- 期刊
Imipenem/cilastatin (Tienam(上标 ®))的使用評估
Drug Use Evaluation of Imipenem/Cilastatin (Tienam(superscript ®))
摘要
目的：Imipenem/cilastatin(Tienam(上标 ®))是一個廣效的抗生素，臨床上常使用於嚴重的院內感染，特別是對Acinetobacter baumannii菌所造成的感染，為了確保院內imipenem/cilastatin合理有效性，並且降低不必要的醫療資源浪費，因此本研究欲以2004年使用該藥患者作一用藥上評估。 方法：本次評估以回溯性方式收集某區域教學醫院2004年1至12月使用imipenem/cilastatin之病患為收案對象，刪除沒有完成療程之病人後共得60名個案。之後以SPSS分析軟體統計結果。 結果：本研究收案60人，年齡以老人居多，有6人(11.7%)沒有檢出菌株，檢出菌株排名分別是Acinetobacter baumannii、Pseudomonas aeruginosa、Escherichia coli 和Klebsiella pneumoniae，有31人是多重感染併用抗黴劑（amphotericin B或fluconazole）、vancomycin、teicoplanin 或azithromycin，平均用藥天數為9.5±5.5天，用藥評估發現僅有一件個案使用劑量過高，3件個案合併使用相同抗菌範圍的抗生素。在預後方面，個案治療後病情穩定者佔48.3%，轉院有10.0%，不穩定有41.7%，其影響原因有待將來更進一步的分析。 結論：透過此次imipenem/cilastatin 的使用評估，提供給相關醫療人員參考，雖然用藥情形大致合理，但仍應繼續針對有疑慮的用藥劑量和合併藥物，透過電腦的警示系統來訂出追蹤評估機制，以更積極的態度來提供醫療人員合理用藥之建議。
並列摘要
Objective: Imipenem/cilastatin(Tienam(superscript ®)) is a broad-spectrum antibiotic drug. It has been used clinically in severe nosocomial infections especially caused by Acinetobacter baumannii. Appropriat use of the antibiotics will prevent bacterial resistance and reduce medical costs. This study evaluates the appropriateness, safety and efficacy of the drug use during the period 2004. Methods: A retrospective drug use evaluation was performed for the inpatients who received intravenous imipenem/cilastatin from 1 January to 31 December 2004. Relevant data related to use of imipenem/cilastatin were collected from chart review and analyze it by SPSS software package. Results: During the study period, 60 patients who had ever recept imipenem/cilastatin were available for evaluation. The aged people had the highest percentage of patients (80.0%). Six treatment courses had culture spacimen with negative finding. The most common cultured bacteria were Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. There were 31 treatment courses combined with antifungal therapy (amphotericin B or fluconazole), vancomycin, teicoplanin and azithromycin due to the concern of multiple infections. The average drug use regimen was 9.5 5.5 days. Drug use evaluation of imipenem/cilastatin was almost rational. Only one patient was overdose; three patients combined antibiotics with the same antibacteric spectrum. The outcome in percents of treatment courses as stable condition, transferred to other hospital, unstable condition were 48.3%, 10.0% and 41.7% respectively. The causes of outcomes will be analyzed further. Conclusions: In this study, besides to understanding the utilizing situation of imipenem/cilastatin, it could also help the physicians to cognize the problem that the dosage and combined drugs. We suggested that hospital could develop a computer system to monitor and follow the medication to provide the physicians in appropriate drug utilization constructively.