Fluoroquinolone在結核病人的使用評估

研究背景與目的：根據WHO最近發表的報告指出，全球Multi-drug resistance(MDR)的發生率已達到歷年最高，而Fluoroquinolones(FQNs)又是治療MDR的一項重要藥物，因此如何謹慎小心的使用FQNs對於治療肺結核病人來說是很重要的。國內醫院少有針對FQNs類處方在結核病人的藥物使用評估；因此本研究希望針對醫院內使用FQNs治療結核病的情況來做藥物使用評估。研究方法：本研究採回溯性次級資料分析，主要資料來源為高雄市某醫學中心，擷取2006年1月1日至2009年4月15日之間曾確診為結核病且用藥處方中含有FQN者之所有病人資料，評估藥物使用理由的適當性以及處方內容的合適性。研究結果：研究結果發現全部56位納入分析的病人中，有27位的使用理由不適當，最多的理由為「只對單一藥物過敏或有抗藥性就加入FQNs到治療組合中」，共有14位(25%)病人；次多的理由為「未確認產生過敏的藥物前就加入FQNs到治療組合中」，共有9位(16.07%)。另外在處方內容合適性方面，也發現到最常出現與治療指引規範不符的是「治療的時程」以及「藥物組合」，分別有4人(21.05%)及15人(78.95%)。結論：研究發現，研究對象的FQNs使用理由符合準則規範的比率為33.93%，有48.21%的使用理由不符合指引的建議。站在預防抗藥性的角度，或許在還有其他一線藥物可以使用的情況下，盡可能的保護二線藥物是比較重要的。而且在遵照診治指引的同時也必須要考慮到病人的狀況，調整治療組合，以預防抗藥性的產生。

關鍵字

Fluoroquinolone ；使用評估；結核病人

並列摘要

Background: Accroding to the reprot of World Health Organization, the globle incidence rate of mulitidrug resistance(MDR) is reaching the highest level among these years. Fluoroquinolones(FQNs) is one of the most important drug to treat MDR, and how to use FQNs appropriately to treat Tuberculosis(TB) patients yet not developing drug resistance is an very important thing. Methods: A retrospective study based on reviewing medical records was conducted in an 1600-bed medical centre in southern Taiwan. We selected TB patients who ever used a FQNs during his treatment duration between 1 january 2006 and 30 april 2009. We then abstract relevant informations to evaluate the reason of using FQNS and the compliance of prescribing rules by a local guideline of TB Diagnosis & Treatment. Result: Among all 53 patients, inapporpriate reason of using FQNs was in 25 patients(47.17%) for the following reasons: using FQNs in patients with only resistant/allergy to one drug, 14; using FQNs before confirm the drug that causes serious adverse evant, 7. Among the group of 19 patients(33.93%) who have appropriate reason to use FQNs, we found 4 of them with inappropriate treatment duration, 14 of them with inappropriate treatment combination. Conclusion: In our study, the rate of appropriate use of FQNs in TB patients is 33.93%, and the rate of inappropriate use of FQNs is 48.21%. In order to save the second-line drugs for MDR and extensively drug resistant(XDR) patients, we suggest not to use FQNs while there is other first-line drug able to use. Following the guideline is suggested when using FQNs to TB patients.

並列關鍵字

Fluoroquinolone ； DUE ； Tuberculosis

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Fluoroquinolone在結核病人的使用評估

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