抗生素ppt课件（英文精品） rational drug use of antibiotics in a neonatal intensive care unit

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) 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, and at the lowest cost to them and their community.” (Quick et al 1997:422) According to Quick et al (1997:422) RDU includes the following criteria: Correct drug Appropriate indication Appropriate dosage, administration, and duration of treatment; Appropriate patient Correct dispensing - this includes correct dispensing Patients adherence to treatment. Rational Drug use objectives 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. Background 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 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 With 882 discharges and 159 deaths Data collection period: 8 months (131days) Ward occupancy rate of 107.17% 100 patients data were selected as a sample. 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 units protocol Four patients received alternative antimicrobial therapy (e.g. tobramycin and ceftazidime) as required by their clinical conditions and sensitivity results. Results Results Antimicrobials included in the investigation of IV use in NICU Amikacin Ampicillin Benzylpenicillin Cefepime Cefotaxime Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Ciprofloxacin Cloxacillin Co-trimoxazole Erythromycin Gentamicin Meropenem Metronidazole Piperacillin/ tazobactam Tobramycin Vancomycin Results 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. Frequency of antibiotics use Number of antibiotics per patient 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 antibiotics. 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 Results 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. Implementation and improvements to practice Results Pharmaceutical care risk assessment referral sheet Pharmaceutical care risk assessment score sheet New pharmaceutical care forms for NICU Amphotericin B rational prescribing tool Results Proposed process for providing pharmaceutical care: - Receive a referral letter from a health care professional Score and allocate the patient Re-score and re- allocate the patients on a daily basis Follow the patient with appropriate Pharmaceutical care 1 2 3 4 Entry Exit Time demand related to pharmaceutical care visits Score:6 to 20 Low 1 to 2 visits per week 21 to 34 Moderate 2 to 3 visits per week =35 High Everyday 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. 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.” Conclusion Babies and their parents for participating in the