全国多地区儿童社区获得性肺炎住院患儿抗菌药物使用情况分析
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摘要
目的统计全国多地区儿童社区获得性肺炎(CAP)抗菌药物的使用情况,为进一步加强儿童CAP的规范治疗及抗菌药物合理使用提供参考依据。方法统计2014年4月14日至2016年1月1日全国9个城市10家三甲医院儿科住院的1 383例CAP患儿的抗菌药物使用情况,分析华北、东北、华东、华南4个区域住院患儿的抗菌药物使用情况。结果 CAP患儿抗菌药物总使用率为89.08%,其中华北88.7%,东北95.5%,华东83.3%,华南86.6%。使用种类主要为头孢类、大环内酯类、β内酰胺类抗菌药物的复方制剂、多磷类广谱抗菌药物、其他β内酰胺类抗菌药物。抗菌药物的选用基本合理,但仍存在单纯病毒感染时使用抗菌药物、单纯感染时联用抗菌药物等现象;抗菌药物的不合理应用例数共有131例,不合理使用率为10.63%。结论儿童CAP抗菌药物使用率、不合理用药率偏高,应加强对儿童CAP抗菌药物使用的规范化管理。
Objective To investigate the use of antibiotics in children with community-acquired pneumonia(CAP)in multiple regions of China,and to provide a reference for CAP standard treatment and rational antibiotic use in children.Methods The medical data of 1 383 children with CAP who were hospitalized in the department of pediatrics in 10 grade A tertiary hospitals from 9 cities between April 14,2014 and January 1,2016 were reviewed,to analyze the status of antibiotic use in hospitalized children in North China,Northeast China,East China,and South China.Results The overall rate of antibiotic use in children with CAP was 89.08%,with 88.7%in North China,95.5%in Northeast China,83.3%in East China,and 86.6%in South China.The main types of antibiotics used were cephalosporins,macrolides,compound preparations ofβ-lactam antibiotics,polyphosphoric broad-spectrum antibiotics and otherβ-lactam antibiotics.The selection of antibiotics was generally rational,but antibiotics were still used in some patients with viral infection alone or a combined use of≥2 kinds of antibiotics were noted in some patients with infection caused by one kind of pathogen.Irrational antibiotic use was observed in 131 children(10.63%).Conclusions There are high rates of antibiotic use and irrational use of antibiotics among children with CAP.Standard management of antibiotic use in children with CAP should be strengthened.
Objective To investigate the use of antibiotics in children with community-acquired pneumonia(CAP)in multiple regions of China,and to provide a reference for CAP standard treatment and rational antibiotic use in children.Methods The medical data of 1 383 children with CAP who were hospitalized in the department of pediatrics in 10 grade A tertiary hospitals from 9 cities between April 14,2014 and January 1,2016 were reviewed,to analyze the status of antibiotic use in hospitalized children in North China,Northeast China,East China,and South China.Results The overall rate of antibiotic use in children with CAP was 89.08%,with 88.7%in North China,95.5%in Northeast China,83.3%in East China,and 86.6%in South China.The main types of antibiotics used were cephalosporins,macrolides,compound preparations ofβ-lactam antibiotics,polyphosphoric broad-spectrum antibiotics and otherβ-lactam antibiotics.The selection of antibiotics was generally rational,but antibiotics were still used in some patients with viral infection alone or a combined use of≥2 kinds of antibiotics were noted in some patients with infection caused by one kind of pathogen.Irrational antibiotic use was observed in 131 children(10.63%).Conclusions There are high rates of antibiotic use and irrational use of antibiotics among children with CAP.Standard management of antibiotic use in children with CAP should be strengthened.
引文
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[10]Zar HJ,Jeena P,Argent A,et al.Diagnosis and management of community-acquired pneumonia in childhood-South African Thoracic Society Guidelines[J].S Afr Med J,2005,95(12 Pt 2):977-981,984-990.
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[13]β-内酰胺类抗生素/β-内酰胺酶抑制剂合剂临床应用专家共识编写委员会.β-内酰胺类抗生素/β-内酰胺酶抑制剂合剂临床应用专家共识[J].浙江医学,2016,38(1):1-8.
[14]邵鹏群.青霉素类药物的临床使用情况分析[J].中国现代药物应用,2014,8(10):136-137.
[15]朱庆龄,杨声坪,叶新华,等.阿奇霉素与红霉素治疗小儿支原体肺炎的系统评价[J].儿科药学杂志,2013,19(11):10-15.
[16]WHO.Antimicrobial resistance:global report on surveillance2014[DB/OL].(2014-04).https://www.who.int/drugresistance/documents/surveillancereport/en/.
[2]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[3]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):856-862.
[4]胡亚美,江载芳.诸福棠实用儿科学[M].第7版.北京:人民卫生出版社,2002:1175-1180.
[5]王雪峰,郑健.中西医结合儿科学[M].北京:中国中医药出版社,2016:69-79.
[6]陆权.儿童社区获得性肺炎抗菌药物的合理使用[J].实用医院临床杂志,2013,10(6):1-4.
[7]医政医管局.2013年全国抗菌药物临床应用专项整治活动方案[DB/OL].(2013-05-07)http://www.nhfpc.gov.cn/yzygj/s3585u/201305/823b9d131ff4416ab7b41b2c4e1f0e83.shtml.
[8]Bradley JS,Byington CL,Shah SS,et al.The Management of community-acquired pneumonia in infants and children older than 3 months of age:clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America[J].Clin Infect Dis,2011,53(7):e25-e76.
[9]Harris M,Clark J,Coote N,et al.British Thoracic Society guidelines for the management of community acquired pneumonia in children:update 2011[J].Thorax,2011,66 Suppl2:ii1-23.
[10]Zar HJ,Jeena P,Argent A,et al.Diagnosis and management of community-acquired pneumonia in childhood-South African Thoracic Society Guidelines[J].S Afr Med J,2005,95(12 Pt 2):977-981,984-990.
[11]Kabra SK,Lodha R,Pandey RM.Antibiotics for communityacquired pneumonia in children[J].Cochrane Database Syst Rev,2010,(3):CD004874.
[12]Song JH,Jung SI,Ko KS,et al.High prevalence of antimicrobial resistancec among clinical Streptococcus pneumonia isolates in asia(an ANSORP study)[J].Antimicrob Agents Chemother,2004,48(6):2101-2107.
[13]β-内酰胺类抗生素/β-内酰胺酶抑制剂合剂临床应用专家共识编写委员会.β-内酰胺类抗生素/β-内酰胺酶抑制剂合剂临床应用专家共识[J].浙江医学,2016,38(1):1-8.
[14]邵鹏群.青霉素类药物的临床使用情况分析[J].中国现代药物应用,2014,8(10):136-137.
[15]朱庆龄,杨声坪,叶新华,等.阿奇霉素与红霉素治疗小儿支原体肺炎的系统评价[J].儿科药学杂志,2013,19(11):10-15.
[16]WHO.Antimicrobial resistance:global report on surveillance2014[DB/OL].(2014-04).https://www.who.int/drugresistance/documents/surveillancereport/en/.