某醫學中心Vancomycin/Teicoplanin藥品使用評估

Evaluation the Use of Vancomycin and Teicoplanin in a Medical Center

陳文慧(Wen-Hwei Chen) ； 林慧玲(Fe-Lin Lin Wu) ； 周華(Hua Chou) ； 陳政女(Cheng-Nu Chen) ； 陳昭廷(Chao-Ting Chen) ； 何蘊芳(Yunn-Fang Ho) ； 張上淳(Shan-Chwen Chang) ； 陳燕惠(Yen-Hui Chen)

《台灣醫學》 10卷1期 (2006/01) Pp. 28-41

https://doi.org/10.6320/FJM.2006.10(1).04

摘要

近年抗藥性菌株已引發全球警訊。Vancomycin resistant enterococci (VRE)和vancomycin resistant Staphycoccus aureus (VRSA)的出現，更成為感染管控的重要挑戰。Glycopeptides 的使用型態，足以影響VRE等抗藥性菌株的增生。本研究籍由訂定醫院glycopeptide類抗生素的使用規範，並運用藥品使用評估方式，於91年到92年間追蹤院內使用glycopeptide抗生素的適應症是否合理。追蹤結果，vancomycin約有70%，teicoplanin則有85%符合合理適應症。不合理適應症方面，主要為心臟外科使用葉克膜體外維生系統(extra-corporeal membrane oxygenation, ECMO)、骨科利用vancomycin攪拌入骨水泥、或腎臟透析病患使用vancomycin作為預防性抗生素。為減少院內VRE的增生與傳播，應避免預防性探用vancomycin，或僅限用於手術中而不應於術後繼續使用。此外血液或透析病患採用vancomcycin (2%)或teicoplanin (1%)當作經驗性治療的首選用藥，或中性白血球缺乏症(neutropenia)的病患經驗性加入glycopeptide抗生素治療（約15% vancomycin組和7% teicoplanin組的病患），或其他病人，醫師也會經驗性加入glycopeptides。儘管因資料不完整致無法確認使用是否合理，但經驗性治療若無明確治療率則仍可能有濫用之虞，因此建議日後應明定使用標準，並請專人管控。本次的評估主要限制在於單由藥師追蹤分析，礙於資料可能疏漏或判斷標準過度複雜，分析結果可能不夠精確。日後應整合院內其他相關部門，由多部門進行合作評估，且能針對適應症以外如劑量、用法、天數等問題加以分析。同時落實其他非藥品的感控措施，方能有機會避免抗藥菌株肆虐。

關鍵字

Vancomycin ； Teicoplanin ； 藥品使用評估

並列摘要

Resistant bacteria have caused global alarm. The emergence of vancomycin-resistant enterococcus (VRE) and vancomycin-resistant S. aureus (VRSA) has further challenged infection control strategies. Usage of glycopeptides has also been reported to influence the selection and spread of VRE. This study tried to evaluate the indication of glycopeptide usage at a medical center. A DUE project was launched to follow up on the indications for glycopeptide usage. Results showed that 70% of vancomycin usage and 85% of teicoplanin usage met the criteria of appropriate indications. Inappropriate indications include prophylactic use of vancomycin in surgical patients on ECMO and patients on dialysis and mixing vancomycin in bone cement in orthopedic patients. Prophylactic glycopeptide usage should be curtailed. Other indecisive indications include empirical use in patients on dialysis patients with neutropenic fever and other medical patients. Data were insufficient to identify if these usage are appropriate. We suggest further establishing clear guideline and perhaps designate infection specialists to help facilitate appropriate usage of this class of antibiotics. The limitation of this analysis is incomplete data collection. The overt complexity of the evaluation criteria may have also dampened the precision of the analysis. Combining other disciplinary and adopting joint effort to curtail inappropriate use of glycopeptides, focusing not only on indications but also dosage, duration, as well as other indicators will be our future goal. Other infection control measures need to be solidified and hopefully resistant strains may be contained.

並列關鍵字

Vancomycin ； Teicoplanin ； Drug Use Evaluation DUE