专项整治前后某院喹诺酮类抗菌药应用情况对比分析

目的:分析评价南京某三甲医院抗菌药专项整治前后喹诺酮类抗菌药使用情况和发展趋势,为抗菌药临床应用专项整治活动及管理提供依据。方法:调取该院2010年(整治前)和2011~2013年(整治后)所用喹诺酮类抗菌药的使用记录,采用回顾性方法,对该类药物的销售金额、用药频度(DDDs)、限定日费用(DDC)、细菌耐药情况及药品不良反应进行统计分析。结果:整治后(2011~2013年)喹诺酮类抗菌药销售金额及占抗菌药总销售金额比例较整治前(2010年)有明显下降;整治前注射用门冬氨酸洛美沙星的销售金额和DDDs最高,整治后的2012~2013年,莫西沙星注射剂和盐酸左氧氟沙星注射液的销售金额最高,分别位于第1、2位;盐酸左氧氟沙星片和盐酸左氧氟沙星注射液的DDDs最高,分别位于第1、2位;莫西沙星注射剂DDC最高。主要耐药菌葡萄球菌、肠杆菌科细菌、非发酵菌对左氧氟沙星、诺氟沙星、环丙沙星的耐药率有所下降;整治后该院抗菌药所致不良反应例数及喹诺酮类抗菌药所致不良反应占抗菌药不良反应的比例低于整治前。结论:该院通过抗菌药专项整治,喹诺酮类抗菌药的各项应用指标明显改善,喹诺酮类抗菌药的合理应用也取得成效,专项整治的效果比较明显。但该院还应加强对第4代喹诺酮类抗菌药的临床应用加以督导。

Comparative Analysis of the Usage of Quinolones before and after Special Rectification in a Hospital

ABSTRACT Objective: To analyze and evaluate the usage and tendency of quinolones before and after the special rectification of antibacterial in one grade III level A hospital in Nanjing to provide evidence for the special rectification of antibacterial and management. Methods: The usage records of quinolones in 2010 (before the special rectification) and in 2011 2013 (after the special rectification) were collected, and the sales revenue, DDDs, defined daily cost (DDC), drug resistance and adverse drug reactions (ADR) were analyzed retrospectively. Results: Both the amount and ratio of the sales revenue of quinolones were declined dramatically after the rectification (2011 2013). Among all kinds of quinolones, the sales revenue and DDDs of lomefloxacin aspartate injections was the highest before the rectification while moxifloxacin injections and levofloxacine hydrochloride injections ranked the first and the second respectively in sales revenue after the rectification(2012 2013). As for the DDDs, levofloxacin hydrochloride tablets and levofloxacine hydrochloride injections were the highest after the rectification. Besides, moxifloxacin injections had the highest DDC after the rectification. Moreover, the drug resistance of the main drug resistant bacteria (namely staphylococcus, enterobacteriaceae and non fermentation bacteria) to levofloxacin, norfloxacin and ciprofloxacin was declined after the rectification. The adverse drug reactions of levofloxacin, lomefloxacin, enoxacin and moxifloxacin were declined year by year after the rectification, and the ADR ratio of quinolones in all anti bacterial agents was also declined.Conclusion:After the special rectification of antibacterials, the hospital exhibits obvious improvement in all the application indices of antibacterials, reflecting a good result of the special rectification. However, the hospital still needs to strengthen the inspection over the clinical application of the fourth generation of quinolones.