大竹县人民医院抗菌药物分级管理实施办法.doc

Pushing ahead, East, North, West development, facilitating shanty, complete xincheng West Road, stability and reconstruction of the street, Star Ding garden built century Garden District, subject public housing construction, heating the gas expansion accelerated implementation, Jing Rui River and bridge style line solid shaft, further expanded the town development. Beautiful country adhere to the advance and typical for a group to lead. According to ecological lay based, and industry increased income, and live upgrade civilization, and culture rich connotation of thought, caught built beautiful village, and whole village advance, and easily relocation, and five modified three built, project near 30 a; depth into ecological, and industry, and culture, and tourism, elements, high standards caught party original city Liu, and jade are Xia AO, model village, in province City set has benchmark. Four is equal benefits to promote sharing, coordinated development of various social undertakings. In the case of rigid spending slowing revenue growth, increase, financial 75% to the peoples livelihood, the masses have more access in the sharing. Cuoban something good and benefit. Adhere to the affordable, best, carefully cuoban village oil, water and heat, cultural, city and County columns practical, developments benefit families, bring more welfare to the masses. Development of social convenience. Acceptance of balanced development of compulsory education through the national assessment, the County vocational education center was named top School of vocational education in China, the third batch of national reform and development model through provincial . Five is to deepen reform and innovation to break bottlenecks and endogenous development of effective fire. As an engine of dynamism, adding reform key to adopting reform measures stress energy and break bottlenecks and promoting development. Pay close attention to the key areas of reform. Conscientiously implement the provincial deployment and cancel, adjustment, to undertake the administrative approval items according to Regulation 347 to further improve administrative efficiency continuing deepening reform for poverty alleviation, speeding up rural land right registration certification pilot project, encouraging the orderly transfer of land management, utilize the land resources, in order to promote scale management laid the Foundation. Actively cultivate the market. Firmly establish a market-oriented, nurturing family farms, industrial users, professional cooperation organization new market management main body 456, effectively improve the industry, intensive and marketization of encouraging support social capital into the small micro-credit, urban development, culture and tourism, public services and other areas, easing development shortfall. To promote mass innovation. To support the rural sector to use new thinking and new ideas, creative work incentives such as actively promoting financial intermediation, bring added 159 in non public enterprises, individually-1540, created a大竹县人民医院抗菌药物分级管理实施办法 （2011年修订）第一条 根据药品管理法、药品管理法实施条例等有关法律法规，以及抗菌药物临床应用指导原则、四川省基本医疗保险、工伤保险和生育保险药品目录（2010年版）、四川省新型农村合作医疗基本用药目录、达州市新型农村合作医疗新增用药目录，由医院药事管理委员会组织专人对我院使用的每种抗菌药物的特点、临床疗效、细菌耐药性、不良反应以及当地经济状况、药品价格等因素进行综合分析，将抗菌药物分为非限制使用、限制使用与特殊使用三类，实行分级管理，制定本实施办法。第二条 非限制使用：经临床长期应用证明安全、有效，对细菌耐药性影响较小，价格相对较低的抗菌药物。第三条 限制使用：与非限制使用抗菌药物相比较，这类药物在疗效、安全性、对细菌耐药性影响、药品价格等某方面存在局限性，不宜作为非限制使用药物。第四条 特殊使用：不良反应明显，不宜随意使用或临床需要倍加保护以免细菌过快产生耐药而导致严重后果的抗菌药物；新上市的抗菌药物；其疗效或安全性任何一方面的临床资料尚较少，或并不优于现用药物者；药品价格昂贵。 第五条 临床选用抗菌药物应遵循抗菌药物临床应用指导原则，根据感染部位、严重程度、致病菌种类以及细菌耐药情况、患者病理生理特点、药品价格等因素加以综合分析考虑，参照抗菌药物临床应用指导原则中“各类细菌性感染的治疗原则及病原治疗”的有关要求合理选择。第六条 一般对轻度与局部感染患者应首先选用非限制使用抗菌药物进行治疗。第七条 严重感染、免疫功能低下者合并感染或病原菌只对限制使用抗菌药物敏感时，可选用限制使用抗菌药物治疗；特殊使用抗菌药物的选用应从严控制。第八条 临床医师可根据诊断和患者病情开具非限制使用抗菌药物处方；“限制使用”的抗菌药物，须由主治医师以上专业技术职务任职资格的医师开具处方（医嘱）。 “特殊使用”的抗菌药物，须经具有高级专业技术职务任职资格的医师开具处方（医嘱）。紧急情况下临床医师可以越级使用高于权限的抗菌药物，但仅限于1天用量。第九条 住院病人进行抗菌治疗前，必须先留取相应样本，送细菌培养，明确病原菌和药敏结果，有针对地予以抗菌治疗。第十条 门诊病人及危重患者的抗菌治疗，按照指导原则中的相应规定执行。 第十一条 药事管理委员会定期开展合理用药培训与教育，督导本单位临床合理用药工作；依据抗菌药物临床应用指导原则和抗菌药物分级管理实施办法，定期与不定期对各科室应用抗菌药物进行监督检查。 第十二条 药事管理委员会定期召开会议，组织修订新增加的品种，并通过医院信息下发各科。第十三条 抗菌药物合理使用纳入医疗质量检查内容和科室综合目标管理考核体系。第十四条 加强合理用药管理，杜绝不适当的经济激励。任何科室不准以任何形式将开出的药品处方与个人或科室经济利益挂钩。第十五条 药剂科严把合理用药关，不合理处方拒绝调配并反馈给临床医师修改，且进行登记。第十六条 因不合理应用抗菌药物而导致的医疗事故及纠纷，按医院相关规定处理。第十七条 抗菌药物分级表。见附录。第十八条 本办法自2011年3月1日起施行附录：抗菌药物分级表一、非限制类抗菌药编号药品名称剂型备注1青霉素注射剂2氨苄青霉素注射剂3苯唑青霉素注射剂4阿莫西林口服制剂5哌拉西林注射剂6阿莫西林克拉维酸钾注射剂、口服制剂7头孢唑啉注射剂8头孢呋辛注射剂9头孢呋辛酯口服制剂10头孢塞肟注射剂11头孢曲松注射剂12庆大霉素注射剂、口服制剂13克林霉素注射剂14磷霉素注射剂15甲硝唑注射剂、口服制剂16替硝唑注射剂17阿米卡星注射剂18诺氟沙星口服制剂19乙酰螺旋霉素口服制剂20红霉素口服制剂21罗红霉素口服制剂22阿奇霉素注射剂、口服制剂23麦迪霉素口服制剂24链霉素注射剂25四环素口服制剂26氯霉素滴眼液27金霉素眼膏28氧氟沙星滴眼剂、口服制剂、滴耳剂29左氧氟沙星口服制剂、注射剂30环丙沙星注射剂31磺胺嘧啶银散剂32复方磺胺甲噁唑口服制剂33柳氮磺吡啶口服制剂34异烟肼注射剂、口服制剂35利福平口服制剂36乙胺丁醇口服制剂37吡嗪酰胺口服制剂38利福喷丁口服制剂39呋喃妥因口服制剂40制霉菌素口服制剂41益康唑外用制剂42克霉唑外用制剂43咪康唑外用制剂44特比萘芬外用制剂45酮康唑口服制剂、外用制剂46盐酸小檗碱口服制剂47乌洛托品口服制剂二、限制使用抗菌药编号药品名称剂型1萘夫西林注射剂2美洛西林注射剂3阿洛西林注射剂4呋布西林注射剂5氨苄西林钠氯唑西林钠注射剂6哌拉西林/他巴唑坦注射剂7哌拉西林/舒巴坦注射剂8拉氧头孢注射剂9头孢米诺注射剂10头孢硫脒注射剂11头孢匹胺注射剂12头孢替唑注射剂13头孢西丁注射剂14头孢克肟口服制剂15克拉霉素口服制剂16米诺环素口服制剂17