实施专项整治前后北京地区65家基层医疗机构抗菌药物应用调查分析

目的:了解实施专项整治前后北京地区基层医疗机构抗菌药物应用情况和整治效果,为合理用药与专项整治活动深入开展提供依据。方法:对实施专项整治前(2010年5月-2011年4月)、整治后(2011年5月-2012年4月)北京地区65家基层医疗机构的购药数据,进行回顾性统计、分析。结果:整治后注射剂减少了19个规格,口服剂增加了12个规格。15类抗菌药物中购入金额有14类下降,唯唑酮类上升62.84%。整治前后用药集中在头孢菌素类、青霉素类、喹诺酮类、大环内酯类,合计用药频度(DDDs)比例均在90%以上,头孢菌素类抗生素DDDs比例在52%以上;其中头孢呋辛占头孢菌素类抗生素DDDs比例在35%以上,占全部抗菌药物DDDs比例在18%以上。整治后口服剂、注射剂金额分别下降26.25%、27.18%,DDDs分别下降22.89%、3.44%,日均费用(DDC)分别下降4.35%、24.53%。整治前后各级抗菌药物DDDs、金额比例变化不大,非限制级DDDs比例都在72%以上。整治后国家基本药物金额、DDDs分别下降了27.79%、22.24%,比例分别在27%、64%左右;DDC下降7.08%。整治前后二级医院DDDs比例均在63%以上,金额比例均在90%以上;整治后一、二级医院金额分别下降了21.16%、27.42%。整治前后各代头孢菌素类抗生素DDDs、金额比例略有下降,唯第2代头孢菌素上升;整治后合计金额、DDDs、DDC分别下降26.76%、25.33%、1.95%,唯头霉素类抗生素DDDs上升了29.04%。结论:整治措施得力,效果显著,临床用药需进一步规范。

Investigation and Analysis of the Use of Antibiotics in 65 Primary Medical Institutions from Beijing Area be- fore and after Special Rectification

OBJECTIVE： To investigate the application and improvement effects of antibiotics in primary medical institutions from Beijing area before and after special rectification, and to provide reference for rational drug use and deep development of spe cial rectification. METHODS ： In retrospective study, the drug-purchasing data of 65 primary medical institutions from Beijing area were analyzed statistically before （May 2010--Apr. 2011） and after intervention （May 2011--Apr. 2012）. RESULTS： The injec tion reduced 19 specifications, and oral preparation increased 12 specifications after rectification. Among 15 antibiotics, the procure ment values of 14 categories decreased, while oxazole ketones rose by 62.84%. The drug used mainly were cephalosporins, penicil lins, quinolones and macrolides, and the proportion of total DDDs were above 90% and that of cephalosporins were more than 52% ; in which that of cefuroxime was above 35% in cephalosporins, and above 18% in the total DDDs of antibiotics. After rectifi cation, the amount of oral preparations and injections decreased by 26.25% and 27.18%, DDDs of them decreased by 22.89% and 3.44%, and DDC decreased by 4.35% and 24.53%, respectively. The amount and DDDs of all levels of antibiotics had no signifi cant difference before and after rectification, while the proportion of non-restricted DDDs was more than 72%. The amount and DDDs of national essential medicines reduced by 27.79% and 22.24% respectively, whose proportions were 27% and 64%, re spectively after rectification; DDC decreased by 7.08%. The proportions of DDDs were all more than 63%, and the proportion of the amount were above 90% in second-class hospitals either before or after rectification. The amount of the first-class and the sec ond-class hospitals reduced by 21.16% and 27.42%. DDDs and amount of each generation cephalosporins decreased slightly after rectification, while only second-generation increased. Moreover, after rectification, the total amount, DDDs and DDC of all genera tions decreased by 26.76%, 25.33% and 1.95%, respectively; while only cephamycins increased by 29.04%. CONCLUSIONS： The special rectification tasks have been proved quite successful and effective, whereas clinical drug use still need be further stan dardized.