临床药师干预对儿科住院患者抗菌药应用影响调查

目的：探讨临床药师干预对儿科住院患者抗菌药应用的影响。方法：分别选取干预前（2012年6月）和干预后（2012年12月）儿科所有住院病历64份和102份,比较用药频度（DDDs）及合理用药指标（抗菌药使用率、不合理使用率、联用率、抗菌药分级使用率以及不合理换用率）。结果：1干预前抗菌药的选用多为限制级和特殊级抗菌药,DDDs排名前3名分别是：美洛西林/舒巴坦、头孢美唑、头孢唑林。干预后非限制级抗菌药的选用品种明显增加,无特殊级抗菌药的使用;其DDDs排名前3名分别是：美洛西林/舒巴坦、头孢美唑、头孢地嗪。2干预后,抗菌药的使用率由100%下降到84.3%（P〈0.01）。不合理使用率由20.3%下降到6.9%（P〈0.05）。二联使用率由23.4%下降到7.0%（P〈0.01）,三联使用率由3.1%下降到0%（P〉0.05）。非限制级抗菌药的使用率由0上升到6.5%,而特殊级抗菌药的使用率由7.2%下降到0%（P〈0.01）。抗菌药的不合理换用率由70%下降到35.7%（P〈0.05）。结论：临床药师干预促进了抗菌药的合理应用。

Investigation on the Impact of the Use of Anfimicrobial Agents in Inpatient Pediatric by Clinical Pharmacist Intervention

Objective：Investigate the effect of clinical pharmacist intervention on the application of antimicrobial agents in pediatric inpatients. Methods： Sixty-four parts of pediatric inpatient medical records before intervention （June 2012） and 102 parts of records after intervention （December 2012） were taken. Compare antimicrobial drug use indicators. Results： （1）Before intervention, the selection of antimicrobial agents were restricted and special class of antibacterial drugs, the top three durg of DDDs were mezlocillin/sulbactam, cefmetazole, cefazolin. Mter intervention, the useage of non-re- stricted antimicrobial agents increased significantly and no special class of antimicrobial agents were chosen;the top three durg of DDDs were mezlocillin/sulbactam, cefmetazole, cefodizime. （2）Mter intervention, the rationality of antimicrobial a- gents was improved ：the usage rate of antibiotics dropped from 100% to 84.3% （P 〈 0.01 ）. Unreasonable utilization rate fell from 20.3% to 6.9% （ P 〈 0.05 ）. Two drug utilization from 23.4% down to 7.0% （ P 〈 0.01 ）, triple usage from 3.1% down to 0% （ P 〉 0.05 ）. Non-restricted antibiotic usage rose from 0% to 6.5 %, while the special class of antibiot= ic usage down from 7.2% to 0% （P 〈 0.01 ）. Unreasonable exchange rate dropped from 70% to 35.7% （P 〈 0.05）. Conclusion： Clinical pharmacist intervention to promote the rational use of antimicrobial agents.