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·药师与药学服务·

        北京市基层医疗机构儿童抗菌药物使用及合理性分析                                                            Δ


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        玉米提·塔西甫拉提 ,杨瑶瑶 ,陈世才 ,杜可欣 ,周 越 ,胡 琳 ,郑 波 ,管晓东 ,海沙尔江·吾守尔 ,
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        史录文 (1.北京大学药学院药事管理与临床药学系,北京 100191;2.首都医科大学附属北京潞河医院药剂
        科,北京 101100;3.北京大学第一医院临床药理研究所,北京 100191;4.北京大学医药管理国际研究中心,北
        京 100191)
        中图分类号 R969.3          文献标志码 A          文章编号 1001-0408(2022)02-0236-05
        DOI   10.6039/j.issn.1001-0408.2022.02.18
        摘   要   目的 了解北京市社区卫生服务机构处方点评机制下基层医疗机构儿童抗菌药物使用情况及合理性,为促进基层医疗机
        构合理使用抗菌药物提供参考。方法 提取北京市社区卫生服务机构处方点评系统中基层医疗机构2019年的全部儿童处方数据,
        根据世界卫生组织与国际合理用药网络(WHO/INRUD)的相关指标描述抗菌药物使用情况,根据药品的解剖学、治疗学及化学
        (ATC)分类法,WHO AWaRe分级目录和诊断情况分析抗菌药物的使用结构。结果 共纳入288家基层医疗机构,共涉及10 422张
        儿童处方;在高收入区、中等收入区、低收入区的机构数量分别为119、80、89家,涉及处方数量分别为2 430、2 163、5 829张;其中
        抗菌药物处方有 1 447 张(占 13.9%)。在 1 447 张处方中,抗菌药物联用处方率为 1.4%(20 张),抗菌药物注射剂处方率为 9.7%
        (141张),处方点评结果为不合理的抗菌药物处方率为4.8%(69张);最常使用的3类抗菌药物分别为大环内酯类(40.2%)、第二
        代头孢菌素类(26.5%)和第三代头孢菌素类(23.4%);可用级、慎用级、备用级和不推荐使用级抗菌药物处方占比分别为9.1%、
        92.1%、0.3%和0;诊断中,扁桃体炎的抗菌药物处方率最高(31.9%)。在69张不合理的抗菌药物处方中,用药不适宜处方最多(56张,
        占81.2%)。结论 北京市基层医疗机构儿童抗菌药物处方率低于WHO抗菌药物处方率标准(20.0%~26.8%),但慎用级抗菌药物使
        用率太高。
        关键词 基层医疗机构;儿童;抗菌药物;处方;合理用药;北京

        Analysis of antibiotic use and rationality for children in primary healthcare institutions from Beijing
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        Yumiti·Taxifulati ,YANG Yaoyao ,CHEN Shicai ,DU Kexin ,ZHOU Yue ,HU Lin ,ZHENG Bo ,GUAN Xiaodong ,
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        Haishaerjiang·Wushouer ,SHI Luwen (1. Dept. of Pharmacy Administration and Clinical Pharmacy,School of
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        Pharmaceutical Sciences,Peking University,Beijing 100191,China;2. Dept. of Pharmacy,Beijing Luhe
        Hospital Affiliated to Capital Medical University,Beijing 101100,China;3. Institute of Clinical Pharmacology,
        Peking University First Hospital,Beijing 100191,China;4. International Research Center for Medicinal
        Administration,Peking University,Beijing 100191,China)
        ABSTRACT    OBJECTIVE To investigate the antibiotic use and rationality for children in community health service institutions
        from Beijing,and to provide reference for promoting rational use of antibiotics in primary healthcare institutions. METHODS All
        the prescriptions for children from primary healthcare institutions in 2019 were extracted from prescription review system of
        community health service institutions in Beijing. The use of antibiotics was described according to the related indicators of the
        World Health Organization/International Network for Rational Use of Drug(WHO/INRUD). The structure of antibiotics use was
        analyzed according to the anatomical therapeutic chemical (ATC) classification as well as the WHO AWaRe classification and
        diagnosis. RESULTS A total of 288 primary healthcare institutions and 10 422 prescriptions for children were included. The number
        of institutions in high-income areas,middle-income areas and low-income areas were 119,80 and 89 respectively,and the number
        of prescriptions involved were 2 430,2 163 and 5 829 respectively,including 1 447 prescriptions involving antibiotics(13.9%).
        Among 1 447 prescriptions,the rate of prescriptions involving combined use of antibiotics was 1.4%(20 pieces);the rate of
        prescriptions involving antibiotics injection was 9.7%(141 pieces);4.8% antibiotics prescriptions were rated as unreasonable(69
        pieces). The three most commonly used antibiotics were the macrolides(40.2%),the second-generation cephalosporins(26.5%)
        and the third-generation cephalosporins (23.4%). The proportion of antibiotics prescriptions from groups of access,caution,
                                                            reserve and not recommended were 9.1%,92.1%,0.3%,and
            Δ 基金项目:国家自然科学基金国际(地区)合作与交流项目
                                                            0, respectively. The rate of antibiotics prescriptions for
        (No.81861138048);国家自然科学基金面上项目(No.81973294)
                                                            tonsillitis was the highest (31.9% ). Among 69 irrational
            *博士研究生。研究方向:基层医疗机构合理用药。电话:
        010-82805019。E-mail:umut1109@163.com                antibiotics prescriptions,main of them were irrational drug use
            # 通信作者:助理研究员,博士。研究方向:合理用药与药物经济                 (56 pieces,81.2%). CONCLUSIONS The rate of antibiotics
        学。电话:010-82805019。E-mail:kaiser@pku.edu.cn          prescriptions for children in primary healthcare institutions


        ·236 ·  China Pharmacy 2022 Vol. 33 No. 2                                    中国药房    2022年第33卷第2期
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