注射用左氧氟沙星的药物利用评价

目的：从横断面角度了解某院注射用左氧氟沙星的临床应用情况，为加强左氧氟沙星的临床应用管理和优化给药方案提供依据。方法：采用连续多点横断面法对某院2014年8月至2015年3月每月13日注射用左氧氟沙星的使用情况进行统计和分析，结合浓度依赖性抗菌药物PK/PD理论、左氧氟沙星特点和抗菌药物临床应用指导原则，分别从用药目的、用药剂量、感染部位和联合用药等方面评判其用药合理性。结果：一日一次给药方案为224例（43.41%），一日两次给药方案为292例（56.59%）；日剂量0.6 g为251例（48.64%），日剂量0.4 g为78例（15.12%），日剂量0.3 g为162例（31.40%），日剂量0.2 g为25例（4.84%）；患者肌酐清除率在20~49 mL·min^-1区间的药物利用指数为1.61，肌酐清除率在10~19 mL·min^-1区间的药物利用指数为1.67，大于65岁老年患者药物利用指数为1.56；无适应证用药73例（14.15%），其中非手术无适应证用药17例（3.29%）；手术预防用药56例（10.85%）；未考虑患者年龄、肾功能和感染部位，给药剂量过高39例（7.56%），给药剂量过低69例（13.37%）；中枢神经系统感染用药17例（3.29%）；同类药物联合用药10例（1.94%），无指征三/四联用药31例（6.01%）。210例患者用药存在问题，总的不合理使用率40.70%。结论：左氧氟沙星PK/PD理论适用于其临床应用评价，判断其临床应用的合理性还需综合考虑患者肾功能、感染部位和手术部位。

Drug use evaluation of levofloxacin injection

OBJECTIVE To investigate the drug use evaluation of levofioxacin injection by cross section investigation, and provide a reference for the management of clinical application and optimization administration method.METHODS Continuous multi-points cross-sectional investigation was utilized to summarize and analyze levofloxacin injection in our hospital from August 2014 to March 2015, on the 13th per-month. PK/PD theory of concentration dependent antibacterials, characteristic of levofloxacin and guidelines for clinical use of antibiotics were combined. The rationality of levofloxacin use was judged from the aspects of drug dosage with renal function, age of patient, infected site and purpose of drug use.RESULTS Once daily dosing regimen was applied in 224 cases (43.41%), twice daily dosing regimen in 292 cases (56.59%). Daily dose of 0.6g was used in 251 cases (48.64%), daily dose of 0.4g in 78 cases (15.12%), daily dose of 0.3 g in 162 cases (31.40%), daily dose of 0.2 g in 25 cases (4.84%). DUI was 1.61 in creatinine clearance rate range of 20-49 mL·min^-1, and 1.67 in range of 10-19 mL·min^-1. Patients older than 65 years old patients had a DUI of 1.56. Drug was used in 73 cases (14.15%) without indications, including 17 non-operative cases (3.29%) and 56 operative cases (10.85%); in 56 cases (10.85%) for preventive medication; in 39 cases (7.56%) at high doses and 69 cases (10.85%) at low doses without considering patient age, kidney function and infection site; in 17 cases (3.29%) for central nervous system infection; in 10 cases (1.94%) combined with drugs of similar category; in 31 cases (6.01%) for triple/quadruple medication without indications. 210 patients had drug use problems, and the total unreasonable utilization rate was 40.70%.CONCLUSION The PK/PD theory of concentration dependent antibacterials applies suitably to evaluate the use of levofloxacin injection, and individual factors such as age, renal function, infection site and type of surgical incision should be evaluated comprehensively.