From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics

Bin Zheng,Zhijian Hu,Maobai Liu,Na Li

doi:10.1186/s40360-018-0245-y

Abstract

BackgroundThis study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.MethodsUtilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred.ResultsThe indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels.ConclusionsThe ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.

Highlights

This study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system
The National Program of Special Renovation Activity on the Clinical Application of Antibiotics published by the NHFPC in 2012 [17] states that “the use rate (UR) should be no more than 60% and the use density (UD) should be controlled under 40 DDDs per 100 patient days in general hospitals”
The UD exceeded 40 DDDs and the UR were less than 60% in the departments of hematology, general surgery, nephrology, rheumatology, neurology, and burns

Summary

Introduction

This study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. The number of DDDs [2] and drug use density (DDDs per patient day [3], DDDs per 100 patient days [3,4,5,6], DDDs per 1000 patient days [7,8,9,10], DDDs per admission [3, 11], DDDs per 1000 admissions [3, 12, 13], or DDDs per operation [14]) established based on the ATC/DDD system have been widely used as important indicators of antibiotic utilization research. This article proposes a new indicator, i.e., ratio of use density to use rate (UD/UR), for the appropriateness evaluation of antibiotics and investigates its application at the macroscopic and microscopic levels

Objectives

Methods

Results

Discussion

Conclusion