| AIM: To explore the application situation of antibacteraial drug in operative departments of a hospital and evaluate the rationality of medication, offering the epidemiological evidence for further standardized administration.METHODS: 900 medical records of operative departments from 2005-2007 were collected randomly. The general data and the medication of the patients were filled out in questionaires, and the rationality of the antibacterial's application was evaluated according to the regulation of "The Principle Guidelines of Antibacterial's Utilization". For the records of irrational we pointed out the reasons, including medication without indecation, selection of drug, continued exchange of drug medication frequency, medication time, medication course, big dosage and combined use... Then the collected data and the evaluate results were analyzed.RESULTS: 1. The average cost of antibacterial for each patient was 1551.3 RMB, Which accounted for 12.9% of medical expense of hospitalization or 33.6% of total expense for drug. 2 (1). Antibacterial had a 97.4% use rate among the patients of operative departments, of which preventive medication accounted for 82.8% and it was increasing (χ~2=11.25/ P<0.01) .The rates of preventive medication were respectively 78.3%, 81.5% and 88.6% from 2005 to 2007. The irrational rate of preventive medication (98.9%) was significantly higher than treatment (76.1%) (χ~2= 135.63, P<0.01) . (2) For the application of treatment, The rates of irrational were respectively 70.3%, 79.6%和81.8% from 2005 to 2007. The average rate was 76.1%. As the important indication of medication, the check rate of pathobiology test and chemosensitivity test was respectively 6.0% and 4.6%. (3) For the application of prevention, The rates of irrational were 98.7%, 98.3% and 99.6% from 2005 to 2007. The everage rate was 98.9%. The irrationality included many aspects. Some of them were not very serious, such as big dosage (4.4%) and continued exchange of drug (5.4%). Some of them were serious, such as medication frequency (48.6%), medication without indication (35.1%), selection of drug (33.6%) and combined use (19.7%). Others were very serious, such as medication time (98.9%) and course (86.9%). In the records of combined medication, irrational records accounted for 36.9%, the reason included combined using without indication (33.2%) and combined using repeatly (5.9%). Fortunately, some irrational situations have improved in 2007, such as selection of drug (χ~2=25.65. P<0.01) and combined using of drug (χ~2=87.06, P<0.01) .In combined using, the situation of using without indication(χ~2=94.57, P<0.01) and using repeatly (χ~2= 11.13, P<0.01) had improved significantly. But irrational medication of frequency (χ~2=23.38, P<0.01) was more serions in 2006. 3. In 2005 and 2006,the main kinds of drugs were compound preparations of beta-lactamase inhibitors, the third and the forth generation's cephalosporins, quinolones, clindamycin and nitiomidazoles. In 2007,the application of clindamycin decreased, but the utilization of the first and the second generation's cephalosporins increased.CONCLUSION: 1. Antibacterial had a high using rate among the patients of operative departments. 2. Preventive medication accounted for a large propotion and it was increasing. 3. The check rate of pathobiology test and chemosensitivity test was very low. 4.The irrataionality of preventive medication was more serious than treative medication. The irrationality included many aspects. Some had improved but some was more serious. 5.The phenomenon of irrational use of drugs in operative departments of our hospital is widespread and serious, and there are many problems needed to be solved urgently. |
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