我国在抗菌药物合理使用方面存在的主要问题和对策..doc

我国在抗菌药物合理使用方面存在的主要问题和对策 缪晓辉1 任慧琼2 （1第二军医大学长征医院 上海 200003；2中国人民解放军第85医院肝病中心 上海 200235） 【作者简介】缪晓辉，上海第二军医大学长征医院副院长，上海市医学会感染病学会主任委员，主任医师、教授。主要研究方向：感染性疾病的诊治。 【摘要】我国滥用抗菌药物的主要原因是医务人员知识缺陷和盲目用药，但政府和卫生行政部门监管不到位，以及医院管理方面存在缺陷也是重要因素。滥用抗菌药物的直接后果是导致药物不良反应的增加和加重，而最严重的后果是诱导细菌耐药。抗菌药物滥用的问题需要综合治理。建议：政府要加大力度，强化落实和监管；在国产新药审批和抗菌药物流通领域要严格把关；应建立一支有较高专业素质的临床药师队伍；在医院内建立抗菌药物合理使用指导委员会；实行对医院院长问责制；医保监管部门要把抗菌药物的药占比纳入医院考核指标。 【关键词】抗菌药物；耐药；不合理用药；整治 【Abstract】Abstract: Antibiotics abuse is a severe problem in China and the primary cause for the misuse is that healthcare providers have inadequate knowledge about antibiotics. Meanwhile, the government and health care administrative department’s imperfect supervisory system and the hospital’s management defects have both contributed to it. The consequence of antibiotics abuse is the increased risk of adverse drug reaction, and the worst scenario is drug resistance. Effective action requires a multi-faceted strategy, and the following suggestions should be considered. Firstly government’s guidance, implement and supervision must be strengthened. Secondly, SFDA and other related administrative departments must be strict in the approval of generics antibiotics and its distribution and sales. Thirdly, clinical pharmacists’ training should meet the clinical needs. The forth, a hospital-level guidance committee for rational use of antibiotics should be set up through legislation. The fifth one is to implement the accountability system to the hospital’s president. Finally, the ratio of antibiotics to all medicines consumed instead of total drug proportion in a hospital should be considered as an assessment index by medical insurance supervision department. 【Key words】antibacterial drug，drug resistance，Irrational drug use，improvement and rectification 我国门诊约有75%的感冒患者应用抗菌药物，而外科手术中抗菌药物的使用率更高达95％，人均年消费抗菌药物量138克左右，而美国仅为13克。80%以上的患者存在滥用抗菌药物的可能[1]。本文就抗菌药物在临床应用中存在的主要问题进行分析并提出相应的对策和建议。 1 抗菌药物合理使用方面存在的主要问题 1.1医务人员相关知识的缺陷。不少医务人员对抗菌药物的抗菌谱、药代动力学和药效学（PK/PD）、用药指征、用药原则、