抗菌药物临床应用指导原则(指南)在合理药中的价值.pptVIP

Dr.HU Bijie Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands The consensus-based guidelines were developed by a multidisciplinary group of experts in bacterial meningitis. Patients were assigned to one of four categories: age 16–60 years, no risk factors; age 60 years, no risk factors; age 16 years with risk factors; age 16 years, recent neurosurgery. An antibiotic regimen was recommended for patients in each of the categories. The guidelines were disseminated in booklet form and the audit was begun 1 year after they were issued. Overall, only 87 patients (33%) received treatment that was in accordance with the guidelines; the rates of compliance for patients in the four groups ranged from 16% to 49%. Reassuringly, although adoption of the guidelines was poor, 95% of patients were treated with antibiotics to which their pathogens were susceptible. In the case of the 87 patients whose treatment was in accordance with the guidelines, 98% of pathogens were susceptible. van de Beek, D. et al. (2002) Journal of Antimicrobial Chemotherapy 49, 661–6 临床常见手术围术期抗生素预防性应用的建议(2) 抗生素单次与多次给药预防大手术SSI效果比较的系统综述 干预措施定义，入选与剔除论文标准 最后入选：28篇9478例病人 总计： 单次比多次的OR为1.12 (0.89, 1.42; P = 0.33) Beta-lactam (21)：OR = 1.10 (0.90,1.33) 非beta-lactam (7)：OR = 0.65 (0.34, 1.23), P = 0.13 妇产科 (10 , N = 1480)：OR = 1.14 (0.62, 2.09) 其他科 (19)：OR = 1.03 (0.82, 1.28). P = 0.75 盲法评价(15)：OR = 1.24 (0.95, 1.63) 非盲评价(13)：OR = 0.91 (0.71, 1.17). P = 0.10 多剂24 h(16)：OR = 1.03 (0.77, 1.36) 多剂24 h(12)：OR = 1.03 (0.76, 1.40). P = 0.95 Prevention of endocarditis: Cardiac conditions and antimicrobial prophylaxis Recommended Not recommended previous endocarditis prosthetic valves most congenital heart disease all acquired valvular heart disease hypertrophic cardiomyopathy mitral valve prolapse with valvular regurgitation surgically constructed systemic-pulmonary shunts, or conduits isolated secundum atrial septal defect previous coronary artery bypass graft surgery p