Drug Utilization Research And Pharmacoeconomic Evaluation On Antibacterial Drugs In Patients With Renal Insufficiency

Part 1.Antibacterial Drugs Utilization Inpatients with Anti-infective Effect of Renal InsufficiencyBackground: In clinical manifestations,the rational application of antibacterial drugs inpatients with anti-infective effect of renal insufficiency has been a problem worthy to further study.According to the principle of use of antibacterial drugs,drug selection is carried out,but there are still many controversial problems in practice.To evaluate the use of antibiotics in patients with renal insufficiency associated with infection in there teaching hospitals in Anhui Province,and to provide reference for clinical rational drug use.Methods: Based on multicenter data collection,this study collected prescriptions for treating various infections in patients with renal dysfunction admitted to three general hospitals from January 2017 to December 2017 in Anhui Province.Review 506 cases,calculate antibiotic DDDs and drug utilization index(DUI)and B/A to evaluate the rational use of antibiotics.Results: Among the 506 collected cases,the top three antibacterial drugs used most frequently were cefotiam,moxifloxacin and cefoperazone/sulbactam.And the cephalosporins and β-lactam antibiotics have higher DDDs among these drugs.The DUI of topic ten antibacterial drugs uesd are all not less than 1.Conclusion: The selection and use of antibiotics in this special group of the three hospitals are basically reasonable,but the injections are abused.It is also necessary to pay attention to the rational application of antibacterial drugs to the elderly.Part 2.Cefotiam and Cefoperazone/sulbactam for Treatment of Respiratory System Infections in Renal Insufficiency Patients: Pharmacoeconomic EvaluationBackgroud: The rational use of medicines in patients with renal insufficiency has always been an topic clinical concerned issue.Clinically,patients with renal insufficiency combined with respiratory system infections are often controversial in antibacterial drug selection,espically the common cephalosporins.Objectives: To evaluate the outcomes and pharmacoeconomic impact of using cefotiam and cefoperazone/sulbactam to treat respiratory system infections,provide reference for clinical rational drug use.Setting: Hospital-wide patients at the First and the Second Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China(Anhui Province,China).Method: A retrospective,multi-center cohort study was conducted in three large-scale general hospitals in China.Clinical records and treatment results,in addition to cost data,were collected and analyzed.A cost minimization analysis was performed to compare the relative costs of treatment with cefotiam and cefoperazone/sulbactam.Main outcomes measure: The outcomes were clinical excellent improvement and frequency and onset days of nephrotoxicity after beginning treatment.Results: Eighty-five patients treated with cefotiam and 85 with cefoperazone/sulbactam were included.Excellent improvement was observed in 92.94% and 95.29% of patients treated with cefotiam and cefoperazone/sulbactam,respectively(P=0.746);Nephrotoxicity was observed in 5.88% and 3.53% of patients in cefotiam and cefoperazone/sulbactam groups,respectively(P=0.720);and onset time of nephrotoxicity was 9.01 ± 4.04 days for cefotiam and 14.36 ± 9.64 days for cefoperazone/sulbactam group.Cefotiam treatment had a lower cost per patient compared to the cost for cefoperazone/sulbactam treatment(USD $437.46 vs.USD $682.28,respectively).Conclusion: We found no difference between excellent improvement and nephrotoxicity between groups;however,cefoperazone/sulbactam proved to have an economic advantage from a pharmacoeconomic point of view.