新生儿重症监护室抗生素的合理使用英文PPTRationaldruguseofantibioticsi

allocate the patients
21 to 34 ModeFraotellow[2thteo 3pavitsieitsnpt er week]
on a daily basis
>=35
High
[Everyday]
with appropriate
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-
3
Pharmaceutical care
Exit
Results …
What antibiotics were used and how were they administered – “Correct drug”
• Of the 100 patients followed, 95 patients received intravenous antibiotics, of which 91 received antibiotics included in the unit's protocol
• Medical Research Council for financial support • Department of Pharmacy for logistical support
Results
Antimicrobials included in the investigation of IV use in NICU
Amikacin Ampicillin Benzylpenicillin Cefepime Cefotaxime
Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Ciprofloxacin
Duration of antibiotic use
Methicillin-resistant Staphylococcus aureus (MRSA)
• Ten of 91 patients who were given antibiotics from the ward protocol received vancomycin. For all ten of these patients laboratory sensitivity cultures had been requested and the vancomycin was instituted following the positive sensitivity results for MRSA.
25
10
66
10
12
28
62 47
48
Amikacin Tazocin Benzylpenicillin Meropenem Ciprofloxacin Metronidazole Vancomycin Erythromycin Other
Results …
Number of antibiotics per patient
• Third line
– Meropenem 20 mg/kg/dose administered 12 hourly
• Fourth line
– Ciprofloxacin 10 – 20 mg/kg/dose administer in 2 doses 12 hourly
Methods
A total of 1041 patients
The average number of antibiotics used per patient during the study period was 3.3. Figure 2 shows the numbers of patients who received different numbers of
Background
• Following recurrent outbreaks of neonatal Candida in the NICU prompted the management of the hospital to investigate the use of antibiotics in the NICU, to eliminate the likelihood that irrational use of antibiotics might have been one of the causes.
and at the lowest cost to them and their community.” (Quick et al 1997:422)
Rational Drug use objectives
• According to Quick et al (1997:422) RDU includes the following criteria:
from a health care
professional
1
Score and allocate the patient
Re-score and re- Time dema4nd related to 2 pharmaceutical care visits
Score: 6 to 20 Low
[1 to 2 visits per week]
Data collection period: 8 months (131days)
With 882 discharges and 159 deaths
Ward occupancy rate of 107.17%
100 patient’s data were
selected as a sample.
Cloxacillin Co-trimoxazole Erythromycin Gentamicin Meropenem
Metronidazole Piperacillin/ tazobactam Tobramycin Vancomycin
Results …
Frequency of antibiotics use ..
• New pharmaceutical care forms for NICU
• Amphotericin B rational prescribing tool
Results…
Proposed process for providing pharmaceutical care:
Entry
Receive a referral letter
Figure 1 illustrates the eight antibiotics most frequently used in the 95 patients monitored in this study. Note that most patients received more than one antimicrobial.
• Four patients received alternative antimicrobial therapy (e.g. tobramycin and ceftazidime) as required by their clinical conditions and sensitivity results.
Introduction
• Rational Drug use in the NICU is defined as
“the rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time,
Conclusion …
Antibiotics were used according to the ward protocol in the majority of cases. Deviations from the protocol were due to the fact that patients’ clinical condition and sensitivity results necessitated alternative antimicrobial treatment.
antibiotics.
Number of patients
30
25
24
20
20
15 12
13 12
10wk.baidu.com
5
5
3
2
0
1
2
3
4
5
6
7
9
Number of antimicrobials received
Results …
Duration of use
Of the 91 patients who received intravenous antibiotics included on the ward protocol, 52 received at least one of their antibiotics for more than 10 days. Table 2 shows the minimum, average and maximum number of days of use of each antibiotic
• Correct drug • Appropriate indication • Appropriate dosage, administration, and duration of
treatment; • Appropriate patient • Correct dispensing - this includes correct dispensing • Patient’s adherence to treatment.
Antibiotic protocol
• First line:
– Penicillin 100 000 IU/kg/dose and – Amikacin 25 mg/kg/dose (LD) and maintenance dose
of 20 mg/kg/dose
• Second line
– Piperacillin and Tazobactam (Tazocin) 50 mg/kg/dose
Rational drug use of antibiotics in a Neonatal Intensive Care Unit
Dr N Schellack, Prof AGS Gous Department of Pharmacy
University of Limpopo (Medunsa Campus)
Acknowledgements
• Babies and their parents for participating in the study
• Doctors and nurses in the NICU for their cooperation
• Monika Zweygarth for assistance with the analysis of the data
Conclusion
As one of the doctors stated:
“All parties benefit, the patient, doctors, nurses and pharmacists from the discussion
we have during the ward rounds.”
Results …
Implementation and improvements to practice
• Pharmaceutical care risk assessment referral sheet
• Pharmaceutical care risk assessment score sheet