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汕头大学精神卫生中心2002～2005年抗精神病药物应用特点

中国组织工程研究与临床康复 2007年第17期11卷 3434-3435页

作者：林凌云袁粤赵丹青陈丽钰汕头大学精神卫生中心广东省汕头市515063

为了解汕头大学精神卫生中心2002/2005抗精神病药的用药情况,分析其用药物点及发展趋势。以限定日剂量以指标,对汕头大学精神卫生中心2002/2005抗精神病药的品种、用量、金额及用药频度、年平均增长率等情况进行统计分析。结果,抗精神... 详细信息

为了解汕头大学精神卫生中心2002/2005抗精神病药的用药情况,分析其用药物点及发展趋势。以限定日剂量以指标,对汕头大学精神卫生中心2002/2005抗精神病药的品种、用量、金额及用药频度、年平均增长率等情况进行统计分析。结果,抗精神病药的销售金额平均增长率为38.48%,而用药频率平均增长率为15.77%。抗精神病药医保甲类品种尽管金额份额为9.41%,但临床使用率为76.29%。2002/2005单品种金额前5名主要是非典型抗精神病药,利培酮连续4年稳居第1位。2002/2005用药频度前5名主要是廉价抗精神病药,舒必利、氯氮平和氯丙嗪连续4年位列前3名。近年来高价位非典型抗精神病药的临床使用率在逐渐上升,占据费用主要份额,但典型抗精神病药仍为临床一线药物。结果说明低价位的经典抗精神病药临床使用广泛,而高价位的非典型抗精神病药则占据了绝大多数的金额份额。非典型抗精神病药使用的比例在逐年增长。

关键词：抗精神病药治疗应用药物利用/统计学和数值数据广东

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Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: A national study of hospital-based emergency departments

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ANNALS OF EMERGENCY MEDICINE 2000年第4期36卷 320-327页

作者： Stone, S Gonzales, R Maselli, J Lowenstein, SR Univ Colorado Hlth Sci Ctr Dept Surg Div Emergency Med Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Div Internal Med Dept Med Denver CO 80262 USA

Study objective: Antibiotics are often used to treat viral upper respiratory tract infections, even though they are usually ineffective. However, frequent inappropriate antibiotic use contributes to the emergence of drug-resistant bacterial pathogens. This study used a national database to evaluate antibiotic use in treating upper respiratory tract infections in emergency departments. Methods: Data were obtained from the 1996 National Hospital Ambulatory Medical Care Survey. Antibiotic prescribing rates were examined for colds, upper respiratory tract infections, and acute bronchitis. Patients with comorbid conditions or secondary diagnoses, such as chronic obstructive pulmonary disease, pneumonia, sinusitis, and HIV, were excluded. Bivariate and multivariate analyses were used to assess predictors of antibiotic use. Results: Overall, there were an estimated 2.7 million ED visits for colds, upper respiratory tract infections, and bronchitis by children and adults in 1996. Antibiotics were prescribed for 24.2% (95% CI 18.9, 29.5) of patients with common colds and upper respiratory tract infections and for 42.2% (95% CI 35.2, 49.2) of patients with bronchitis. There were no significant associations between antibiotic use and patient race, sex, Hispanic ethnicity, geographic location, or source of payment. Antibiotics were prescribed less often by interns or residents than by staff or other physicians (odds ratio 0.43;95% CI 0.19, 0.98), and patients younger than 18 years were less likely to receive antibiotics than adults (odds ratio 0.32;95% CI 0.20, 0.52). Smokers were 4.3 (95% CI 2.2, 8.3) times more likely to receive antibiotics than nonsmokers. Conclusion: Antibiotics are commonly prescribed for ED patients with upper respiratory tract infections even though they are usually ineffective in otherwise healthy adults. Efforts should be made to reduce inappropriate antibiotic use for the sake of containing costs, preventing side effects, and limiting the spread of an

关键词：抗菌药/治疗应用支气管炎/药物疗法感冒/药物疗法药物利用/统计学和数值数据急诊室医院/统计学和数值数据国家卫生统计中心(美国) 中耳炎/药物疗法美国青少年成年人儿童女(雌)性人类男(雄)性

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Analysis of antimicrobial resistance among gram-negative bacilli and antimicrobial use in intensive care unit patients for 5 years in a Veterans Affairs medical center

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第7期30卷 411-416页

作者： Gentry, C Flournoy, DJ Reinert, R Oklahoma City VA Med Ctr Pharm Serv 119 Oklahoma City OK 73104 USA Oklahoma City VA Med Ctr Pathol & Lab Med Serv Oklahoma City OK 73104 USA Merck & Co Inc Human Hlth Div W Point PA USA

Background: Gram-negative bacilli antimicrobial resistance remains a significant problem for patients in the intensive care unit (ICU). Patterns of antimicrobial use may be a contributing factor. Methods: Gram-negative bacilli from ICU patients of a Veterans Affairs (VA) medical center were tested to determine in vitro antimicrobial susceptibility (205 isolates in 1995 and 209 in 1999). Antimicrobial use was calculated from 1995 through 1999. Results: For Pseudomonas aeruginosa, significant declines in susceptibility to ciprofloxacin (medical ICU [MICU] individually and all units) and aztreonam (all units) were noted. For gram-negative bacilli that was non-P aeruginosa, significant increases in susceptibility to ceftazidime (MICU, surgical ICU, and all units), gentamicin (all units), and ticarcillin/clavulanate (MICU) were noted. The most notable trends in antimicrobial usage were sharp increases in fluoroquinolone use in the MICU and surgical ICU and substantial decreases in the use of third-generation cephalosporins, monobactams, and aminoglycosides. In each instance of significant change in the susceptibility of a group of organisms to an antibiotic, there was a corresponding inverse change in the use of the antibiotic and/or its antimicrobial category (except for aztreonam). Conclusions: significant changes in antimicrobial use may affect certain gram-negative bacilli antimicrobial susceptibilities in ICUs.

关键词：抗菌药/投药和剂量抗菌药/药理学抗菌药/治疗应用抗药性细菌药物利用/统计学和数值数据革兰氏阴性菌/药物作用革兰氏阴性菌感染/药物疗法革兰氏阴性菌感染/微生物学医院退伍军人微生物敏感性试验危险因素时间因素美国美国退伍军人事务部女(雌)性人类男(雄)性

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Vancomycin use in pediatric neurosurgery patients

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第6期27卷 482-487页

作者： Shah, SS Sinkowitz-Cochran, RL Keyserling, HL Jarvis, WR Ctr Dis Control & Prevent Hosp Infect Program Natl Ctr Infect Dis Atlanta GA 30333 USA

Objective: The objective of this article is to describe a pediatric neurosurgery patient population receiving vancomycin and examine the indications for and appropriateness of vancomycin use. Methods: A cross-sectional study was performed on the pediatric neurosurgery patients at Egleston Children's Hospital who received vancomycin from January 1 through December 31, 1996. Vancomycin use was compared with the Centers for Disease Control and Prevention Hospital Infection Control Practices Advisory Committee recommendations for vancomycin use. Results: Thirty patients received 115 doses of vancomycin. The median patient age was 8.0 years, and 17 (56.7%) were male. Vancomycin was used for prophylaxis in 28 (93.3%) patients and empiric therapy in 3 (10.0%) patients;one patient received vancomycin for surgical prophylaxis followed by empiric therapy for suspected meningitis. Vancomycin prophylaxis was initiated after the incision in 6 (21.4%) patients and was continued as prophylaxis for more than one dose in 26 (92.9%) patients. Conclusions: Vancomycin was used primarily as surgical prophylaxis in pediatric neurosurgery patients, and use was not consistent with the Hospital Infection Control Practices Advisory Committee recommendations. These data suggest that for certain subpopulations, such as pediatric neurosurgery patients, there is a need for more specialized recommendations. Furthermore, prudent vancomycin use is warranted to successfully decrease the risk of further emergence of vancomycin resistance. Because vancomycin use may be prevalent in this population, assessment of vancomycin use in pediatric neurosurgery patients followed by establishment of vancomycin clinical guidelines may help improve the appropriateness of vancomycin use in this population.

关键词：抗菌药/治疗应用抗生素预防横断面研究药物利用/统计学和数值数据医院科室/统计学和数值数据神经外科手术/方法手术后并发症/药物疗法登记可重复性结果抽样研究美国万古霉素/治疗应用万古霉素抗药性青少年儿童儿童学龄前女(雌)性人类男(雄)性

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Changes over time in the use of aspirin in patients hospitalized with acute myocardial infarction (1975 to 1997): A population-based perspective

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AMERICAN HEART JOURNAL 2002年第2期144卷 259-268页

作者： Jackson, EA Sivasubramian, R Spencer, FA Yarzebski, J Lessard, D Gore, JM Goldberg, RJ Univ Massachusetts Sch Med Dept Med Div Cardiovasc Med Worcester MA 01655 USA

Objective The purpose of this study was to examine 2 decade-long trends in the use of aspirin and associated outcomes in patients hospitalized with acute myocardial infarction. Background Aspirin has been shown to be beneficial in the seconclary prevention of AML However, little is known about changes over time in the use of aspirin in patients hospitalized with AMI and associated outcomes, particularly from a more generalizable population-based perspective. Methods We examined trends in aspirin use and hospital and long-term outcomes in 9336 metropolitan Worcester, Mass, residents hospitalized with validated AMI in all area hospitals between 1975 and 1997. Results Between 1975 and 1986, the hospital use of aspirin remained stable at approximately 20%. Use of aspirin increased markedly after this time from 49% in 1988 to 91% in 1997. Younger age, male sex, and a history of hypertension or stroke were associated with an increased likelihood of receiving aspirin. Patients with diabetes were less likely to receive aspirin than were patients without diabetes. Patients who received aspirin during hospitalization were more likely to receive beta-blockers and coronary interventions. Patients treated with aspirin were significantly less likely to have heart failure or cardiogenic shock develop or to die during hospitalization as compared with patients not treated with aspirin. Patients treated with aspirin had significantly higher survival rates over a 10-year follow-up period. Conclusion The results of this community-wide study show that aspirin use in patients hospitalized with AMI has dramatically increased over time. Despite the beneficial effects associated with the use of aspirin, this therapy remains under-used in several high-risk groups.

关键词：年龄分布阿司匹林/投药和剂量药物利用/统计学和数值数据住院/统计学和数值数据纵向研究马萨诸塞/流行病学多元分析心肌梗死/药物疗法心肌梗死/流行病学人群监测前瞻性研究性别分布存活率老年人女(雌)性人类男(雄)性中年人

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Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction:: The EPICAL study

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AMERICAN HEART JOURNAL 2000年第4期139卷 624-631页

作者： Echemann, M Zannad, F Briançon, S Juillière, Y Mertès, PM Virion, JM Villemot, JP CHU CIC INSERM F-54035 Nancy France Hop Marin Serv Epidemiol & Evaluat Clin Nancy France Univ Henri Poincare Fac Med Pharmacol Clin Lorraine France

Background Angiotensin-converting enzyme (ACE) inhibitors have been demonstrated to reduce morbidity and mortality rates in patients with heart failure with left ventricular systolic dysfunction. Nevertheless, these drugs are underutilized in current practice and prescribed at doses below those usually recommended. The aim of this work was to identify the social, demographic, laboratory, clinical, and therapeutic factors associated with nonprescription of ACE inhibitors and/or their prescription at doses below those recommended in the treatment of severe long-term congestive heart failure (CHF). Methods and Results An epidemiologic observational study, EPICAL (EPidemiologie de l'Insuffisance Cardiaque Avancee en Lorraine), studied 417 patients with severe CHF surviving after the index hospitalization. Multivariate logistic regression determined the factors associated with ACE inhibitor nonprescription and with their prescription at lower-than-recommended doses. ACE inhibitors were taken by 75% of the patients but 38% took lower-than-recommended doses. Factors shown to be associated with nonprescription included patients >65 years of age with renal impairment (odds ratio 19.5, confidence interval [CI] 7.9-48.0), nonsinus cardiac rhythm (odds ratio 2.0, CI 1.2-3.2), and prescription of potassium-sparing diuretics (odds ratio 2.4, CI 1.2-4.7). Renal impairment was the single most important factor associated with prescription of lower-than-recommended doses, particularly in elderly patients. Conclusions Our results underline the need for optimal and better use of ACE inhibitor therapy. CHF treatment guidelines must be more uniformly applied by all physicians caring for patients with heart failure.

关键词：慢性病剂量效应关系药物用药计划表药物利用/统计学和数值数据法国肾功能试验处方药物/统计学和数值数据前瞻性研究心缩期/药物作用心室功能障碍左/诊断心室功能障碍左/药物疗法女(雌)性人类男(雄)性中年人

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Is there an association between lipid-lowering drugs and cholecystectomy?

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AMERICAN JOURNAL OF MEDICINE 2000年第5期108卷 418-421页

作者： Mamdani, MM van Walraven, C Bica, A Williams, JI Naylor, CD Inst Clin Evaluat Sci Toronto ON Canada Univ Ottawa Dept Med Ottawa ON Canada Ottawa Hosp Loeb Hlth Res Inst Clin Epidemiol Unit Ottawa ON Canada Univ Toronto Toronto ON Canada Sunnybrook & Womens Coll Hlth Sci Ctr Toronto ON Canada

Several studies have shown that fibrates can raise the biliary cholesterol saturation index (1–3), which is critical for gallstone formation (4). The Coronary Drug Project, which studied men with prior myocardial infarction, found that treatment with clofibrate increased the risk of cholecystectomy and gastrointestinal complications (5). A cross-sectional survey of the prevalence of gallstone disease in Spain found that fibrate use was the strongest independent risk factor for gallstones, albeit without delineating the effect of specific fibrate drugs (6). Other studies have implied that newer fibrate drugs, such as bezafibrate, fenofibrate, and gemfibrozil, may be less lithogenic than clofibrate (7–10). The Helsinki Heart Study did not find a statistically significant association between gemfibrozil use and cholecystectomy among dyslipidemic, middle-aged men, although the incidence was higher in the gemfibrozil group compared with the placebo group (11,12). Conversely, some (13,14), but not all (15), studies have suggested that statins reduce biliary cholesterol saturation and could protect against gallstones.

关键词：降血脂药/治疗应用胆囊切除术/统计学和数值数据药物利用/统计学和数值数据发病率比值比回顾性研究危险老年人女(雌)性人类男(雄)性

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Risk of resistance related to antibiotic use before admission in patients with community-acquired bacteraemia

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1999年第1期43卷 119-126页

作者： Pedersen, G Schonheyder, HC Steffensen, FH Sorensen, HT Aalborg Hosp Dept Med M Aalborg Denmark Aalborg Hosp Dept Clin Microbiol Aalborg Denmark Univ Aarhus Danish Epidemiol Sci Ctr Dept Epidemiol & Social Med Aarhus Denmark Aarhus Univ Hosp Dept Med 5 Aarhus Denmark

We analysed the association of antibiotic therapy before admission and antibiotic resistance of blood isolates in a total of 1717 community-acquired bacteraemias in the County of Northern Jutland during 1992-96. Antibiotics had been prescribed to 14% of the patients during the 30 days before admission and to 37% during the 6 months. The most frequently prescribed antibiotics within 30 days were ampicillin (28%), penicillin G (27%), sulphonamides and/or trimethoprim (16%) and macrolides (14%). The most frequent blood isolates were Escherichia coli (33%), other Enterobacteriaceae (8%), Streptococcus pneumoniae (23%) and Staphylococcus aureus (10%). Of the 575 isolates of E. coli, 425 (74%), 432 (75%) and 518 (90%) were susceptible to ampicillin, sulphonamides and trimethoprim, respectively. Previous antibiotic prescriptions were strongly associated with resistance to ampicillin, sulphonamides and trimethoprim in E. coli. The association was less pronounced for S. aureus and enteric rods other than E. coli. Antibiotic prescriptions within the last 3 months predicted antibiotic resistance, and this should be taken into account when selecting empirical antibiotic therapy of severe community-acquired infections.

关键词：氨苄西林/药理学氨苄西林/治疗应用抗菌药/药理学抗菌药/治疗应用菌血症/药物疗法菌血症/流行病学菌血症/微生物学社区获得性感染/药物疗法社区获得性感染/流行病学社区获得性感染/微生物学丹麦抗药性微生物药物利用/统计学和数值数据肠杆菌科/药物作用大肠杆菌/药物作用试验预期值处方药物/统计学和数值数据葡萄球菌金黄色/药物作用甲氧苄啶/药理学甲氧苄啶/治疗应用老年人女(雌)性人类男(雄)性中年人

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Underutilization and clinical benefits of angiotensin-converting enzyme inhibitors in patients with asymptomatic left ventricular dysfunction

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第6期86卷 644-648页

作者： Kermani, M Dua, A Gradman, AH Western Penn Hosp Dept Med Pittsburgh PA 15224 USA

Despite evidence of therapeutic benefit of angiotensin-converting enzyme (ACE) inhibitors for congestive heart failure and asymptomatic left ventricular (LV) dysfunction, recent studies suggest that in heart failure patients, rates of ACE inhibitor usage in clinical practice remain low. In this study, the medical records of 107 patients with documented LV dysfunction were investigated for patterns of ACE inhibitor usage;6-month and 1-year outcomes and event rates were evaluated. At index admission, 48% patients did not receive ACE inhibitor treatment, 32% were initiated on treatment, 19% continued on a prior regimen, and 1% were discontinued, Patients seen by a cardiologist were more likely to receive ACE inhibitor treatment (53% vs 35%, p = 0.172), as were patients with histories of hypertension (60% vs 40%, p = 0.044) or myocardial infarction (56% vs 44%, p = 0.221). Significantly shorter hospitalizations (5.9 vs 9.5 days, p = 0.001) were noted for patients with on-going ACE inhibitor treatment compared with those receiving newly initiated treatment or no treatment. At time of hospital discharge, 102 patients were alive. Of 54 patients who received ACE inhibitors, 67% received an insufficient dose. At a 6-month follow-up, of 51 patients on ACE inhibitors, 23% died or were readmitted to hospital compared with 55% of nonusers (p = 0.001). At 1 year, this event rate was 31% amang ACE inhibitor users versus 71% among nonusers (p <0.0001). Bivariate and multivariate analysis revealed absence of ACE inhibitor use as the only significant variable associated with the event rate (p <0.0011). Thus, about half of patients with asymptomatic LV dysfunction received ACE inhibitors;2/3 of these did not receive a sufficient dose. ACE inhibitor usage increased with involvement of a cardiologist, presence of coexistent hypertension, or prior myocardial infarction. Ongoing ACE inhibitor therapy was associated with shorter hospitalizations and fewer hospital readmissions or deaths. (

关键词：血管紧张素转换酶抑制药/治疗应用无病生存药物利用/统计学和数值数据住院时间宾夕法尼亚医师的作用回顾性研究心室功能障碍左/药物疗法成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Use and abuse of antibiotics: experience at a university teaching hospital in Nnewi, Nigeria

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TROPICAL DOCTOR 2000年第3期30卷 161-162页

作者： Ofiaeli, RO Osuigwe, A Nnamdi Azikiwe Univ Teaching Hosp Dept Surg Nnewi Nigeria

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