五家三级甲等儿童医院实施《抗菌药物临床应用指导原则》前后抗菌药物消耗情况的调查

目的调查2002至2006年五家三级甲等儿童医院门诊和住院患儿抗菌药物消耗情况,并对2004年10月颁布的《抗菌药物临床应用指导原则》(指导原则)实施前后的药物消耗情况进行评价。方法选择五家三级甲等儿童医院:首都医科大学附属北京儿童医院(医院B)、上海交通大学医学院附属上海儿童医院(医院SA)、复旦大学附属儿科医院(医院SB)、重庆医科大学附属重庆儿童医院(医院C)以及广州医学院附属广州儿童医院(医院G)进行研究。分别统计不同年份五家医院全年门诊部和住院部所有抗菌药物的消耗量。应用药物解剖-治疗-化学的分类系统和限定日剂量(DDD)方法进行抗菌药物利用研究。抗菌药物的用药频度(DDDs),门诊患儿:每100个患儿每天的DDD数目(DDDs/100患儿-天),住院患儿:每100个住院日的DDD数目(DDDs/100住院日)。按照指导原则将抗菌药物分为非限制使用、限制使用和特殊使用药物。结果①各选择医院门诊部抗菌药物总的DDDs差异有统计学意义,DDDs的差距呈逐年降低趋势。门诊部大环内酯类、头孢菌素类和青霉素类的DDDs较高。②选择医院门诊部非限制使用药物平均DDDs指导原则颁布后(11.4)较颁布前(15.2)有显著降低趋势,其中医院B、SA和SB的下降趋势较明显;选择医院限制使用药物平均DDDs指导原则颁布后较颁布前降低趋势不明显。门诊部非限制使用药物单品种以乙酰吉他霉素、阿莫西林和阿莫西林/克拉维酸DDDs所占比例最高,限制使用药物单品种以阿奇霉素、头孢克洛和头孢他美酯DDDs所占比例最高。③2002至2006年选择医院住院部抗菌药物总的DDDs为49.9～65.8,DDDs在2006年较2002至2004年下降了22.6%。选择医院DDDs的差距呈逐年降低趋势。住院部青霉素类、头孢菌素类和大环内酯类的DDDs较高。④选择医院住院部非限制使用药物平均DDDs指导原则颁布后(22.7)较颁布前(34.0)有显著降低趋势,各医院亦有不同程度的降低;限制使用和特殊使用药物平均DDDs较指导原则颁布前变化不明显,五家医院各有升降。各医院住院部非限制使用药物中以青霉素类、第一和二代头孢菌素DDDs所占比例最高,指导原则颁布前后的DDDs最高单品种均在同一类或同一代抗菌药物中变化;指导原则颁布前限制使用药物中以第三代头孢菌素为主,颁布后以第二代头孢菌素为主。结论五家儿童医院抗菌药物DDDs较高,各医院各类抗菌药物DDDs有所不同。指导原则实施后抗菌药物的使用呈降低趋势,医院间DDDs差距缩小,提示指导原则的颁布对抗菌药物的使用起到了一定的指导和制约作用。

Antibiotic consumption in five tertiary children′s hospitals before and after implementation of guidelines for antibacterial use in clinical practice

Objective To investigate the pattern of antibacterial consumption in five tertiary children′s hospitals from 2002 to 2006. To see if the Guidelines for antibacterial use in clinical practice have any impact on the use. Methods Five children′s hospitals including Beijing Children′s Hospital affiliated to Capital Medical University Beijing, Tianjin Children′s Hospital of Tianjin Medical University, Children′s Hospital of Fudan University, Chongqing Children′s Hospital affiliated to Chongqing Medical University, Shanghai Children′s Hospital affiliated to Shanghai Jiaotong University, Guangzhou Children′s Hospital Affiliated to Guangzhou Medical College were chosen. The Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 patient-days for outpatients and DDD/100 bed-days for inpatients. Antibiotic data were collected for systemic drug in number of packages and doses retrospectively from each hospital computer database for the entire year from 2002 to 2006. In October 2004, national Guidelines for antibacterial use in clinical practice were issued, which divided antibiotics into non-restricted, restricted and special use grades. The trend of DDDs was investigated before and after national Guidelines for antibacterial use in clinical practice were issued. Results ①In outpatient departments of five children′s hospitals, the antibacterial consumption was different from each other. The overall antibiotic consumption decreased after the guideline was issued in some hospitals and the variation in antibiotic use between hospitals was also reduced. ②A significant decrease in non-restricted antibiotics use was observed in outpatient departments of the five hospitals. Also the use of restricted antibiotics was reduced in two hospitals. However, a decrease in the use of first-generation cephalosporins, and an increase in the use of third-generation cephalosporins as well as in the combination of penicillins and β-lactamase inhibitors were observed in outpatient departments. ③The overall use of antibiotic drugs of inpatients was 682, 584, 658, 656 and 499 DDD/100 bed-days for the years 2002 to 2006, respectively. While the overall antibiotic use in 2005 was not greatly changed compared with previous years, by 2006 antibiotic use was decreased by 22.6% and the variation in antibiotic use among hospitals was also reduced. ④The use of non-restricted grade antibacterials reduced one year after the guideline was issued and the use of restricted grade antibacterials remained stable. The antibiotic use may be improved because of the exchange in the top class from third-generation cephalosporins, Ceftriaxone and Cefoperazone to second-generation cephalosporins, Cefuroxime. Conclusions This multicentre survey on antibiotic use in five tertiary children′s hospitals showed that the DDDs were relatively high and considerable variation both in the pattern and amount of antibiotics use could be found in each hospital. The differences of DDDs were observed among five children′s hospitals. The decline in overall antibiotic use, especially in antibiotics of non-restricted grade, and variation in antibiotic use between hospitals may be attributed to the impact of national Guidelines for antibacterial use in clinical practice. The survey indicated that overuse of antibiotics might be reduced. To develop and implement guidelines is therefore crucial for rational use of antibiotics.