基于指南的急诊依替米星使用合理性分析(1)
摘 要：目的 对我院急诊依替米星处方合理性进行分析，为抗菌药物的合理应用提供参考依据。方法 调阅2017年1月1日～12月31日首都医科大学石景山教学医院急诊科依替米星处方共2599张，依据疾病的治疗指南对处方的合理性进行分析。结果 依替米星使用率排名前三位的诊断为腹腔感染(59.87%)、皮肤软组织感染(58.91%)、泌尿系感染(55.91%)，将依替米星作为该诊断的经验性用药与指南推荐的一线用药不符。依替米星用于年龄较轻、无基础疾病青壮年的呼吸道感染治疗亦为不合理用药。结论 我院依替米星使用存在一定的不合理现象。抗感染药物的选择应遵循疾病的治疗指南并结合病原学及药物的药代动力学特点，建议不要将依替米星作为经验性治疗的常规推荐。
关键词：依替米星;抗生素使用;治疗指南
中图分类号：R978 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.21.035
, 百拇医药
文章编号：1006-1959(2018)21-0125-04
Analysis on Rational Use of Etimicin from the Emergency Department Based on Guideline
WANG Rui，CHEN Jin-ping
(Department of Pharmacy，Shijingshan Teaching Hospital，Beijing 100043，China)
Abstract：Objective Analysis on rational use of Etimicin from the emergency department in hospital to provide referential significance of rational administration of antibiotic. Methods A total of 2599 Etimicin prescriptions of emergency department was collected from January 1，2017 to December 31，2017. Analysis the prescriptions reasonableness based on the guidelines of the treatment of disease. Results The top three diagnosis of using Etimicin were abdominal infection(59.87%)、skin and soft tissues infection(58.91%)、urinary tract infection(55.91%)，empirical use of Eitmicin in this diagnosis is inconsistent with the guidelines recommended first-line medication. The use of etimicin for the treatment of respiratory infections in younger， younger age-free diseases is also an irrational use. Conclusion There was certain irrational use of Eitmicin in our emergency department. The choice of antibiotics should depend on guidelines of treatment、pathogen and pharmacokinetics. It is not recommended to use Etimicin as a routine recommendation for empiric therapy.
, 百拇医药
Key words：Etimicin;Antibiotic use;Treatment guideline
氨基糖苷類抗生素在临床上主要用于革兰阴性菌感染的治疗。由于该类药物对革兰阴性菌的耐药率总体偏低、过敏率低、艰难梭菌感染发生率低、每日给药次数少(1次/d)、患者依从性好等优势，在临床上得到广泛使用。但近年来，考虑到该类药物的肾毒性、耳毒性、需要血药浓度监测等缺点，越来越多的临床医生认为应减少此类药物的使用，尽量选择更安全的抗生素[1]。近年来的一些临床指南对氨基糖苷类的推荐也发生了变化，例如腹腔感染的治疗，美国外科感染协会在2002年版腹腔感染的治疗指南中推荐氨基糖苷类联合甲硝唑[2]，而2017年版该指南进行更新，不推荐氨基糖苷类进行经验性治疗[3]。我院门急诊的氨基糖苷类药物包括庆大霉素、异帕米星、依替米星3个品种。而依替米星在2017年连续数月处于急诊药品金额排名前10位，抗生素用量排名前5位，此种用药情况与指南的推荐背道而驰。基于以上原因，本文对我院2017年急诊科依替米星使用的情况进行分析，以期对临床抗菌药物的合理使用有一定的参考意义。, 百拇医药(王 蕊 陈金萍)
关键词：依替米星;抗生素使用;治疗指南
中图分类号：R978 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.21.035
, 百拇医药
文章编号：1006-1959(2018)21-0125-04
Analysis on Rational Use of Etimicin from the Emergency Department Based on Guideline
WANG Rui，CHEN Jin-ping
(Department of Pharmacy，Shijingshan Teaching Hospital，Beijing 100043，China)
Abstract：Objective Analysis on rational use of Etimicin from the emergency department in hospital to provide referential significance of rational administration of antibiotic. Methods A total of 2599 Etimicin prescriptions of emergency department was collected from January 1，2017 to December 31，2017. Analysis the prescriptions reasonableness based on the guidelines of the treatment of disease. Results The top three diagnosis of using Etimicin were abdominal infection(59.87%)、skin and soft tissues infection(58.91%)、urinary tract infection(55.91%)，empirical use of Eitmicin in this diagnosis is inconsistent with the guidelines recommended first-line medication. The use of etimicin for the treatment of respiratory infections in younger， younger age-free diseases is also an irrational use. Conclusion There was certain irrational use of Eitmicin in our emergency department. The choice of antibiotics should depend on guidelines of treatment、pathogen and pharmacokinetics. It is not recommended to use Etimicin as a routine recommendation for empiric therapy.
, 百拇医药
Key words：Etimicin;Antibiotic use;Treatment guideline
氨基糖苷類抗生素在临床上主要用于革兰阴性菌感染的治疗。由于该类药物对革兰阴性菌的耐药率总体偏低、过敏率低、艰难梭菌感染发生率低、每日给药次数少(1次/d)、患者依从性好等优势，在临床上得到广泛使用。但近年来，考虑到该类药物的肾毒性、耳毒性、需要血药浓度监测等缺点，越来越多的临床医生认为应减少此类药物的使用，尽量选择更安全的抗生素[1]。近年来的一些临床指南对氨基糖苷类的推荐也发生了变化，例如腹腔感染的治疗，美国外科感染协会在2002年版腹腔感染的治疗指南中推荐氨基糖苷类联合甲硝唑[2]，而2017年版该指南进行更新，不推荐氨基糖苷类进行经验性治疗[3]。我院门急诊的氨基糖苷类药物包括庆大霉素、异帕米星、依替米星3个品种。而依替米星在2017年连续数月处于急诊药品金额排名前10位，抗生素用量排名前5位，此种用药情况与指南的推荐背道而驰。基于以上原因，本文对我院2017年急诊科依替米星使用的情况进行分析，以期对临床抗菌药物的合理使用有一定的参考意义。, 百拇医药(王 蕊 陈金萍)