Nghien cuu Y hgc Y Hoc TP. Ho Chi Minh * Tap 21 * So 5 * 2017
KHAO SAT LIEU XAC DINH TRONG NGAY CUA CEFOTAXIME DANG TIEM TAI 11 BENH VIEN THUOC TINH AN GIANG
Hodng Thy Nhac VU*, Hodng Thi Bich Thdo*
TOMTAT
M^c tiew Lieu xdc dinh trong ngay (Defined Daily Dose - DDD) Id mot thdng tin quan tiong giOp binh viin theo doi, gidm sdt ding nhu ddnh gid so Ididi iinh hinh tiiu thu vd su dung thuoc tqi benh viin. Nghien deu thuc hiin nham Idido sdt lieu xdc dirih tiong ngay cua cefotaxime dang tiem tqi 11 binh viin tuyen huyen tinh An Giang.
Phuong phdp n^ien ciht Nghien cuu nw td cat ngang, thuc hien thong qua dec hoi deu die Uiu sir dung cefotaxime dang tiem cua toan bd cdc luot dieu tri noi tru trong giai doan 01-12/2015.
Kei qud: Mdu nghien deu co 19090 heat diiu tri, trong do 80% truong hop ngudi binh Idiong co binh kem theo, 68% trucmg hap sie dung cefotaxime Id thuoc chinh trong diiu tri. Dua vdo muc dich sie dung khdng sinh, nghiin deu ghi nhdn c^otaxime dugc sie dung vdi 16 muc didt khdc nhau, tiong do 4 tnedng hap w lugt sie dung nhieu nhoi Id viim phoi (26%), viim nhiim hi tiiu hoa (18%), mo lay thai (12%>) vd viim nhiim do nam viin (6%). Lieu xdc dinh tiong ngay cim cefotaxime dSi vai nhom muc didi sie dung giao dgng tie 6,7 dw deh 13,4 DDD/1000 ngudi binh/ ngay. Ndm nhom muc didt su dung co gid tri lieu xdc dinh trong ngay cao nh^ Id lao phoi boi nhiem (13,4); nhiim triing ho hcq) (12,3); viim nhiim do nam vien (12,2); viem da mo tebao (11,5) vd ma lay thai (11,0). Trong do. dm vdi ding mgt loai binh nhung c6 su khdc biet co y nghta thong ke vi lieu xdc dinh tiong ngay giiea cdc benh viin (P<0,05).
Kei lu0n: Nghiin deu cung c^ nhimg kit qud chi tiit vi gid tri liiu xdc djnh tiong ngay cua c^taxime, too can degiup Sd Y ttAn Giang ddnh gid cu thi viic sie dung cefotaxime, tie do xdy dung chinh sdch, ke hoach quan ly sie dung khdng sinh tiim toi uu theo chi dao dm Bg Y te.
Tit khoa: cefotaxime, liiu xdc dmh trong ngay, khdng sinh tiim.
ABSTRACT
DEFINED DAILY DOSE OF CEFOTAXIME AT 11 HOSPITALS IN AN-GLANG PROVINCE Hoang-Thy Nhac-Vu, Hoang-Thi Bich-Thao * Y Hoc TP. Ho Chi Minh * Vol. 21 - No 5 - 2017:90 - 96 Objective: The defined daily dose (DDD) is a statistical measure which provides the important inforrrmtion to evaluate and contiol the drug utilization in hospitals. The study was conducted to investigate the defined daily dose of cefotaxime at 11 hospitals in An-Giang province.
Method: The cross-sectional study was carried out on the medical data of inpatients who received injectable cefotaxime and met the inclusion study criteria over the 01-12/2015 period.
Results: Among 19090 cases included in the study, the proportion of cases with comorbidity in the whole of hospitals was 80%. There were 16 types of diseases which required cefotaxime treatment. Among them, pneumonia, gastrointestinal infoctions. cesarean, and infection-related hospitalization were indicated cefotaxime injection most frequently (26%, 18%, 12% and 6%, respectively). The defined daily dose of c^otaxime for the 16 disease types ranged from 6.7 to 13 4 DDD/1000 inpatients/day. Five types with the highest defined daily dose were superinfection in pulmonary tuberculosis (13.4); respiratory infoctions (12.3); infection-related
* DH Y Dupe Tp Ho Chi Minh
Tdc gid lien lac: TS.DS. Hoang Thy Nhqic Vu DT: 0913.110.200 Email hoangthynhacvu®uphcm.edu.v
90
Y Hpc TP. H^ Chi Minh * T | p 21 * So 5 * 2017 N g h i e n cuu Y hgc hospitalization (12.2); cellulitis (11.5) and cesarean (11.0). The defined daily dose of cefotaxime for same diseases is significantly different between hospitals in the sample (P < 0.05).
Conclusion: The study provides detail results about the defined daily dose of cefotaxime This information will help An-Giang Health Department control the drug utilization well and issue logic strategy of antibiotics management.
Keywords: cefotaxime, defined daily dose, injectable antibiotics.
D A T V A N D E
Cimg vdi cae hoat dong hudng ling Idi keu gpi cua To chiic Y te the gidi "Khdng hanh dpng hdm nay, ngay mai khdng cd thuoe chiia", trong nam 2015, Bo Y te Viet Nam da ban hanh cac tai Ueu'i- ^^ nham hudng dan su dung khang sinh hop ly va tang eudng q u ^ ly viec sii dung khang sinh duoc hieu qua tai cac benh vi^n Viet Nam. Viec danh gia hieu qua su dung khang sinh chi cd the thue hien chinh xac khi benh vien hieu duoc tinh hinh su dung khang sinh trong thuc te. Ket qua thu duoc tu cac nghien cuu ve thue trang sii dung khang sinh''^''"- "• ^^' se giiip cae benh vien cd CO sd cho nhiing danh gia bude <^u de thuc hien cac nghien eijfu chuyen biet tap trung vao cac truong hap sii dung khang sinh chua toi mi so vdi hudng dan dieu tri eiia benh vien.
Theo "Hudng dan thuc hien quan ly sii dung khang sinh trong berth vien" duac ban hanh kem theo Quyet dinh sd 722/CS>-BYT oia Bp trudng Bp y te, cung vdi cac thong tin ve chi phi khang sinh va ngay dieu tri, thdng tin ve h^u xac dinh trong ngay (Defined Daily Dose - DDD) la mpt thdng tin quan trong gjiip benh vien theo ddi, gjam sat ciing nhu danh gia so khdi tinh hinh tieu thu va sti dung thudc tai benh vien.
Phuong phap tinh heu xac dinh trong ngay la phuong phap duac thdng qua bdi To chiic Y te the gidi tii nhiing nam 1970 vdi muc dich chuan hda nhung nghien cihi ve six dung thuoc gjiia eae quoc giat"'. Ngay nay, lieu xac dinh trong ngay da dupe thiia nlian rdng rai nhat va Ud thanh dem vj phd bim nhat de do ludng va so sanh viee su dung khang sinh giiia cac vimg mien khac nhau hay giiia cac khoMg thdi gian khac nhau, dae biet thuan loi khi danh gia tdng
luang khang sinh sii dung dio cung mpt nhdm dieu trP\ Lpi diem eiia viec so sanh tinh hinh sii dung thudc Ihong qua DDD la khdng hi phii thudc vao gia ca va each pha ehe tiiuoe. Tinh ling dung va hieu qua etia no da dupe ehiing minh trong nhieu nghien cihi ve khang sinh hem '^^"l Tuy nhien, de cd duac thdng so nay thi can phai thu thap dupe dii lieu chi tiet, d^y dii, chinh xac ve viee sii dung thuoc tren ngudi berth.
An Giang la mpt tinh cd md hinh benh tat kep, vdi mpt so benh nhiem trimg, truyen nhiem nhu benh viem dudng hd hap, nhiem khuan dudng tieu hda, sot xuat huyet, aim, cd ti le kha eao trong nhiing nam gan day. Cefotaxime la mpt khang sinh the he mdi thupc nhdm cephalosporin, duoc sir dung nhieu Uong d£eu tri nhiem khuan tren the gjdi'^ ^^ ciing nhu tai Viet Nam'5'*''. Theo "Hudng dan thue hien quan ly su dung khang sinh trong benh vien" eiia Bp Y te, cefotaxime dang hem la mpt trong eae khang sinh dupe khuyoi cao dieu tri xuong thang, nghia la chuyen tir dudng tiem sang dudng udng khi viec dieu tri tinh trang nhiem khuan cd tim trien tdt. Nhiing thdng tin ve DDD oia cefotaxime ndi rieng va khang sinh ndi chung se la can cii khoa hpe quan trpng doi vol So Y te An Giang de viec danh gia va so sanh viec sii dung khang sinh tai cac benh vien dupe chinh xac va i^y dii. Trong tinh lunh dd, nghien ciiu thue hien nham khao sat heu xac dinh trong ngay oia cefotaxime tai 11 benh vien tuyen huyen tinh An Giang.
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Nghien ciiu md ta eat ngang, thue hien thdng qua viec hdi ciiu du Heu sii dung cefotaxime dang tiem trong dieu tri ndi tni tai 11
N g h i e n c u u Y hpc Y H p c TP. H b Chi M i n h * T a p 21 * So 5 * 2017 benh vien tuyai huyen tinh An Giang trong nam
2015. Nghien ciiu loai bd cac trudng hqrp dieu tri cd ngay nhgp vien nam 2015 nhung xuat v i ^ vao nam 2016 hoac tnrdng hop khdng ed thdng tin luu trong phan mem quan ly ciia benh vien.
MSu nghien ctiu bao gom 19090 luot dieu trj npi tni cd tiem cefotaxime trong giai dogn nam 2015 tai 11 benh vien tuyai huyen tinh An Giang.
T h u thap va tong h g p dii li^u
Nghien cuu thu thap thdng tin sii dung cefotaxime bao gom ham luong, co so sir dung, chan doan kem theo oia timg trudng hgp trong tdng 19090 lupt dieu tri trong mau nghien ciiu.
Cefotaxime duac sir dung vdi eae ham lupng Ig va l,5g. Lieu xac dinh trong ngay dupe tinh toan eho tdng 11 benh vien theo muc dich dimg khang sinh (dieu tri - du phdng), theo vai tro dieu tri oia khang sinh (dieu tri chinh - dieu tri phu), theo tinh trang ngudi benh (khdng co benh kem (heo - ed benh kem theo), va theo timg mi^c didi dieu t 4 benh cu the.
P h u o n g p h a p p h a n tich t h o n g ke ap d v n g Viee md ta eae dac diem chung ve viec sir dung cefotaxime (so luot dieu tri, so luong cefotaxime sii dung) dugc ftiuc hien thdng qua tan so va ti le phan tram. Lieu xac dinh trong ngay dugc tinh toan dua theo cdng thiic oia Td chiic y te the gidi'"'. Trong dd, thai gian tinh toan cho tdng sd lugng cefotaxime sir dung la 365 ngay, ham lugng oia cefotaxime dugc quy doi ve gam; Heu trung binh duy tri hang ngay ciia mgt ngudi benh cho chi dinh chinh cua cefotaxime dimg dudng tiem sau khi Ua ciiu theo ma ATC oia cefotaxime (JOlDDOl) tren trang dien hi eua Td ehiic y te the gidi la 4g.
Theo dd eong flnie ap dyng eho timg trudng hgp cu the de tinh toan lieu xac dinh trong ngay la:
DDD/1000 ngudi/ngdy
L u ^ ^ g t h u a c Su- dung t r o n g 1 tiatn x 1000 4 X Tong BO n g u m b e n h x 3 65
Dii U ^ dupe tdng hgp being Microsoft excel 2010 va phan tich bang phan mem thong ke R (phi&i ban 3.1.3).
K E T Q U A
Ti le sii d u n g cefotaxime
Trong 12 thang tim hanh thu thap dii lieu, nghien euru ghi n h ^ So lugt dieu trj cd dimg cefotaxime chimn 69,2% tong lugt dieu tri cd khang sinh tiem t ^ 11 benh vien tuy&i huyen tinh An Giang nam 2015. Tong chi phi danh cho cefotaxime dang tiem tai 11 tuym h u y ^ la 4,76 ti dong, chian 70,4% tdng chi phi danh eho khang sinh tiem trong 12 thang tai cac b|nh vien tuyen huyen tinh An Giang. (Bang 1) Dac di&n c h u n g cua chin doan dupe chi d i n h cefotaxime
Vdi tdng so 19090 lugt dieu tri cd sir dung cefotaxime, vdi hai ham luong la cefotaxime Ig va l,5g cd ti le Ian lugt la chian 84,4% va 15,6%.
Ngudi benh dugc ehi dinh cefotaxime cd the co hole khdng cd benh kem Iheo, vdi ti I^ benh kem theo la 20% lugt dieu tri Uong mau nghien cihi.
Muc dich sir dung cefotaxime cho ngirdi berth trong mau nghien ciiu cd the tuang ling vdi d i m doan chinh hoac chan doan phu trong qua trinh dieu tri, vdi ti Ie Ian lugt la 68,4% va 13,6%.
Dua vao mue dich sir dung khang sinh, nghien ciiu ghi nhan cefotaxime dugc sir dung vdi 16 muc dich khae nhau, trong dd 4 trudng hpp cd lugt sii dung nhieu nhat la viem phSi (26,1%), viem nhiem he tieu hda (17,9%), mo lay thai (11,9%) va viem nhiim do nam vien (6,4%). Tl le sii lua chon ham lugng cefotaxime cd su thay doi tu^' v^o chan doan. Dac di&n chung ve vi?c sir dung cefotaxime cho 19090 lugt trong mau nghien ciiu theo 2 ham lugng khac nhau dupe trinh bay trong bang 2. Ti Ie so Ixrgt dieu trj cd chi djiih cefotaxime va ti le so lugng sir dyng cefotaxime ciing nhu cua 11 benh vien tuyen huyen cd su khac biet giiia 11 b | n h vien, Uong dd ed 1 benh vien cd ti le cao vugt trdi so vdi 10 b|nh vi|n cdn Iai, chiem hem 1/3 gja tri eua mSu.
(Hinhl)
Y Hgc TP. H o Chi M i n h * T$p 21 * So 5 * 2017 Nghien cihi Y hgc Lii&u x^c dinh trong ngay cua cefotaxime
Tai 11 berth vien tuyen huyen tinh An Giang, nghien ciiu tinh lieu xac dinh trong ngay oia cefotaxime theo so lupng ngudi b#nh thue te.
Lieu xac dinh trong ngay eua cefotaxime doi vdi 16 nhdm benh trong mau nghien cihi giao dpng til 6,7 eho d m 13,4 DDD/1000 ngudi/ngay. Nam nhdm muc dich sir dung ed lieu xac djnh trong ngay cao nhat la lao phoi bdi nhiem (13,4); nhiem trung hd hap (12,3); viem nhiem do nam vi|n (12,2); viem da mo te bao (11,5) va mo lay thai (11,0). Khi so sanh gia tri lieu xac dinh trong ngay giua cac benh vien, nghien ciiu ghi nhan su Bdng 1: Dgc dian sie dung khdng sinh tiim tqi 11 binh
khac biet ed y nghia thdng ke (p<0,05); ket quit khdng dugc trinh bay trong bang). Lieu xac djnh trong ngay cita mdi benh v i ^ doi vdi 9 muc dich sir dung cd cd gia tri DDD cao nhat trong mau nghien ciiu dugc trinh bay trong cho thay ddi vdi cimg mdt nhdm muc dich sir d\mg khang sinh nhung cd su chenh lech ro net ve lieu xac dinh Uong ngay gjiia cac herih vien cimg tuy&i.
Bieu do hinh mang nhen cho phep nhan dang benh vien nao cd gja tri DDD khac biet so vdi cae berth vien cimg t u y ^ Uong timg nhdm muc dich sue dung cefotaxime. (Hinh 2)
viin tiong mdu nghien deu
So lLH?t "Sieu tn (\UfCft) Chi phi thuoc (tVNB)
Co so SU' dyng (ong)
Cefotaxime ttSm n 19090
4,76 246033
(69.2)
(%)
(70.4) (74.5)
Khdng sinh ti£m l<hic cefotaxime n
S503 2.0 84259
(30.8)
(%)
(29.6) f25,5;
IMiu nghidn ci>u 27593 luvt dieu tli 6.761iVNB 330292 ong Bang 2: Dac diem chung vi viec sie dung cefotaxime dang tiSm tiong mdu nghiin cim
D|c diem tinh ti^ng benh Mucdichchungsi^
dgng cefotaxime Vai trd cua ceibtaxime
trang dieu til
Myc didi eg the Sl>
dgng cefotaxime
Kiifing c6 benh l(6m theo Co benh i(6m theo Cefotaxime dung de dieu tri Cefotaxime diing voi myc dich dtf phdng
Cefotaxime la thuoc dieu tn chinh Cefotaxime chi la thuoc dieu tri phy
i^o phoi boi nhiem lulo lay thai Nhiim trOng huy^t Nhiem Id sinh triing Nhiem tniing hd hip Vidm nhiim tiiu h6a
Thiithult Vit thu'ong Vigm oa quan chli'C nSng
Vigm hd hSp l<hdc phdi VigmnhiSmdam&t^bdo Vi§m nhiim do nim vi^n Vidm nhiim ]<hdc
Vidm phi quan Vi&m phSi Vien tai mQi hgng
cefotaxime 1g (n = 16117 luvt)
n(%) 12714 (78.9) 3403 (2f,)) 13480 f83,6;
2637 (16.4) 14084 (87.4) 2033 (1Z6)
295 (1.8) 1974 f12,2;
218 (1.4) 562 f3.4;
856 f5.3) 2843 (17.6)
442(2,7;
934 (5,S;
399 (2,5;
406 (2,5;
486 (3,0;
889 (5,5;
234 (1,5;
587 (3,6;
4257 (26,4;
746 (4,6;
cefotaxime 1,5g (n = 2973liM)
n(%) 2565 (86,3;
408 (13,7;
2601 (87,5;
372 (12,5;
2408 (81,0;
565(19,0;
37 (1,2;
290 (9,8;
51 (1,7) 77(2,6;
85 (2,9;
571 (19,2;
40 (1,3;
95 (3,2;
45 (1,5;
132 (4.4) 85 (2,9;
325 (10,9;
53 (1.8) 148 (5,o;
727 (24,5;
212(7,1;
Todn b$ m l u nghidn cuu (n-19090llF7t)
n(%) 15279(60,0;
3811(20,0;
16081 (84,2;
3009 (i5,e;
16492 (86,4;
2598 (13.6) 332(1,7;
2264(11,9;
269 (1,4;
629 (3.3) 941 (4.9) 3414 (17,9;
482 (2,5;
1029 (5,4;
444 (2,3;
638 (28;
570 (3,o;
1214 (6,4;
287 (1,5;
735 (3,9;
4984 (26,2;
958 (5,0;
93
Nghiin ciira Y hpc Y Hpc TP. Ho Chi Minh • T i p 21 * S6 5 * 2017 Tl LE LUtTT Ol6U TRI BANG CEFOTAXIM
Cllft 11 BENH V l f N (N=19090 LlfgrT) BVl
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Tl LE LlflJfNG CEFOTAXIM B A SCT Dl^NG CUA 11 BENH VIEN (N=2S2517 GAM)
Hinh LMotitililimt dmi trim luang sit dung cefotaxime cim 11 binh vien tm/m huyen tinh An Giang trong mau nghien cim
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Hinh 2. Md td lieu xdc dinh tiong ngay ciia cefotaxime theo tieng nhom muc dich sie dung khdng sinh ti-ong mSu nghien dm (DDD/1000 ngudi benhlngdy)
- T iTAN Uii tai 11 benh vien tuyen huyen thupc tinh An Giang ciing nhu da xac djnh dugc lieu xac dinh Nghien ciiu da md ta dugc dac diem chung ^^^^ ^^^y ^ ^ cefotaxime trong cac tnrdng hgp cita vi?c sii dung cefotaxime trong dSeu tri npi
Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017 Nghien cuu Y hpc dieu tri eu the. Nghien ciiu cho tiiay cefotaxime
la mpt khang sinh dugc su dimg vdi ti Ie cao nhat so vdi cac khang sinh tiem khac trong dieu tri npi tni tai cac benh vien tuyen huyen ndi rieng va tren toan tinh An Giang ndi ehung. Ket qua nghien eiiu ghi nhan heu xac dinh trong ngay ciia cefotaxime cho cimg mot loai benh khdng ddng lihat giiia cae benh vien cung tuyen ndi ehung va benh vien cimg quy md giudng benh ndi rieng. Cd the thay khdng phai benh vien cd quy md Ion thi gia tri h'eu xac djnh trong ngay cao hon berth vien cd quy md nhd hon, chimg td each tinh lieu xac dinh trong ngay giiip vi?c so sanh giiia cac b#nh vien duoc thuan Igi, khach quan, khdng phu thupc qua nhieu vao quy md giudng benh oia cae benh vien. Don cir la tnrdng hgp sir dung cefotaxime trong dieu tri nhiem trimg hd hap, lieu xac dinh trong ngay ciia cefotaxime dao dpng tCr 4,4 deh 17,2 DDD/1000 ngudi berih/ngay; trong dd mdt benh vien cd sd giudng ke hoach nhd hon 100 giudng va mpt benh vien cd so giudng ke hoach Idn hon 200 giudng deu cd Ueu xac dinh trong ngay oia cefotaxime la 17,2. Lieu khang sinh sii dung tiiy thudc vao tinh trang lam sang ctia ngudi benh trong thuc te, nen k^t qua thu dugc tir nghien aiu chi ed y nghfe tham khao, khdng cho phep danh gia viec sir dung thuoe la hgp ly hay khdng hop ly. Ben canh viec sir dung cefotaxime trong dieu tri benh, nghien cuu ghi nhan ed mpt ti Ie khdng nhd ngudi benh phai dimg cefot2ixime do viem nhiem khi nam vien, day la mdt thirc trang dMg tiec, gay ra do nhiem trimg berth vien, va la dieu khdng the tranh khdi trong mdi tnrdng benh vien tai Viet Nam. Rat it nghien cim dugc cdng bd cd cung cap sd lieu ve lieu xac dinh trong ngay oia cefotaxime tai Viet Nam, nen viee so sanh k ^ qua eua nghien ciiu edn han che. Ket qua ngiiien cim se eung cap nhiing thdng tin tham khao can thiet eho cac nghien ciiu tiep theo ve lieu xac dinh trong ngay oia cefotaxime.
Viec sir dung nguon dii lieu dien hi gjtip viec thu thap so lugng mau Idn dugc thuan Igi va chinh xac, tao dieu kien cho viec ap dung
phuang phap lay mhi toan bp Uong tiidi gjan 12 tiiang tai toan bp 11 benh vien tuyoi huyen. Ket qua thu dugc vi vay cd cd tinh dai dien trong viec cung cap nhiing ket qua chi tiet ve lieu xac dinh trong ngay cua tai cac benh vien tuym huyen tinh An Giang. Nhiing ngjiien eiiu tiep theo ed the tien hanh tinh toan heu xac dinh trong ngay vdi cae khang sinh tiem khae de viee danh gia tinh hinh sir dung khang sinh dugc day du hon. Ben canh do, nhiing nghien eiiu tiep theo can md rdng pham vi dhpn mau, khdng chi rieng benh vien huyen ma cac benh vien tuyoi tinh, va thuc hien d nhiing nam tiep theo de dii heu mang tinh cap nhat, tao dieu kien cho viec so sanh danh gja xu hudng sii dung khang sinh trong mdt pham vi rdng hon ve khdng gian va tiidi gian.
KETLUAN
Day la mdt trong nhiing so it nghien ciiu cung cap nhiing tiidng tin ve lieu xac dinh trong ngay oia cefotaxime trong dieu trj ndi tni tai co sd y te Viet Nam. Ket qua ciia nghien eiiu bd sung eae thdng tin ve viee su dung cefotaxime, loai khang sinh tiem dugc sir dung vdi so lupng vugt trdi so vdi cac khang sinh edn lai tai cac benh vien tuyen huyen ndi rieng va trong toan tinh An Giang ndi chung, giiip cho Sd Y te An Giang va cac benh vien cd them can cii khoa hoc cho cac dieu ehinh sir dung khang sinh dudng tiem, tir dd toi u u hda cdng tac kham ehua benh tai B|nh vien ciing nhu vi$c xay dung ke hoaeh va cd ehinh sach quan ly sir dung khang sinh tiem hop ly, va phu hgp vdi hudng dan cua Bp Y te.
LOT cam an: nhdm nghiin cuu Iran trgng cam an Ban gidm doc va cac Tru&ng Khoa Dugc cita 11 benh viSn tuyeh huyen Hnh An Giang, xin cim an Ban gidm docSYTAn Giang dabStrgvatao dieu Men thuan Icji cho nhom nghien cuu trong qud trinh thu thap thong tin va thuc hien nghien cuu.
TAI UtV THAM KHAO
1 Bp Y le (2015). Huong din sir iJvng khang snh, ban hanh kem theo Quyet dinh so 708/CS'-BVr.
2. Bp Y le (2016) Huong din thirc hi?n quan iy sur dung khang sinh trong b?nh v i ^ ban hanh kem theo Quyet ^ n h so 772/QD-BYr,
95
Nghien cuu Y hpc Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 ' 2017
3 Gould IM, Van der Meer (2005). Antibiotic Pohdes: Theoiy and Practice, Plenum Bup Corp, vol 4(7): pp. 68 - 87.
4 Hadi U, Duerink DO, Lestari ES, et a!. (2008). Audit of antibiotic prescribing in two govemmaital teadiing hospitals in Indonesia. Clin Miavbid Inject, vol 14(7): pp, 698-707.
5 Hoang Thy Nh^c Vu, Cu n t a n h TuySn, Nguyen M m h Tam, Nguyfin l i i i Knn l l i y a i (2016). Khao sat Hnh hinh sir dyng khang smh t ^ benh v i ^ q u | n 7 thanh p h o H a Chi Minh giai dosn 01A)l/2014-31/12/a)lt TgpddYHoc Thuc Hanh, so 1030, tr 95-99.
6 Hoang Thy Nh3CVu,Nguy&i Thi Mai Huong, Hoang Thj Bich Thao, Hoang I h u Ha, D o Th) Hwig TlKii (2016). Khao sat vi^c sd dyng kh^ng sinh trong dieu h i n g o ^ tni d i o ngucri b^nh co bao h i ^ y te tai B ^ v i ^ t d a khoa thcaig nhat SOR^ Nai. Tcqn dn Y Hpc Thin: Hanh, so 1030: tr. 129 - 1 3 2 .
7 Hoang Thy Nh?c Vu, Vu Thanh Tiing (2017). So sanh d^c d i S n sir dyng khang sinh trcngdiSu tri n g o ^ tiu va npi tru t ^ B | n h vien Phoi tinh B o n g NaL Tap chi Duoc kic, so 492 pT): ir. 12-14 8 McMullaii BJ, Andresen D, Blyth C Q eJ al. (2016). Antibiotic
duration and timing of the switdi bora intravenous to oral route for bacterial infections in diildren: systematic review and guidelines. TTie Lancet Infictious Diseasts. 16(8): p.139-152.
9 N a b d i S, Hekster YA, Jong R. ef ol. (1998). "Application of the ATC/DDD meOiodology to mcsutor antibiotic drag use". Eur } Clin Microbiol Inject Dts, vol 17: p p . 20-24
10. Nguyin Vi^t H u n g (2010). n i ^ c trgng sir dving khang sinh t^i mSt so benh vien tinh, Ihanh pho khu v u c phia Bac. TaprfiiY hoc l i m sang, so 48(1): tr. 5fr6Z
11. Polk RE, Fox C, Mahoney A,etal. (2007). Measurement of adult antibacterial drug use in 130 US hospitals: compariscai of
defined daily dose and days of t h a a p y . d i n In/a* Dis, v d 44p): pp. 664^70.
1^. Hodnguez-Pardo D, Pigrau C, CaiiTany ^ ' ** "'• PO^^)- Efiectiveness of sequential intravaious-to-oral antibiotic switch therapy in hospitalized patients wifti gram-posihve infectiOT:
(he SEQUENCE cctunt study. Eur] Clin MkrdlM Inject Dis, v d 35(48): pp.1269-1276.
li. Tran ESnh Binh ^ 1 4 ) . N ^ u o i ciiu finh hinh sur d^ng khang sinh b cac khoa co phau d\uat t^i b ^ v i ^ T m o n g El^i hpc Y Duvc H u e nam 2012-2013. Tflj dii Y hoe Thac harA, so 911(12):
tr.85.fl9.
1 4 Tian Nhan I h a n g (2013). Khao sat finh hinh s u dyng khang sinh trong dieu tr) ngo^i try Igi benh vien Badi Mai nam 2013.
Top dii YHpc Tliur Hanh, so 878(8): tr. 84-88
15. TruMig Anh Thy, Rahman M, Coffin S, et aL (2012). Antibiotic use m \^etnainese hospitals: A multicenter pcrint-prevalence study". Atiterkan Joumal ciflnfictum Control, vol 40^): [^. 840- 8 4 4
16. W H O (2003). Introducfion to Drug Utilizafion Researdi.
Ngay nhdn bdi bdo: (E/07i2017 Ngay phan bien nhan x6t hdi bdo: 10/07/2017 Ngdy bdi bdo duoc dang: OS/09/2017