- 學位論文
南部某區域教學醫院使用augmentin、tazocin、zinacef 治療未明示病原菌肺炎之研究
The Study of Treatment for Unspecified Organism Pneumonia With Augmentin, Tazocin and Zinacef in a District Teaching Hospital in Southern Taiwan
摘要
研究背景: 未明示病原菌性肺炎(unspecified organism pneumonia) 是肺炎疾病中一種常見的疾病，其治療常用的抗生素有augmentin、tazocin或zinacef ，且耗用醫療保健花費非常高。 研究目的: 現今醫療支出快速成長，選取適當藥品治療可達成經濟的成效，因此探討使用augmentin、tazocin或zinacef對未明示病原菌性肺炎的治療成效，及評估其住院治療費用，可供爾後選用augmentin、tazocin或zinacef治療未明示病原菌性肺炎的參考。 研究方法: 本研究是以回溯性之方式，自2002年1月至2006年12月因未明示病原菌性肺炎住院的病歷中篩選出使用治療用藥品為augmentin、zinacef或tazocin的病歷共624份，並依病患住院當時情形以Fine發表之 Pneumonia Severity Index (PSI)積分法修飾肺炎嚴重程度分成為輕、中、重三級。治療成效以病歷上抗生素的選用情形及醫療指標[體溫(temperature)、液白血球計數(white cell counts)、C－反應性蛋白(C-protein reaction)、X光照射結果]評估，並分組統計分析augmentin、zinacef或tazocin對未明示病原菌性肺炎治療的有效率與治療費用。 研究結果: (1)augmentin和zinacef在輕、中、重(1、2、3)級三個疾病分級中，其 治療有效率在第1、2、3級p值分別為0.449、0.759、0.271，顯示augmentin、 zinacef這兩種抗生素對於未明示病原菌性肺炎的治療在各不同嚴重程度， 其治療有效率統計上並無明顯的差異。 (2)augmentin與tazocin這組顯示，在第1、2、3級治療有效率的p值分別為 0.047、0.001、0.003，是有統計上顯著之差異;選用augmentin在治療未明 示病原菌性肺炎時，在每一個分級的治療結果皆是優於選用tazocin。 (3)tazocin與zinacef這組比較，治療有效率僅在第2級的p值是0.03 統計上有顯著之差異，也就是說在2級情形選用zinacef來治療未明示病原 菌性肺炎是優於選用tazocin。 (4)augmentin被使用於治療各個分級情況是最經濟的，因為使用augmentin有 效治療一人之可能住院治療費用依1、2、3分級分別為73,015元、108,428 元、141,165元。使用zinacef者分別是78,572元、109,269元、153,993 元。使用tazocin者分別為295,896元、335,329元、451,517元，我們發 現各分級中皆以使用augmentin的有效治療一人之可能住院治療費用。 結論: 我們建議在未明示病原菌性肺炎的疾病可依PSI積分來分級並選用治療有效率較好的抗生素來治療。本研究發現在探討的三種抗生素中以augmentin來治療未明示病原菌性肺炎時，其治療有效率最高，1~3級合併考慮下其有效治療一人之可 能住院治療費用也最少。
並列摘要
Background: Unspecified organism pneumonia (UOP) is the important parts of pneumonic disease. augmentin, tazocin, or zinacef are recommended as the pharmacological therapy of UOP which medical spending is very high. Objective: Health-care costs are rising today. How to choose appropriate drugs which are cost-effetive is the major issue. The objective of this study is to assess the efficacy and cost of antibiotics for UOP among augmentin, tazocin, and zinacef. Method: 624 UOP cases treated with augmentin, tazocin , or zinacef were analysed from Jan. 2002 to Dec. 2006, retrospectively. The patients were classed as mild, moderate, and serious by the Pneumonia Severity Index(PSI). The response rate is determined by antibiotic using records and temperature, white cell counts, C-protein reaction, and radioautograph. We compared the differences of response rate and pharmaceutical service costs between each group. Results: There is no significantly statistical differences in all outcome between augmentin and zinacef group. On the contrary, augmentin group has the better benefit in all outcome than tazocin group (P< 0.05). In moderate level of PSI, zinacef gourp has better response rate than tazocin group (P=0.03). augmentin is the most economy in all levels. The estimated costs of hospitalization for effective treatment per person in mild, moderate, and serious level respectively are 73,015 NT, 108,428 NT, 141,165 NT in augmentin; 78,572 NT, 109,269 NT, 153,993 NT in zinacef; 295,896 NT, 335,329 NT, 451,517 NT in tazocin. Conclusion: We suggest choosing antibiotic with the better response rate for UOP according the level of PSI. In the treatment groups of the study, augmentin has the highest response rate when the efficacy is comparable in the different levels of PSI and also least costs of hospitalization for effective treatment per person in all the different levels of PSI.