| Objective: Cases in the Department of Respiration in a tertiary hospital as the subjects,this study analyzed every discharged records from the Department of Respiration in 2015 based on the pre-set clinical specification.The control index of the usage ratio and intensity of the antibiotics was set,the irrational use of antibiotics in the Department of Respiration was found by case analysis,and the managing criteria of antibiotics use was set to provide references for the rational use and the scientific management of antibiotics use in the Department of Respiration.Methods:1.Foreign and domestic treatment guidelines,guiding principle,expert consensus,randomized controlled trial,Meta analysis,rules of management of antibiotics were searched through Medline,Embase,Pub Med,The Cochrane Library,CNKI,Wan Fang Data,etc.Together with the specific condition of bacteria-resistance in the Department of Respiration,we set the clinical specification of antibiotics use for common diseases in the Department of Respiration.2.All hospitalized records in the Department of Respiration from January 2015 to December 2015 were obtained via hospital electronic medical record system to calculate the actual value of the antibiotics usage ratio and usage intensity.According to the clinical specification of antibiotics use for common diseases in the Department of Respiration,the theory value of the antibiotics usage ratio and usage intensity was calculated.Inappropriate usage including doses and duration of antibiotics was analyzed to adjust the theory value,based on the pathology and physiology characteristics,the severity of diseases,co-morbidity,results of laboratory tests,concentration of antibiotics distributed in the lung and disease recovery.The control indexes for the antibiotics usage ratio and usage intensity in the Department of Respiration were set after considering all the other factors of antibiotics usage.3.According to the clinical specification of antibiotics use for common diseases in the Department of Respiration,the antibiotics application of the Department of Respiration in 2015 was evaluated.Results:1.22 articles were found and the clinical specification was formulated,which included the treatment of common pathogens in the respiratory tract and the treatment of patients with liver or kidney dysfunction and other special antibiotics application specifications.2.Extracting the discharged patients cases of respiratory medicine from January 2015 to December 2015,a total of 1376 cases were collected,and average hospitalization days of 9.6 d.13 kinds of diseases were got,which related to acute upper respiratory tract infection,acute bronchial-bronchitis,pneumonia,chronic obstructive pulmonary disease,bronchiectasis,bronchial asthma,lung cancer,etc.1121 cases used antibiotics,1044 cases were rational while 77 cases were irrational.The actual value,the theoretical value and the corrected value of antibiotics usage ratio was respectively 81.47 %,75.87 % and 79.14 %.And the true value,theory value and the correction value of the antibiotics usage intensity was respectively161.60 DDDs,83.91~146.23 DDDs and 120.60 DDDs 100 person day.Considering the factors including antituberculosis therapy,minors,inappropriate assessment system of rational drug use,the usage ratio of antibiotics use in the Department of Respiration was 75.18 % ~ 83.10 %,and the antibiotics usage intensity was 114.57~126.63 DDDs.3.The antibiotics of the Department of Respiration involved 10 categories and 37 species,most of them were quinolones and ?-lactams.The special-level antibiotics involved 5 categories and 16 species,mainly embodied in third generation cephalosporins and compound preparations,carbapenems,glycopeptides and tetracycline.The unreasonable elements of antibiotics utilization in the the Department of Respiration were mainly manifested in ten aspects,inculding unreasonable frequency(18.93 %),doses(15.09 %),treatment course(13.31 %)and so on.So we make suggestions to strengthen the supervision of antibiotics including hospital management,clinical department use and pharmacy sector.Conclusions: The antibiotic clinical specification of the Department of Respiration would provide sufficient evidence for the formulation of antibiotics control index,which was based on the above specification,the distributed disease features of the Department of Respiration,and the analysis of 1376 cases,so it has reference value to us.There are many unreasonable elements of antibiotics utilization in the Department of Respiration,and the rational antibiotic management strategy is must made from three levels(hospital,clinical department and pharmacy department),which would help to raise the level of clinical rationality application of antibiotics. |
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