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OBJECTIVE：To evaluate the efficacy and safety of prophylactic use of low-dose aspirin in patients with chronic renal disease ，and to provide reference for evidence-based reference for rational use in the clinic. METHODS ：Retrieved from PubMed，Embase，Cochrane Library ，CNKI，VIP，Wanfang database ，RCTs about prophylactic use aspirin 75-150 mg/d（aspirin group）versus no aspirin and other antiplatelet drugs or placebo （control group ）were collected from inception to May 14th，2019. Relevant data were extracted. After quality evaluation with bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0，Meta-analysis of the incidence of cardiovascular events ，renal events and bleeding events in patients with chronic renal disease was performed by using Rev Man 5.3 software. RESULTS ：A total of 5 RCTs were included ，involving 4 728 patients；among them ，there were 2 392 persons in aspirin group and 2 390 persons in control group. Results of Meta-analysis showed that there was no statistical significance in the incidence of cardiovascular events [OR ＝0.59，95％CI（0.13，1.12），P＝0.11] and the incidence of renal events [OR ＝0.42，95％CI（0.08，2.23），P＝0.31] between aspirin group and control group. The incidence of bleeding events [OR ＝2.12，95％CI（1.23，3.66），P＝0.007] in aspirin group was significantly higher than control group. After exculsion of two heterogeneity literatures ，the incidence of cardiovascular events [OR ＝0.27，95％CI（0.13，0.55），P＝0.000 3] in aspirin group was significantly lower than control group. CONCLUSIONS ：Prophylactic use of low-dose aspirin can prevent cardiovascular events in patients with chronic renal disease to certain extent. The low-dose aspirin should be used carefully to prevent cardiovascular events in chronic renal disease patients with high risk of bleeding.
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OBJECTIVE：To systematically evaluate the effectiveness of prophylactic use of antibiotics for infection after acute stroke，and to provide evidence-based reference for clinical treatment for infection after acute stroke. METHODS ：Retrieved from PubMed，Embase，Cochrane library ，CJFD，VIP，Wanfang database and trial registration platforms such as Central ，randomized controlled trials （RCTs）about the effectiveness of prophylactic use of antibiotics （trial group ）versus placebo or non-prophylactic use of antibiotics （control group ）in the prevention of infection after acute stroke were collected during the inception to Dec. 2019. After data extraction ，the quality of included literatures were evaluated with Cochrane bias risk assessment tool 5.1.0 and modified Jadad scale. Meta-analysis was carried out by using Rev Man 5.3 statistical software. GRADE system was used to analysis the result of Meta-analysis. RESULTS ：A total of 7 RCTs were included ，involving 4 310 patients. The results of Meta-analysis showed that there was no statistical significance in the mortality of patients [RR ＝1.05，95％CI（0.92，1.20），P＝0.47] or the incidence of pneumonia [RR ＝0.92，95％CI（0.77，1.11），P＝0.40] between 2 groups. The total infection rate [RR ＝0.69，95％CI（0.57， 0.85），P＝0.000 3] and the incidence of urinary tract infection [RR ＝0.38，95％CI（0.29，0.49），P＜0.000 01] in the trial group were significantly lower than control group ，and the difference was statistically significant. Result of GRADE showed the out- comes were in high-quality grade. CONCLUSIONS ：Prophylactic use of antibiotics can reduce the total infection rate and the incidence of urinary tract infection after acute stroke ，but can not significantly affect the mortality and the incidence of pneumonia.
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OBJECTIVE： To systematically evaluate effectiveness of prophylactic application of carbapenems for severe acute pancreatitis （SAP）， and to provide evidence-based reference in clinic. METHODS： Retrieved from PubMed， Embase， Medline， Cochrane Library， CNKI and VIP database，randomized controlled trials （RCTs） about effectiveness of prophylactic application of carbapenems （trial group） versus placebo or non-prophylactic use of antibiotics （control group） for SAP were included， and the retrieval time was from establishment to Dec. 2018. After extracting data from clinical studies that met the inclusion criteria， methodological quality of included studies were evaluated by using Cochrane bias risk assessment tool 5.1.0 and modified Jadad scoring scale， and Meta-analysis was performed for pancreatic infection rate， extrapancreatic infection rate， surgical intervention rate and mortality rate by using Rev Man 5.3 statistical software. RESULTS： A total of 8 RCTs were included， involving 544 patients. Meta-analysis showed that there was no statistical significance in the pancreatic infection rate [RR＝0.84， 95％CI （0.58， 1.22）， P＝0.36]， extra-pancreatic infection rate [RR＝0.76， 95％CI （0.43， 1.35）， P＝0.35] and surgical intervention rate [RR＝0.93， 95％CI （0.65， 1.32）， P＝0.68] or mortality rate [RR＝0.99， 95％CI（0.59，1.65）， P＝0.97] between 2 groups. CONCLUSIONS： The prophylactic use of carbapenems can not reduce pancreatic or extra-pancreatic infection rate， surgical intervention rate and mortality rate.
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OBJECTIVE:To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS:Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st,2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS:Among 5 288 patients underwent laparoscopy surgery,1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach,duodenum and small intestine operation was the highest(69.4%);the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%;prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone(83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium(63.9%),metronidazole(13.5%)and cefotaxime sodium(11.85). There were irrational medical orders in 151 cases(8.0%)of perioperative prophylactic use of antibiotics;among prescriptions of irrational drug use,the majority was unsuitable drug selection(50.3%),followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS:The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery,and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital,strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery,relevant rational drug use education.
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Objective To investigate the influence of zoledronic acid injection on body temperature of patients with primary osteoporosis.Methods A total of 142 patients with primary osteoporosis who received intravenous zoledronic acid treatment in Peking university people's hospital during 2013-2014 were enrolled in this study.The body temperature before and after intravenous zoledronic acid treatment were recorded and analyzed with SPSS 17.0 software.Results The patients'body temperature at different time points after intravenous zoledronic acid treatment was significantly different (P =0.000).Prophylactic use of NSAIDs could significantly reduce patients' body temperature at the second day after intravenous zoledronic acid.Conclusion NSAIDs can be given orally on the same day of intravenous injection of zoledronic acid,and continued for three days.
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OBJECTIVE:To investigate the perioperative prophylactic use of antibiotics in thoracic surgery department of 7 hos-pitals in Nantong city,and to provide reference for rational drug use in clinic. METHODS:In retrospective study,6652 dis-charged patients with thoracic surgery were selected from 7"third-level hospitals"of Nantong city during 2015-2016. The gender, age,length of stay,preoperative medication,medication timing,classification of incision,operation time,drug name,usage and dosage,route of administration,drug combination and prognosis were analyzed statistically. According to the relevant regulations of special rectification and the principle of perioperative antibiotics use,the rationality of antibiotics use was evaluated. RE-SULTS:Among 6652 patients,there were 2761 cases of typeⅠincision and 3891 cases of typeⅡincision. All of them used anti-biotics. Primary prophylactic time was 0.5-2 h before operation in 5282 cases,accounting for 79.40％;1370 cases were given medicine more than 2 h before surgery or after surgery,accounting for 20.60％. Totally 1070 cases received prophylactic medica-tion within 48 h,accounting for 16.09％;5582 cases received prophylactic medication more than 48 h,accounting for 83.91％. A total of 5702 cases were given only one antibiotic,and 950 cases received two-drug combination. A total of 6342 patients used an-tibiotics irrationally,accounting for 95.34％. Eight categories 15 kinds of antibiotics were involved. β-lactam/β-lactamase inhibi-tors,fluoroquinolones and cephalosporins were mostly used. CONCLUSIONS:After the implementation of special rectification, there are still many irrational phenomena in the prophylactic use of antibiotics in thoracic surgery department of 7 hospitals in Nan-tong city. Some indexes exceed the national standard and still need to be further managed and improved.
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OBJECTIVE:To evaluate the effects of clinical pharmacists'intervention on prophylactic use of antibiotics in re-moval of internal fixation device for fracture. METHODS:Totally 117 patients underwent removal of internal fixation device for fracture were selected from some on third grade class A hospital during Mar.-Jul. 2015 as pre-intervention group. Totally of 266 pa-tients underwent removal of internal fixation device for fracture were selected during Aug. 2015-May 2016 as post-intervention group. Clinical pharmacists performed interventions based on Rationality Evaluation Criteria for Prophylactic Use of Antibiotics in Removal of Internal Fixation Device for Fracture. The prophylactic use of antibiotics was compared between 2 groups before and af-ter intervention. RESULTS:No unreasonable single dose or additional drug during surgery was found before and after intervention. After intervention,utilization rate of antibiotics for prophylactic use,the proportion of patients receiving antibiotics without indica-tions,the proportion of medication duration more than 24 h decreased from 84.6%,71.8%,48.7% to 17.3%,9.8%,4.9%,re-spectively. Average antibiotics cost,the proportion of total drug cost in hospitalization cost,the proportion of antibiotics cost in to-tal drug cost were all decreased significantly compared to before intervention,with statistical significance(P0.05). CONCLUSIONS:Clinical pharmacists'interventions significantly reduce the utilization rate of antibiotics for pro-phylactic use in patients underwent removal of internal fixation device for fracture,improve drug use without indications and ratio-nality of prophylactic use of antibiotics. There still are problems,such as unreasonable medication timing,continuous use time of more than 24 h,etc. It is necessary to continuous follow-up intervention.
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OBJECTIVE:To investigate the use of prophylactic use of antibiotics for special diagnosis and treatment in our hos-pital,and to provide reference for rational use of antibiotics. METHODS:The patients receiving special diagnosis and treatment were collected from our hospital during Jan.-Aug. 2016. The prophylactic application of antibiotics was analyzed statistically. RE-SULTS:Among 149 included patients,there were 62 cases of prophylactic use of antibiotics with utilization rate of 41.61％. Among 62 patients receiving antibiotics,5 cases were given medicine orally and others were via injection. Nine categories 18 types of antibiotics were used,involving 69 times;cephalosporin were used in 49 times(71.01％),among which top 3 types in the list of use sequence were cefodizime,cefotetan and cefazolin;prophylactic use of antibiotics was not found in angiography(including coronary artery) and stent implantation. Utilization rate of antibiotics for other diagnosis and treatment was more than 50％. The prophylactic use of antibiotics was complex in ureteroscopy and cystoscopy,shock wave lithotripsy;the selection of drug types started from the high level. There were 59 cases of single drug(95.16％)and 3 cases of two-drug(4.84％). Total of 41 cases were given medicine 0.5-2 h before surgery or at the beginning of anaesthesia (66.13％). Medication time of 18 cases was ≤24 h (29.03％);that of 11 cases was >24-48 h(17.74％). CONCLUSIONS:The prophylactic use of antibiotics is relatively standard in angiography(including coronary artery),stent implantation and implantation of peritoneal dialysis tube in our hospital. There are some problems during special diagnosis and treatment,such as the indication of drug delivery is not strict;the selection of drug types starts from the high level;medication timing is not suitable;medication course is excessively long.
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OBJECTIVE:To provide reference for rational use of antibiotics during perioperative period of transcatheter arterial chemoembolization(TACE). METHODS:After full evaluation of 1 cases of primary liver cancerpatient’s conditions,the optimal clinical evidences were retrieved and evaluated,which were related to antibiotics regimen during perioperative period of TACE. Us-ing“hepatocellular carcinoma”“antibiotic prophylaxis”“hepatic cancer”“TACE”as subjects,the evidence were retrieved from Co-chrane Library(issue 4,2015),Medline(1980 to 2015)and CJFD(1990 to 2015)and then evaluated. RESULTS:1 meta-analy-sis or systematic review,10 RCTs and 2 practice guidelines were identified. This patient didn’t need to use antibiotics to prevent in-fection according to literature analysis. CONCLUSIONS:The rational treatment plan according to evidence-based medicine methods for patients can not only promote the rational use of antibiotics,reduce bacterial drug resistence and treatment cost,but also guide both doctors and patients to take the indeterminate risk of medicine.
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OBJECTIVE:To explore the effect of prophylactic use of vitamin B6 with chlorpheniramine on the adverse reactions in fundus fluorescein angiography (FFA). METHODS:326 patients with FFA were randomly divided into observation group and control group. Observation group was orally given Vitamin B6 tablet 10 mg 30 min before angiography+Chlorpheniramine maleate tablet 4 mg;control group was orally given Metoclopramide tablet 10 mg+Chlorpheniramine maleate tablet 4 mg. The occurrence time and incidence of adverse reactions in 2 groups were observed and correlation analysis was conducted. RESULTS:There was no significant difference in the occurrence time of adverse reactions between 2 groups(P>0.05);the incidence of adverse reactions in observation group was significantly lower than control group,the difference was statistically significant(P0.05). CONCLUSIONS:Prophylactic use of vitamin B6 with chlorphenir arnine can reduce the occurrence of adverse reactions in FFA.
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PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.
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Humans , Dexamethasone , Intraocular Pressure , Macular Edema , Optic Nerve , Retina , Retrospective StudiesABSTRACT
PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.
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Humans , Dexamethasone , Intraocular Pressure , Macular Edema , Optic Nerve , Retina , Retrospective StudiesABSTRACT
Objective To understand the prophylactic use of antimicrobial agents in the patients undergoing I incision surgery from 2011 to 2013 in a tumor hospital,to explore the the effects of intervention management measure for antibacterial agents using in the perioperative period.Methods The cases of tumor surgical patients of 2011-2013 were selected and divided into the three intervention groups and non-intervention group.The data of medication after three-stage continuous integrated intervention were collected and compared.Results The percentage of antibiotics use was much lower,from 61.73%pre-intervention to 47.03%,26.78%and 24.85%after three stage intervention. The course of preventive medication treatment was significantly decreased from 81h to 53h,33h,21h,respeetively.The reasons of their rationally utilizing antibiotics were significantly improved after intervention management.Conclusion Rational antibiotics utilization can be improved by intervention management during perioperative period of typeⅠinci-sion operations,which can achieve the goal of health department.
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Para actualizar la Guía de Buenas Prácticas Médicas sobre el uso de antimicrobianos, en el Servicio de Cirugía General del Hospital Clinicoquirúrgico Joaquín Albarrán, se analizaron, discutieron y aprobaron de forma colectiva las directrices sobre el uso de antibióticos ante cada proceso morboso, en dicho servicio. Se ofrecen recomendaciones sobre la elección de los fármacos según las disponibilidades de la institución, uso profiláctico, momento de comienzo, vía de administración y duración del tratamiento. El hecho de disminuir o evitar la infección de las heridas quirúrgicas confiere a este tipo de análisis importancia singular en la cirugía moderna, por lo que es imprescindible su actualización sistemática(AU)
To update the Good Medical Practices Guide on the use of antimicrobials in the General Surgery Service of the Joaquín Albarrán Cliical Surgical Hospital authors analyzed, discussed and approved in a collective way the guidelines in each morbid process in such service offering recommendations on the drugs choice according to the institution availabilities, the prophylactic use, onset time, administration route and treatment length. To decrease or avoid the infection in the surgical wounds give to this type of analysis a peculiar significance in the current surgery, thus, it is necessary its systemic updating(AU)
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Humans , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis/methodsABSTRACT
OBJECTIVE:To investigate the perioperative prophylactic utilization of antibiotics in cataract patients in ophthalmology department of our hospital.METHODS:100 cases of cataract surgery in 2009 were randomly collected from our hospital.Category of antibiotics,administration time point,medication time,wound healing and drug costs in hospitalization period were analyzed statistically and the rationality of above indexes was evaluated.RESULTS:100 cases all received prophylactic antimicrobials by local and systematic administration in the perioperative period(100%).Drugs for systematic administration contained Levofloxacin(n=67,67%),Cefuroxime sodium for injection(n=25,25%),Clindamycin phosphate injection(n=2,2%) and Ceftazidime for injection(n=6,6%).63 cases were only given drugs 30 min before operation(63%);12 cases were given medicine 30 min before operation and within 24 h after operation(12%);above situation accounted for 75%.25 cases were given medicine before operation and within 24 h after operation(25%),in which the average medication duration was 2.5 days and the longest was 4 days.CONCLUSION:The irrational use of drugs in our hospital manifests inappropriate selection and too long use of antibiotics after operation.The interference of perioperative prophylactic utilization of antibiotics should be reinforced and it is urgent to intensify consciousness of physicians about rational use of antibiotics in perioperative period.
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OBJECTIVE:To discuss the influence of Shanghai Guiding Principles of Clinical Use of Antibiotics Implementing Rules(Trial)(named Implementing Rules for short) on prophylactic use of drugs in patients underwent general surgery operation.METHODS:In retrospective study,inpatients of general surgery department in our hospital from Sep.2006 to Feb.2008 were divided into 3 groups(Group 1:6 months before Implementing Rules issued;Group 2:0～6 months after Implementing Rules issued;Group 3:7～12 months after Implementing Rules issued).The utilization of antibiotics was analyzed as well as its rationality.RESULTS:A total of 1 308 cases were enrolled.The utilization frequency of antibiotics was 3 463.Less than half of cases met the indication of antibiotics while the rate of drug sensitivity test was 1.2%.The treatment courses of 3 groups were(3.4?4.3) d,(3.3?2.9) d and(3.1?3.0) d.The proportions of rational drug use were 36.5%,35.1% and 40.7%.But the selection of antibiotics,drug combination and ADR report were not significantly improved.CONCLUSION:The issue of Implementing Rules has promoted the rational use of antibiotics in general surgery department.Further training and monitoring are needed.
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OBJECTIVE:To evaluate the prophylactic use of antibiotics in perioperative period in our hospital. METHODS:The prophylactic use of antibiotics in 841 patients in our hospital in the first 3 months was analyzed statistically. RESULTS:841 patients have used antibiotics,and 74.04% of those patients with typeⅠ incision operation used antibiotics for 3 to 7 days. Cephalosporins and Fluoroquinolones were predominantly used for prophylactic purpose. Irrational use of antibiotics was seen in 714 cases. CONCLUSION:The prophylactic use of antibiotics in our hospital is far from rational,thus it is necessary to put "Guideline on Clinical Use of Antimicrobials" into practice.