Effect of comprehensive quality control intervention on the use of antibiotics and standardized medical record writing in the elderly patients with closed fracture / 中国综合临床

Objective:To explore the effect of comprehensive accusation intervention on the use of antibacterial drugs and the writing of medical records in elderly patients with closed fracture.Methods:A total of 120 elderly patients (aged ≥60 years) with fracture were enrolled from January 2017 to June 2019 in the department of orthopaedics and traumatology of the Second Hospital of Tangshan University and the Affiliated Hospital of North China University of Technology. According to random number table method, 120 patients were divided into intervention group (61 cases) and non intervention group (59 cases) by computer random number method. The patients in the intervention group received pharmaceutical care and quality control management intervention during the perioperative period; The patients in the non intervention group were routinely treated with antibiotics and wrote medical records. The use effect of antibiotics, the cost of antibiotics and the effect of standardized writing of medical documents were compared between the two groups. Independent sample t-test was used for comparison between measurement data groups with normal distribution, and χ 2 test was used for comparison between counting data groups. Results:Compared with the non-intervention group, the rate of perioperative use of antibiotics (49.2% (30/61)), the rate of drug use without indication (4.9% (3/61)), the rate of irrational drug selection (6.6% (4/61)), the rate of irrational drug use (6.6% (4/61)), and the proportion of irrational combined use of antibiotics (3.3% (2/61)) were significantly lower than that in the non-intervention group (81.4% (48/59), 16.9%(10/59), 22.0% (13/59), 20.3% (12/59), 18.6% (11/59)), the difference was statistically significant (χ 2 values were 13.65, 4.49, 5.91, 4.93 and 7.33, respectively; P values were <0.001, 0.034, 0.015, 0.026 and 0.007,respectively). The cost of antibiotics in the intervention group ((283.86±59.86) yuan) was lower than that in the non intervention group ((820.45±136.27) yuan), and the difference was statistically significant ( t=27.478, P<0.001). The eligible rate of the pre-operative informed consent document signing was 100% (61/61) in the intervention group, and the eligible rate of the operative record completion time was 100% (61/61) higher than that in the non-intervention group (84.7% (50/59), 79.7% (47/59)), the difference was statistically significant (χ 2 values were 7.98 and 13.79; P values were 0.005 and <0.001). The loss rate of preoperative alternative therapy (0) and postoperative communication (0) were significantly lower than those of non-intervention group (11.9% (7/59), 10.2% (6/59)) (χ 2 values were 5.68 and 4.56; P values were 0.017 and 0.033). Conclusion:The implementation of comprehensive quality control intervention mode reduced the application of unreasonable antibiotics and standardized the writing of inpatient medical records. It is of great significance for the rational use of antibiotics and the standardization of medical record writing in the elderly patients with closed fracture.

Analysis of the distribution and drug resistance of common bacteria in hospital infections in a Grade III class A hospital in 2015-2019 / 公共卫生与预防医学

Objective To determine the distribution of common bacteria in hospital infections and to provide a basis for the prevention and control of bacterial infection and for rational use of antibiotics in clinical departments. Methods A retrospective analysis was conducted on common bacterial strains isolated from inpatients of a Grade III class A hospital from 2015 to 2019, including sample source and drug sensitivity changes. Results A total of 4,924 strains of Escherichia coli, 2 762 strains of Klebsiella pneumoniae, 1 297 strains of Staphylococcus aureus, 967 strains of Pseudomonas aeruginosa, and 1 585 strains of Acinetobacter baumannii were detected during the past 5 years. The bacteria were detected mainly from sputum. The resistance rate of Escherichia coli to ampicillin was as high as 88%, and the resistance rate to ceftriaxone was 58.22%. The resistance rate of Klebsiella pneumoniae to ampicillin was higher than 97%. The resistance rate of Staphylococcus aureus to penicillin G reached 93%, and the resistance rates to erythromycin and clindamycin were 60% and 70%, respectively. Pseudomonas aeruginosa had a high resistance rate to ampicillin, but a low resistance rate to other types of antibiotics. Acinetobacter baumannii had a high resistance to common antibacterial drugs. Conclusion Escherichia coli and Klebsiella pneumoniae had a high incidence of nosocomial infections. Pseudomonas aeruginosa and Acinetobacter baumannii both showed serious multi-drug resistance. Clinical departments should strengthen the monitoring of drug sensitivity changes of pathogenic bacteria, and manage and use antibiotics purposefully.

Investigation of factors effecting antibiotics use of health services vocational school students

Background: The scope of this study is to evaluate information, behavior and attitude of antibiotics use of students in Golhisar Health Services Vocational School, Burdur Mehmet Akif Ersoy University.Methods: A questionnaire of 19 questions is applied to 701 students. In order to determine students’ attitude at antibiotics use; to evaluate attitude, subjective norm and intention, Likert scale consisting of multiple-choice questions were used.Results: Unattached sample test t showed that there is a significant difference in male and female students in subjective norm effecting antibiotic use and mean points of male students are higher than those of female students. It is found that antibiotic use due to attitude in 20 years and younger students than is significantly higher than 21 years old or older students. No significant difference determined among attitude, subjective norm and intention which effect use of antibiotics in terms of alcohol use, chronic disease and health insurance possession. As the programs that students are attending are evaluated, difference is observed only in attitude factor in this study. It is determined that attitude to antibiotic use of students of first and emergency aid program is lower than pharmacy services and child development programs.Conclusions: This study has shown that students are conscious about antibiotics use and their level of antibiotics use is low. Based on the results of the study, having individuals in the society educated about antibiotics use will substantially contribute to conscious use of antibiotics.

Evaluation of various antibiotics used in the treatment of cellulitis at a tertiary care hospital

Background: Cellulitis is an inflammation of the skin and subcutaneous tissues, usually resulting from microbial invasion. It may occur as a result of tissue injury. The mainstay of treatment includes antibiotic therapy based on the susceptibility and severity of infection. The aim of the study is to evaluate various antibiotics used in the treatment of cellulitis at a tertiary care hospital.Methods: Participants were patients referred by Dermatologists, General surgeons with acute and complicated cellulitis. Demographic data, Clinical and biochemical data were analyzed at admission. Then the time taken for improvement of symptoms and length of stay were analyzed.Results: A total of 58 patients were included in the study of which 38(65.5%) patients were male and 20(34.4%) patients were female. Patients having comorbid conditions were found to be having higher length of stay (mean±SD-13.7±3.6 days), severity of infection and antibiotic therapy. Patients with diabetes(mean±SD-16.8±4days) have higher length of stay and slow wound healing. Patients with left leg cellulitis 32(55%) were higher than the right leg cellulitis 17(29%). The reason behind this remains undetermined, which highlights scope for future research in this region.Conclusions: Management of patients was done with mono or dual/combination antibiotic therapy or surgical treatment was done based on clinical response. According to our study patients with co-morbidities especially Diabetes have slow prognosis of cellulitis as they required longer length of stay in a hospital and prolonged treatment. Rational clinical decision on the use of various antibiotics shall be implemented based on evidence-based methods such as iv-to-po shift, regular evaluation of clinical response and stepping down to a narrow-spectrum to reduce the length of stay which can improve the paradigm and the positive clinical response for the management of cellulitis.

Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.

Características de la prescripción de antibióticos en salas de hospitalización del Hospital de Especialidades Pediátricas Omar Torrijos Herrera, octubre a diciembre 2016

Introducción: Las infecciones asociadas a gérmenes multirresistentes son un problema de salud pública. El conocimiento de las prácticas de prescripción de antibióticos permite establecer programas de optimización de uso de antibióticos que mejoren la calidad de atención y disminuyan la tasa de infecciones asociadas a gérmenes resistentes. La neumonía, infección de vías urinarias e infección de piel y tejidos blandos son de las principales causas de ingresos a salas de hospitalización pediátricas, por lo que son patologías clave para los programas de gestión de antimicrobianos. Material y métodos:Realizamos un estudio observacional, descriptivo, transversal durante 3 meses con pacientes admitidos al Hospital de Especialidades Pediátricas con diagnósticos de neumonía, infección de vías urinarias e infecciones de piel y tejidos blandos con el objetivo de determinar las características de la prescripción de antibióticos. Resultados y conclusiones: 127 sujetos fueron elegibles. 16.5% de estos, carecían de criterios de hospitalización. La selección del antibiótico empírico fue acorde con lo recomendado por las guías en 78.7% de los pacientes. La totalidad de los sujetos recibieron antibióticos prescritos en las dosis e intervalos adecuados. 66.1% cumplían criterios para terapia secuencial, la misma fue realizada en 7.9% de los casos. Las recomendaciones de infectología fueron seguidas por el médico tratante en 68.7% de los casos. El estudio señala la importancia de establecer criterios diagnósticos y de hospitalización, así como instaurar políticas de gestión de antibióticos que incluya un plan de duración.

Introduction: Infections associated with multiresistant germs are a public health problem. Knowledge of antibiotic prescribing practices allows the establishment of antibiotic optimization programs that improve the quality of care and decrease the rate of infections associated with resistant germs. Pneumonia, urinary tract infection and skin and soft tissue infections are among the main causes of admissions to pediatric hospital wards, therefore are key pathologies for antibiotic stewardship programs. Material and methods: We conducted an observational, descriptive, cross-sectional study for 3 months, involving patients with pneumonia, urinary tract infection and skin and soft tissue infections to determine the characteristics of antibiotic prescription in the hospitalization wards of the Hospital de Especialidades Pediátricas Omar Torrijos Herrera. Results and conclusions: 127 patients were elegible. 16.5% lacked criteria for hospitalization. The empiric antibiotic matched the guidelines in 78.7% of the cases. 100% of the patients received antibiotics prescribed normed doses and intervals. 66.1% fulfilled criteria for sequential therapy, this was performed in 7.9% of the cases. Infection recommendations were followed by the treating physician in 68.7% of the cases. We address the importance of establishing diagnostic and hospitalization criteria, as well as instituting antibiotic stewardship policies that include a scheduled therapy plan and step down therapy to improve the use of antibiotics.

Prescripción de antibióticos en el cuarto de urgencia de un hospital pediátrico de tercer nivel en Panamá

Introducción: El uso inadecuado de antibióticos ha demostrado ser uno de los principales causantes de la aparición de resistencia en gérmenes adquiridos en el ámbito hospitalario y en la comunidad. Múltiples esfuerzos a nivel mundial están orientados a formular políticas y guías de uso racional de antibióticos. El objetivo de este estudio es conocer las características de la prescripción antibiótica en pacientes de edad pediátrica con infecciones comunes de la infancia manejados de forma ambulatoria. Materiales y Métodos: estudio descriptivo retrospectivo. Se evaluaron pacientes de 1 mes a 15 años de edad con los diagnósticos de gastroenteritis, rinofaringitis, otitis media aguda y faringoamigdalitis, atendidos en el cuarto de urgencia del 1 de junio al 31 de diciembre de 2015. Para una muestra de 364 sujetos por patología. Se evaluó la justificación y la calidad de la indicación de acuerdo a guías internacionales de manejo. Resultados : 1,456 pacientes fueron incluidos en el estudio. 42 % recibió al menos un antibiótico siendo innecesaria esta terapia en el 77% de los casos. En 25% de los pacientes que ameritaban tratamiento no se utilizó el antibiótico de primera línea. La amoxicilina y su combinación con ácido clavulánico fueron los antibióticos más comúnmente utilizados (84%). Se requiere implementación de medidas de mejora de la calidad que incluya educación y entrenamiento del personal médico

Introduction: Inappropriate use of antibiotics has been shown to be one of the main causes of resistance in germs acquired in the hospital setting and in the community. Multiple efforts at the global level are aimed at formulating policies and guidelines for the rational use of antibiotics. The objective of this study is to know the characteristics of antibiotic prescription in pediatric patients with common childhood infections managed on an outpatient basis. Materials and Methods: retrospective descriptive study. We evaluated patients from 1 month to 15 years of age with diagnoses of gastroenteritis, rhinopharyngitis, acute otitis media and pharyngotonsillitis, treated in the emergency room from June 1 to December 31, 2015. For a sample of 364 subjects by pathology. The justification and the quality of the indication were evaluated according to international management guidelines. Results: 1,456 patients were included in the study. 42% received at least one antibiotic being unnecessary this therapy in 77% of the cases. The first line antibiotic was not used in 25% of the patients who deserved treatment. Amoxicillin and its combination with clavulanic acid were the most commonly used antibiotics (84%). Implementation of quality improvement measures including education and training of medical personnel is required.

Disscusion on Antibiotics Program for Patient Underwent Transcatheter Arterial Chemoembolization during Perioperative Period / 中国药房

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.

Antibiotic prescription and rationalization proposals in a general intensive care unit / 中国基层医药

Objective To assess antibiotic prescription habits,cost pattern and the prospective intervention in Intensive Care Unit was analyzed.Methods Data on antibiotic utilization and antibiotics susceptibility were col-lected prospectively from individual electronic charts from July 2014 to September 2014.Results 225 of 246 patients surveyed used antimicrobial during the ICU stay,and antibacterial drug utilization rate was 91.46%.Cefperazone-sulbactam and piperacillin-tazobactam were the most prescribed medications.Total defined daily dose ( DDDs) was 1121.1 DDDs.Bacteria culture was 98 positive in 677 cases and 101 pathogenic bacteria were isolated.Conclusion Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at mini-mizing the future emergence of bacterial resistance and futile.

Antibiotic Use in 1107 Acute Suppurative Tonsillitis Cases in Pediatric Outpatient Department / 现代医院

Objective To reduce unreasonable use of antibiotics in acute suppurative tonsillitis cases. Methods Retrospective analyses of 1107 acute suppurative tonsillitis cases from the pediatric outpatient department were conducted.According to course of antibiotic treatment, these cases were divided into the group of full course of treatment and the group of insufficient course of treatment.According to the types of antibiotic, the subjects were di-vided into azithromycin group and non-azithromycin group.Three months after the onset of illness, the occurrence of complications and illness relapse between full course of treatment group and insufficient course group, azithromycin group and non-azithromycin group were analyzed.Meanwhile, the cases were divided into Chinese mainland group, Macao and Taiwan group, and foreign group according to their native places and nationalities.We compared the num-ber of cases used insufficient course in these three groups and analyzed their reasons.Results The relapse rate was significantly lower in the full course treatment group compared with insufficient course treatment group ( P<0.05 ) , and significantly higher in non-azithromycin group compared with azithromycin group ( P<0.05 ) .The occurrence rate of insufficient course treatment in the Chinese mainland group was obviously higher than the Macao group, Tai-wan group and foreign group (P<0.05).The main reasons for insufficient course of treatment were the insufficient patients′obedience and some doctors′poor understanding of the disease course.Conclusion A full course treatment with antibiotics on acute suppurative tonsillitis are strongly suggested.It may be of great significant to strengthen the awareness of reasonable use of antibiotics among the inland citizens.

Impacto farmacoeconómico de la revisión diaria de la prescripción de antibióticos controlados / Pharmacoeconomic impact of the daily supervision of controlled antibiotic prescription

OBJETIVO: valorar la eficacia de la revisión diaria de las prescripciones de antibióticos controlados (incluida su justificación de uso en el Servicio de Observación) en el aumento de la calidad asistencial y en la disminución de los costos hospitalarios. MÉTODOS: estudio prospectivo de las solicitudes de antibióticos controlados recibidas en el Departamento de Farmacia del Hospital General Docente Dr. Agostinho Neto de Guantánamo, en el periodo de mayo a noviembre de 2011. El universo de estudio estuvo conformado por los 1 295 pacientes que recibieron la terapia. RESULTADOs: predominaron las prescripciones de ceftriaxona y ciprofloxacina. Los servicios que más lo utilizaron fueron: unidades de urgencias médicas y Cirugía. El 17 por ciento de las indicaciones resultaron inadecuadas. Se suspendió el 9 por ciento de los tratamientos, el 6 por ciento fue cambiado por otro antibiótico y en el 2 por ciento se modificó la dosis. Se logró que la totalidad de los pacientes en el Servicio de Observación utilizaran este tipo de medicamento una vez demostrado su criterio de ingreso en sala. CONCLUSIONES: el método implementado contribuyó al alcance de beneficios farmacoterapéuticos para los pacientes y una disminución considerable de los costos por concepto de utilización de antibióticos controlados(AU)

OBJECTIVE: to assess the effectiveness of the daily revision of the controlled antibiotic prescriptions (included their justified use in the Observation Service) in the increase of assistance quality and in the decrease of hospital costs. METHODS: a prospective study of requests of controlled antibiotics received at the Pharmacy Department of Dr. Agostinho Neto general teaching hospital in Guantánamo province in the period of May through November 2011. The universe of study was 1 295 patients who were under treatment. RESULTS: Ceftraxione and Ciprofloxacine prescriptions were predominant. The services which used them the most were emergencies and surgery. Seventeen percent of the prescriptions were wrong. Nine percent of treatments were suspended, 6 por ciento was replaced by another antibiotic therapy and the dosage was changed in 2 por ciento of cases. It managed that all the patients in the observation service used this type of medication once the admission criteria to hospital was proven. CONCLUSIONS: the implemented method allowed reaching adequate pharmacotherapeutic benefits for the patients and considerably lowering the costs for use of controlled antibiotics(AU)

Clinical analysis of central venous catheter related infection (CRI) / 中华急诊医学杂志

Objective To investigate the characteristics of pathogens and risk factors of the catheterassociated infection (CAI) in emergency ICU (EICU) in order to design an appropriately therapeutic strategy for the future.Methods From January 2008 to December 2010,a total of 1363 patients were enrolled for this retrospective study.Blood sample taken from the vein with indwelling catheterization and the tips of catheters cut in 5 cm after withdrawn from the veins in 1363 patients were collected for bacterial culture.Results Of 1363 catheters,pathogens were found in 147 (10.79％) after venous catheterization.The daily occurrences of CAI were 3.05 ones per 1000 catheters.Of 147 cases of infection,46.94％ pathogens were gram-negative bacilli,40.14％ gram-positive cocci,and 12.92％ fungi.Unconditional Logistic regression analysis suggested that repeated catheterization,femoral vein catheterization,the application of multi-lumen catheter and long-term indwelling catheterization were the independent risk factors responsible for CAI.Conclusions The risk factors responsible for catheter related infections should be controlled to prevent the occurrence of nosocomial infection.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU / 世界急诊医学杂志（英文）

BACKGROUND:Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.METHODS:From January 2008 to December 2010, a total of 1363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1363 patients using the central venous catheter. The peak rate of CRI was 10.79％, with an incidence of 3.05 episodes per 1000 catheter days. Of the 147 patients, 46.94％ had gram-negative bacilli, 40.14％ had gram-positive cocci, and 12.92％ had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Uso racional de antibióticos para médicos de atenção primária / Rational use of antibiotics for the primary care physician

A prescrição de um antibiótico sem uma indicação precisa pode levar ao desenvolvimento de resistência, à emergência de novos patógenos e ao óbito do paciente. O uso racional de medicamentos significa que o paciente recebe fármacos apropriados para as suas necessidades clínicas, em doses que satisfaçam suas necessidades individuais, por um período de tempo adequado e ao menor custo para ele e sua comunidade. Apresenta-se uma revisão da indicação do uso de antibióticos de infecções mais freqüentes em atenção primária (AU)

The prescription of an antibiotics that does not have a precise indication can lead to the development of resistence, the emergence of new pathogens and can even lead to death. The rational use of medication means that the patient receives appropriated medicines to his or hers clinical needs, in a dose that satisfies the individual needs, for a period of time that is regarded as adequate, in the lowest cost for himself or herself and to the community. It is presented a review of the indication of antibiotics for the most frequent infections in primary health care (AU)

Take care when utilize antibiotics

Antibiotic use must carefully and must exactly consider according to indication and combined exactly method and disease. To against antibiotic resistance, urgent methods is needed such as drugs used exactly disease, sufficient dose and enough time. For physicians, should careful if prescribe antibiotic, don't use new drug if older drug still effective, review antibiotic resistance to choose exactly, preservation obey exact standards, limited using antibiotic for cattle and poultry

Evaluation of the Appropriateness of Approved Antibiotic Usage Guidlines in Korea: Comparison of Domestic Package Inserts with Physicians' Desk Reference / 감염과화학요법

BACKGROUND: The appropriate usage of antibiotics needs informations such as its effectiveness for a given infection, administration route, the amount of effective dose, and the dose intervals. In this study, in order to find any significant discrepancy regarding to the details of explanation of the necessary information for appropriate antibiotic usages, we compares informations about 51 antibiotics, one from package inserts in Korea and the other from physician's desk reference (PDR) certified by FDA in the United States of America. MATERIALS AND METHODS: Package inserts about antibiotics, only oral or parenteral agent, were perused to collect three categories of data: the recommended dosage, dose interval, and adjustment of dose to indications or the severity of infection. These data available in Korea were compared with 61 antibiotics (32 oral and 29 parenteral agents) cited in PDR. RESULTS: Package inserts for 51 antibiotics were gathered, because the remaining 10 antibiotics in PDR are not domestically commercialized. Among data on antibiotics comparable with those in PDR, 59% (30 cases:15 oral and 15 parenteral agents) suggested the dose similar to that of PDR, 37% (19 cases:8 oral and 11 parenteral agents) recommend less dose, and 4% in only 2 oral agents showed more dose. About half of the drugs recommending lower dosage were imported from Japanese pharmaceutical company, and the recommended doses of these antimicrobial agents were similar to those in Japan. About 59% (30 cases: 15 oral and 15 parenteral agents) directed dose interval or duration similar to those of PDR and 17% (9 parenteral agents) suggested less administration or longer duration. Surprisingly, in contrast to only 6% (3 cases) of PDR, 24% (12 cases:10 oral and 2 parenteral agents) recommended more administration or shorter duration. About 39% (24 cases:13 oral and 7 parenteral agents) revealed no information for dose adjustment commens to indications or the severity of infection. CONCLUSION: This study revealed that many guidelines in Korea recommend lower doses and/or unreasonable dose intervals. In future studies, improved antibiotic usage guidelines should be established based on pharmacokinetic and pharmacodynamic researches, on the aspect of optimal dosage, dose interval, and dose adjustment commensurate to the indications and the severity of the infection.

Evaluation of the Appropriateness of Approved Antibiotic Usage Guidlines in Korea: Comparison of Domestic Package Inserts with Physicians' Desk Reference / 감염과화학요법

BACKGROUND: The appropriate usage of antibiotics needs informations such as its effectiveness for a given infection, administration route, the amount of effective dose, and the dose intervals. In this study, in order to find any significant discrepancy regarding to the details of explanation of the necessary information for appropriate antibiotic usages, we compares informations about 51 antibiotics, one from package inserts in Korea and the other from physician's desk reference (PDR) certified by FDA in the United States of America. MATERIALS AND METHODS: Package inserts about antibiotics, only oral or parenteral agent, were perused to collect three categories of data: the recommended dosage, dose interval, and adjustment of dose to indications or the severity of infection. These data available in Korea were compared with 61 antibiotics (32 oral and 29 parenteral agents) cited in PDR. RESULTS: Package inserts for 51 antibiotics were gathered, because the remaining 10 antibiotics in PDR are not domestically commercialized. Among data on antibiotics comparable with those in PDR, 59% (30 cases:15 oral and 15 parenteral agents) suggested the dose similar to that of PDR, 37% (19 cases:8 oral and 11 parenteral agents) recommend less dose, and 4% in only 2 oral agents showed more dose. About half of the drugs recommending lower dosage were imported from Japanese pharmaceutical company, and the recommended doses of these antimicrobial agents were similar to those in Japan. About 59% (30 cases: 15 oral and 15 parenteral agents) directed dose interval or duration similar to those of PDR and 17% (9 parenteral agents) suggested less administration or longer duration. Surprisingly, in contrast to only 6% (3 cases) of PDR, 24% (12 cases:10 oral and 2 parenteral agents) recommended more administration or shorter duration. About 39% (24 cases:13 oral and 7 parenteral agents) revealed no information for dose adjustment commens to indications or the severity of infection. CONCLUSION: This study revealed that many guidelines in Korea recommend lower doses and/or unreasonable dose intervals. In future studies, improved antibiotic usage guidelines should be established based on pharmacokinetic and pharmacodynamic researches, on the aspect of optimal dosage, dose interval, and dose adjustment commensurate to the indications and the severity of the infection.

Analysis of Use of Antibiotics in Inpatients in a Rural Hospital / 药物流行病学杂志

In order to get information on the use of antibiotics in rural areas, 300 hospitalized patients were randomly selected from a rural hospital of Guangdong province and investigated for antibiotic use. The rate of antibiotic use in the hospitalized patients was 86.7 %; the four antibiotics at the top of the list were penicilins, cephalosporins, quinolones and macrolide. The rate of combined use of antibiotics was 68.46%. The culture of bacteria was carried out in only 4.62% of the patients and no antimicrobial susceptibility test was conducted. It is concluded that the antibiotics were not used in rational fashion in the rural hospital.