Author/Editor     Černelč, Silvije
Title     Bolnišnična uporaba protimikrobnih zdravil za sistemsko zdravljenje v Sloveniji
Translated title     Utilization review of systemic antimicrobials in Slovene hospitals
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 41, št. Suppl 2
Publication year     2002
Volume     str. 43-52
Language     slo
Abstract     The use of systemic antiinfectives in all 28 Slovenian hospitals between 1983 and 1995 was investigated. The starting points important for understanding of the studies of drug utilization are first presented. For the study, the antininfectives were arranged according to the ATC drug classification and by their nonproprietary names. The analysis showed that the mean length of hospital stay was decreasing gradually from 12.7 days in 1983 to 10.4 days in 1995 (p < 0.001), and revealed significant differences in choice as well as in frequency of drug use in the study period. However, there was no increase in the overall use of systemic antiinfectives in hospitals expressed as defined daily doses per hundred bed days. The use of aminoglycosides was fairly constant, but there were changes in the relative use of different drugs. While the use of penicillins with (beta-lactamase inhibitors, cephalosporins, quinolones, macrolides, lincosamides, imipenem/cilastatin, vancomycin, metronidazole, antimycotics and antivirals increased significantly (p < 0.001), the use of tetracyclines, penicillins with extended spectrum, (beta-lactamase sensitive penicillins, sulphonamides and trimethoprim, drugs for treatment of tuberculosis and chloramphenicol, decreased significantly (p < 0.001). The antiinfective that showed the largest increase in use was co-amoxiclav. Reasons for changes in the relative use of different groups of antiinfectives in Slovenian hospitals are most likely complex and would need further analysis, but they definitely mirror the few data available from elsewhere in the world: microorganisms have become resistant, the number of patients with more serious infections has increased, combination therapy and perioperative antiinfective prophylaxis have become more widespread. The study of the rationality of drug utilization which may serve as the basis for planning, control, coordination, education and improvement of drug treatment was grounded.
Summary     Prikazana je poraba protimikrobnih zdravil za sistemsko zdravljenje med letoma 1983 in 1995 za vseh 28 bolnišnic v Sloveniji. Zdravila so razvrščena po anatomsko-terapevtsko-kemijski klasifikaciji in po nezaščitenih imenih, njihova poraba pa prikazana v dnevno določenem odmerku na sto bolnišničnih oskrbnih dni. V obravnavanem obdobju se poraba protimikrobnih zdravil po količini ni značilno spremenila, čeprav se je ležalna doba v obravnavanem obdobju enakomerno zmanjševala od 12,7 dneva v letu 1983 do 10,4 dneva v letu 1995 (p < 0,001). Navedena so izhodišča, pomembna za razumevanje izsledkov raziskav porabe protimikrobnih zdravil. Analiza porabljenih zdravil v bolnišnicah je pokazala značilne razlike v izboru in količini nekaterih zdravil. Poraba aminoglikozidov se v obravnavanem obdobju ni značilno spremenila, nastale pa so spremembe v izboru nekaterih zdravil. Značilno se je povečala (p < 0,001) poraba penicilinov z zaviralci laktamaze (beta, cefalosporinov, kinolonov, makrolidov, linkozamidov, imipenema, vankomicina, metronidazola, protiglivnih zdravil in protivirusnih zdravil; nasprotno pa se je poraba tetraciklinov, širokospektralnih penicilinov, penicilinov občutljivih za laktamazo (beta, sulfonamidov in trimetoprima, protituberkuloznih zdravil in kloramfenikola značilno zmanjšala (p<0,001). Od vseh protimikrobnih zdravil se je najbolj povečala poraba antibiotika, sestavljenega iz amoksicilina in klavulanske kisline. Vzrokov za nastale spremembe v porabi protimikrobnih zdravil v slovenskih bolnišnicah je več in zahtevajo dodatne raziskave. Čeprav nimamo dovolj podatkov, bi lahko med take vzroke uvrstili večjo odpornost mikroorganizmov, več bolnikov z zelo nevarnimi okužbami ter pogostejše kombinirano in kirurško preprečevalno zdravljenje. Raziskave porabe zdravil so utemeljene, saj so lahko podlaga za načrtovanje, preverjanje, usklajevanje, obveščanje in izboljšanje zdravljenja.
Descriptors     BACTERIAL INFECTIONS
ANTIBIOTICS
DRUG UTILIZATION
SLOVENIA
ANTI-INFECTIVE AGENTS