目的： 探討住院的慢性腎臟疾病 (chronic kidney disease, CKD) 患者其抗生素的使用型態及劑量的適當性。方法： 從2008 年9 月至2009 年1月，採回溯性分析，納入條件為年齡大於18 歲，使用標的19 種抗生素，且血清肌酸酐值 (creatinine, Cr) ≥ 1 mg/dL 之病患的抗生素處方。將病人依Cr 值分為二組，A 組為Cr ≤ 1.5mg/dL，B 組為Cr > 1.5 mg/dL，以肌酸酐清除率 (creatinine clearance, CrCl) 作為劑量適當性判斷的依據。
結果： 納入分析處方共7,381 筆，平均31.5% 的處方劑量偏高，最高為amikacin 80.3%、最低為ampicillin/sulbactam 2.7%。劑量偏高處方的比例A 組為32.3%，高於B 組的30.9% (p < 0.001)。後線抗生素如：cefotaxime、ciprofloxacin、fluconazole、levofloxacin、piperacillin/tazobactam、teicoplanin，其劑量偏高處方的比例在A 組高於B 組 (p < 0.05)。劑量偏高處方的平均年齡73.2 歲，高於劑量適當處方的72.8 歲(p < 0.001)；劑量偏高處方平均體重55.5 kg，及平均Cr 2.5 mg/dL，皆低於劑量適當處方的56.9 kg 及Cr2.7 mg/dL (p < 0.05)。
結論： 抗生素劑量調整的適當性，實際計算病人的CrCl會優於只依據病患的Cr，尤其是在Cr ≤ 1.5 mg/dL的病人。
Objective: To investigate antibiotic prescription patterns and dosage appropriateness among hospitalized patients with chronic kidney disease (CKD).
Methods: Retrospectively, prescriptions of 19 targeted antibiotics in hospitalized patients, enrolled from September 2008 to January 2009, were analyzed in this study. The patients, 18 years and older with serum creatinine (Cr) values > 1 mg/dL, were divided into two groups according to their serum Cr values (group A ≤ 1.5 mg/dL, or group B ＞ 1.5 mg/dL). The appropriateness of the dosage was determined by their creatinine clearance (CrCl).
Result: A total of 7,381 prescriptions were studied. Among them 31.5% had their dosages higher than the CrCl estimated dosage, ranging from 80.3% (amikacin) to 2.7% (ampicillin/sulbactam).The percentage of higher dose is more common in group A (32.3%) than group B (30.9%, p < 0.001). Higher dosage is more common in group A in the usage of second line antibictics such as cefotaxime, ciprofloxacin, fluconazole, levofloxacin, piperacillin/tazobactam, and teicoplanin (p < 0.05). The age (73.2 yrs) of patients with inappropriate dosage prescriptions was higher than the age (72.8 yrs) of patients with appropriate dosage (p < 0.001). The average body weight (55.5 kg) and the average Cr value (2.5 mg/dL) in patients with inappropriate dosage prescriptions were lower than those patients with appropriate dosage (56.9kg, 2.7mg/dL, respectively, p < 0.05).
Conclusion: The adjustment of dosage of antibiotics may be more appropriate by evaluating patient’s renal function than by relying on patient’s serum creatinine level alone, especially in patients with their serum creatinine level ≤ 1.5mg/dL.
