南京地区34家医院2009-2012年抗真菌药使用情况分析

目的:评价南京地区抗真菌药利用情况,为临床抗真菌药的使用和管理提供参考。方法:对南京地区34家医院2009-2012年抗真菌药的消耗量、总零售金额、用药频度(DDDs)和日均费用(DDC)等指标进行统计、分析。结果:近4年南京地区抗真菌药用量及用药总金额呈上升趋势,占抗感染药的比重缓慢升高,年增长率起伏明显,最高达59.41%;2009-2011年用药总金额排前4位均为氟康唑、伊曲康唑、卡泊芬净和特比萘芬,2012年伏立康唑用量激增,跃居首位;占销售金额85%左右的抗真菌药为唑类和棘白菌素类;DDDs排前3位的是伊曲康唑注射剂和口服剂、咪康唑外用剂型、特比萘芬口服剂型,多数抗真菌药的DDDs在增长,提示细菌耐药的情况可能有所变化;抗侵袭性真菌药多为新型广谱品种,DDDs最高的是伊曲康唑、特比萘芬和氟康唑,DDC居前列的包括棘白菌素类、伏立康唑和伊曲康唑。结论:要谨慎对待包括深部侵袭性真菌感染在内的抗真菌药的早期经验性治疗;临床需要注意剂型选择以及控制费用,紧密结合国内外治疗规范和指导性要求。

Analysis of the Utilization of Anti-fungal Drugs in 34 Hospitals from Nanjing Area during 2009--2012

OBJECTIVE： To evaluate the utilization of anti-fungal drugs in Nanjing area, and to provide reference for rational use and management of anti-fungal drugs in the clinic. METHODS： The utilization of anti-fi.mgal drugs in 34 hospitals from Nan- jing area were analyzed statistically in terms of quantities, consumption sum, DDDs and DDC, etc. RESULTS： The quantities and consumption sum of anti-fungal drugs showed an increasing trend, and their proportion among anti-infection agents increased slowly; annual growth rate of anti-fungal drugs rose and fell significantly in recent 4 year, and the highest was 59.41%. Flucon- azol, itraconazole, caspofungin and terbinafine kept the top 4 places in the list of consumption sum during 2009--2011, while the quantity of voriconazole greatly increased and occupied the first place in 2012. The consumption sum of azoles and pneumo- candins took up around 85% of the total anti-fungal drugs. Top 3 anti-fungal drugs in the list of DDDs was Itraconazole injection and oral forms, Miconazole external forms and Terbinafine oral tablets. DDDs of the most of anti-fungal drugs was increasing, which suggested drug resistance of bacterial might be changing; most of drugs for invasive fungal infection were new broad-spec- trum agents, and itraconazole, terbinafine and fluconazol occupied the front place in the list of DDDs and echinocandins, voricon- azole and itraconazole took up the front place in the list of DDC. CONCLUSIONS： The utilization of anti-fungal drugs in Nanjing area is basically rational during 2009--2012. It should be cautious of early empirical treatment for invasive fungal infection; great importance should be attached to the selection of dosage form and cost control, treatment standards and guidelines at home and abroad.