。结果及结论:我院的抗感染药物用药品种趋向精简,结构比较合理,抗感染药物品种的选择基本合理,但仍需进一步加强管理,保证临床用药安全、有效、经济。     

骨科抗菌药物不合理应用分析

目的促进临床合理应用抗菌药物。方法通过我院骨科附属医院抗感染药物治疗的病例,从药物选用、用法用量、药物相互作用、配伍禁忌等方面对常见医嘱抗菌药物不合理用药进行探讨,指出用药不当的原因和可能的后果,以期帮助临床防范抗菌药物不合理用药的发生。结果临床常见医嘱抗菌药物的使用存在很多不合理之处。结论抗菌药物使用应全面考虑、综合分析,临床药师在抗菌药物的合理使用上可起到积极作用。     

我院口服抗感染药物的使用分析

目的了解口服抗感染药物的使用状况和用药趋势.方法采用金额排序和用药频率分析方法对2002～2004年口服抗感染药进行统计分析.结果三年抗感染药占药品总金额的比例分别是37.36%,38.56%,38.50%;口服抗感染药占总抗感染药总金额的比例是16.60%,15.31%,15.29%.结论该院抗感染药物的使用基本合理,但也存在一些不合理之处.认真执行<抗菌药物临床使用指导原则>,对规范临床抗感染治疗,延缓或减少细菌耐药性的发生具有极其重要的意义.     

Disposal of outdated anti-infective products

After an unsuccessful search for guidelines to destroy outdated anti-infective products, a procedure was developed for pharmacy that uses currently available biohazardous materials. By using a blood/body-fluid absorbent, an inexpensive waste system was developed to avoid the negative public sentiment caused by use of public landfills and avoid the risk of disposing waste in hospital drainage systems.     

Dendrimer based anti-infective and anti-inflammatory drugs

Alternatives to traditional antibiotics and to antiviral and anti-inflammatory drugs are much in need and the molecular design and development of anti-infective compounds constitute a pivotal area in modern medicinal research. Dendrimers are a relatively new class of structurally well-defined, i.e. monodisperse, synthetic polymers with hyperbranched structures which enable a given molecular motif to be presented in a highly multivalent fashion. Several types of dendrimers with various structural elements and molecular dimensions are commercially available at an affordable price. The surface of dendrimers can be modified relatively easily and, depending on the surface motif, the pharmacological properties of the dendrimer such as cytotoxicity, bacteriocidal and virucidal effect, biodistribution and biopermeability may be modulated to fit a specific medicinal purpose. Dendrimers are thus highly suitable tools in drug discovery and they allow the synthesis of molecules with high and specific binding affinities to a wide variety of receptors, viruses and bacteria. Hence the use of dendrimers for the development of antiviral or antibacterial drugs, destroying the infective agent or disrupting multivalent binding interactions between the infective agent and cells of the host organism has become a highly active research field. The wide range of applications reported for the use of dendrimers as anti-infective and anti-inflammatory drugs in the patent literature demonstrates the general applicability of these molecules as drug candidates. The present review will briefly treat the intrinsic properties of dendrimers in biological systems, as well as general concerns regarding the treatment of infective diseases. The use of dendrimers as anti-infective and anti-inflammatory drugs will be based on a thorough review of the recent patent literature.     

Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of urinary tract infections

The new guidelines of Infectious Diseases Society of America (IDSA) and European guidelines of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) on evaluation of new anti-infective drugs for the treatment of urinary tract infection (UTI) were published in 1992 and 1993, respectively. The experience with these guidelines, including the recommendations for improvement published by an international expert group, are being updated and discussed. The IDSA and ESCMID guidelines define five categories of UTI. Some aspects specific for each group are discussed concerning definition, stratification and outcome. For patients with chronic bacterial prostatitis, a category of its own is proposed rather than using the general category of complicated UTI. The greatest advantage of the new guidelines in comparison with the former FDA guidelines is enrolment of patients according to intention to treat, as has always been recommended by the guidelines of the Japanese UTI Committee. Two problems arising in studies of all categories are addressed: (i) false positive bacteriuria and (ii) handling of dropouts and missing data. Compared with the former FDA guidelines, the new IDSA and ESCMID guidelines reflect much better the clinical situation of the physician taking care of individual patients. Therefore, the results of studies performed according to these guidelines are clinically more significant. A worldwide harmonization of guidelines may finally lead to valid and acceptable results in any country.     

An update on the use of C. elegans for preclinical drug discovery: screening and identifying anti-infective drugs

Introduction: The emergence of antibiotic-resistant and -tolerant bacteria is a major threat to human health. Although efforts for drug discovery are ongoing, conventional bacteria-centered screening strategies have thus far failed to yield new classes of effective antibiotics. Therefore, new paradigms for discovering novel antibiotics are of critical importance. Caenorhabditis elegans, a model organism used for in vivo, offers a promising solution for identification of anti-infective compounds.

Areas covered: This review examines the advantages of C. elegans-based high-throughput screening over conventional, bacteria-centered in vitro screens. It discusses major anti-infective compounds identified from large-scale C. elegans-based screens and presents the first clinically-approved drugs, then known bioactive compounds, and finally novel small molecules.

Expert opinion: There are clear advantages of using a C. elegans-infection based screening method. A C. elegans-based screen produces an enriched pool of non-toxic, efficacious, potential anti-infectives, covering: conventional antimicrobial agents, immunomodulators, and anti-virulence agents. Although C. elegans-based screens do not denote the mode of action of hit compounds, this can be elucidated in secondary studies by comparing the results to target-based screens, or conducting subsequent target-based screens, including the genetic knock-down of host or bacterial genes.     

含硼类抗感染药物的研究进展

随着化学治疗药物的广泛使用,微生物对药物产生的耐药性已经成为全球严重的公共卫生问题。寻找具有新结构和新的作用机制的药物是克服耐药的主要办法之一。硼具有与其他元素不同的独特性质,含硼化合物增加了分子结构的多样性。这类化合物以其全新的结构和特殊的作用机制,成为药物研发的新途径。本文综述了含硼类抗感染药物的研发进展。