Rational use of antibiotics to ensure health
2022-05-06
"Doctor, I have a sore throat. Please prescribe me some antibiotics." "Check the blood picture first. You can only open it if you have an infection." Not long ago, Xu Xiaoai, a resident living in Chaoyang District, Beijing, went to Shuangjing Community Health Service Center for treatment, and was rejected by the doctor on duty. Xu Xiaoai sighed: "antibiotics are more and more strictly controlled!" The problem of drug resistance caused by the abuse of antibiotics has become a major challenge in the field of global public health. A report from the World Health Organization shows that at least 700000 people worldwide die of drug-resistant diseases every year. As the efficacy of key drugs decreases, the economic and health impact of drug resistance has gradually emerged. If countries do not take measures, mankind will face the disastrous impact of "uncontrolled drug resistance". In recent years, China has implemented key supervision on antibiotics, the clinical use and intensity of antibiotics have decreased significantly, and the level of rational drug use has been continuously improved, which has effectively guaranteed people's health. Establish a monitoring network for clinical application of antibiotics and bacterial drug resistance to curb the improper use of antibiotics "We went to three provinces to check the use of antibiotics. When we got off the plane, we went directly to the hospital to check the medical records and dosage. If there were any problems, we had an appointment immediately." Hu Yin, director of the national rational drug use monitoring office, clearly remembers the surprise inspection led by a team more than ten years ago. Hu Yin told reporters that there are six subclasses of systemic anti infective drugs, and the clinical use of antibiotics accounts for about 84%. China was once one of the countries with high use and intensity of antibiotics. In 2010, the amount of clinical use of antibiotics accounted for about 24% of the total amount of Western medicine. Promoting the rational use of antibiotics and finding out the "family background" is the premise. "Before the establishment of the clinical application monitoring network of antibiotics, there was a lack of systematic and reliable data on the use of antibiotics in China." Yang Xiaoqiang, a researcher of the pharmaceutical management research department of the Hospital Management Institute of the National Health Commission, said that in 2005, China began to establish a nationwide monitoring network for the clinical application of antibiotics and bacterial resistance. Up to now, the clinical application monitoring network of antibiotics has covered more than 7000 hospitals in 31 provinces, autonomous regions, municipalities directly under the central government and Xinjiang production and Construction Corps, and the bacterial resistance monitoring network has nearly 4000 member units. Through the "two networks" monitoring, the relevant departments can timely grasp the application of antibiotics and the change trend of bacterial drug resistance, which provides a reference and basis for formulating the application and management policies of antibiotics. Institutional norms are fundamental to curb the improper use of antibiotics. In 2016, multi departments jointly established a working mechanism for joint prevention and control of bacterial drug resistance, and regularly analyzed and judged the management of antibiotics and bacterial drug resistance in China. In recent years, the National Health Commission and other relevant departments have issued a series of targeted documents to regulate the use of antibiotics. For example, the administrative measures for clinical application of antibiotics implemented in August 2012 established a hierarchical management system for clinical application of antibiotics, defined the whole process working mechanism of antimicrobial selection, procurement, clinical use, monitoring and early warning, intervention and withdrawal in medical institutions, and stipulated supervision, management and legal responsibilities. The National Health Commission clearly requires that the rational use of antimicrobial drugs be included in hospital evaluation, public hospital performance assessment, rational drug use assessment and other work, and the assessment weight should be appropriately increased. The implementation of various policies and measures has effectively improved the irrational use of antibiotics. By the end of 2021, the proportion of the amount of clinical use of antibiotics in the total amount of Western medicine had decreased to about 11%. According to the data of the National Antimicrobial clinical application monitoring network, the utilization rate of antibiotics among inpatients in the center member units of the National Antimicrobial clinical application monitoring network decreased from 62.3% in 2011 to 34.1% in 2020; The use rate of antibiotics in outpatients also decreased from 16.2% in 2011 to 6.5% in 2020; In 2020, the use intensity of antibiotics decreased by 34% compared with 2011. The use and intensity of antibiotics decreased, but did not affect the level of infection control. The prevalence rate of nosocomial infection decreased from 3.2% in 2012 to 1.9% in 2020. Strengthen the management and professional guidance of internal medicine in the hospital, and improve the technical content of clinical use of antibiotics The scientific management of medical institutions is the key to promote the rational use of clinical antibiotics. Since 2015, many public hospitals across the country have successively carried out the work of "scientific management of antibiotics", optimized the management process, strengthened technical guidance, and made great efforts in the word "reasonable". "The Pharmaceutical Administration Committee of our hospital has specially set up an antibacterial working group to emphasize science at the stage of antibacterial drug selection." Zhang Bo, director of the pharmacy department of Peking Union Medical College Hospital, believes that this is the most front-end guarantee of rational drug use and also lays a foundation for subsequent scientific management. Moreover, Beijing Union Medical College Hospital has its own methods in the management of antibiotics, especially high-level antibiotics: no compulsory administrative intervention, and more emphasis on technical guidance. In December 2015, Beijing Union Medical College Hospital took the lead in carrying out the antibacterial drug management project for hospitalized patients in China. After completing the routine ward round at 9 a.m. every day, pharmacist Yang Yang will review the doctor's orders for the use of carbapenems and fluoroquinolones in the whole hospital. If there is no problem in the preliminary review, they will be released. If there is any doubt, they will discuss with the infection doctor and give specific suggestions on clinical medication. Li Taisheng, chairman of the infectious diseases branch of the Chinese Medical Association and director of the Infectious Medicine Department of Peking Union Medical College Hospital, told reporters that this multidisciplinary team was led by the medical department of the hospital, with the participation of more than a dozen experts from multiple departments and offices such as the hospital infection Office, the Infectious Medicine Department, the pharmacy department, the laboratory department and the information management center. The Infectious Medicine Department alone sent three experts, fan Hongwei, Zhou Baotong and Ge Ying. "When the drug selection, dosage and method are submitted, we will discuss with the pharmacist and give professional opinions." Fan Hongwei said that the opinions include many aspects. For example, antibiotics do not need to use the restriction level, patients with poor liver and kidney function need to adjust the dosage, and some need further examination to determine the medication. Written opinions will be formed for problems and timely feedback. According to Zhang Bo, these written opinions will be sent to the clinical departments, and the antibacterial working group will also track the infection control of patients and the adoption of opinions by doctors. The project has been implemented for more than 6 years, covering more than 20 departments and more than 40 wards, and the adoption rate of opinions is more than 60%. Technical guidance enables more clinicians to have a more accurate grasp of the rational use of antibiotics. Ge Ying told reporters that when the project was just launched, sometimes more than a dozen written opinions were issued a day. Now, sometimes even one opinion is not needed a day, which also reflects the improvement of doctors' medication level. "Originally, the clinical application management of antibiotics was mainly based on administrative intervention, but now it is gradually based on multidisciplinary and professional cooperation." According to Yang Xiaoqiang, by the end of 2020, 18 medical institutions have become the first batch of "research bases for antibacterial drug management evaluation of medical institutions". At present, more and more medical institutions have incorporated the scientific management of antibiotics into their daily work, and some county and municipal hospitals have also carried out the project. We are committed to the training of clinicians and pharmacists and public science popularization, and establish a long-term mechanism for the rational use of antibiotics In November 2020, a doctor in the emergency department of a third class hospital in Beijing was complained because he did not prescribe antibiotics to an elderly patient. The common cold patient took three kinds of antibiotics successively, which didn't work. I thought of receiving antibiotic drip treatment in the hospital. Unexpectedly, the doctor not only didn't prescribe it, but asked him to stop the previous antibiotics and only take drugs to improve his symptoms. Experts said that the doctor's treatment was not wrong. However, in life, misconceptions such as "take some antibiotics for prevention" and "get better quickly with advanced antibiotics" are common. In 2015, a World Health Organization survey showed that 61% of Chinese respondents believed that antibiotics could treat colds or influenza. The lack of public awareness of antibiotics and the people's wrong drug use habits have become the bottleneck to solve the problem of antibacterial drug abuse. In recent years, the National Health Commission has done a lot of work in health education and health literacy promotion, and has always focused on the publicity of rational drug use. For example, in the "world antimicrobial Awareness Week" in November every year, relevant popular science activities will be launched everywhere. Fan Hongwei suggested that doctors should also shoulder the responsibility of educating patients, strengthen the training of doctors' communication skills, and let patients accept the knowledge and concept of rational drug use. At the same time, we should educate patients with the actual effect of rational drug use. Antibiotics should be used reasonably in clinic, and the short board should be at the grass-roots level. Infection doctors, clinical microbiological inspectors and clinical pharmacists are the "iron triangle" of the technical support of antimicrobial management, while many grass-roots hospitals lack the support capacity of the "iron triangle", which directly affects the improvement of management level. Yang Xiaoqiang said that relevant training work has been carried out and has been inclined to the grass-roots level. At the same time, the expert group aiming at assistance also actively went deep into the grass-roots level to find problems in time and carry out capacity-building guidance. Li Taisheng told reporters that the "antibacterial drug management project study class" of Beijing Union Medical College Hospital has been carried out for five years. Through small class teaching, working groups and other forms, it has trained more than 150 professionals for the whole country. Since 2019, the Shanghai Expert Committee on clinical application and management of antibiotics has established more than a dozen on-site steering groups, successively went to 56 hospitals for on-site "consultation", helped hospitals find problems and shortcomings in the rational use and management of antibiotics, gave feedback one by one, and required hospitals to rectify in time. "Through special rectification, the clinical irrational use of antibiotics has been effectively curbed, but China has a vast region, and the gap of rational drug use between regions still exists, especially for special groups and children." Hu Yin said that we should establish a monitoring and long-term management mechanism for the rational use of antibiotics, improve the whole society's understanding of the harm of antibiotic abuse, and strive to safeguard people's health. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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