藥品使用評估是用藥品質保證的一個探究過程，以確保藥物使用是安全、合理、及有效的。本院兒科部參照健保局規範製訂一套抗生素管制作業流程，二線及以上之抗生素必須經過小兒感染專科醫師核准。因為carbapenem都用在嚴重感染症，評估小組針對住院病兒個案進行追蹤記錄與提供用藥建議，以確認用藥符合規範。評估期是民國九十一年九月至十二月，依據定立之評估訪視記錄表執行觀察、記錄與建議，當抗生素療程結束後完成該份記錄，最後進行統計分析與探討。結果是收案38名病患使用carbapenem療程共49人次，36人次使用Mepem。科別以新生兒科25人次最多，診斷以敗血症24人次最多。有15人次沒有檢出菌株，檢出菌株排名分別是Acinetobacter baumannii, Burkholderia cepacia及E. coli。有48人次在用過第一線或第二線抗生素後更換，因為多重感染併用抗黴菌或vancomycin。平均用藥天數13 9天，改善者32人次，治療失敗5人次，療效不明顯3人次，再度感染9位，校正週數在28週以內的9位個案中5位死亡。結論是透過兒科住院病患carbapenem藥品使用評估，用藥與評估準則大致相符合，評估小組將繼續針對仍有疑慮的用藥劑量問題，定出持續性追蹤評估機制讓carbapenem使用能夠合理且有效。
Introduction: Medication utilization evaluation is a performance improvement method that focuses on evaluating and improving the quality assurance of drug use. Carbapenem have been restricted by the CMUH for severe infections. The department of pediatrics formulated guidelines for second-line antibiotic use, so new antibiotics need to be approved before use by pediatric infectious disease physician. The MUE team conducted a study to survey the appropriateness of carbapenem usage in pediatric inpatients. Methods: This survey was conducted from September to December in 2002. Inpatients who had been treated with carbapenem were followed up and we documented the collected data on follow-up sheets. After finishing the treatment course, we collected data and analyze it. There were 38 patients with 49 treatment courses, and meropenem used in 36 treatment courses. There were 25 prematurities patients in the division of neonatology. The most frequent diagnosis was sepsis found in 24 treatment courses. There were 15 treatment courses had culture spacimen with negative finding. The most common cultured bacteria were Acinetobacter baumanni, Burkholderia cepacia and Escherichia coli. There were 48 treatment courses had changed antibiotics, and all of them went through the first and/or second-line antibiotic shift regulation. There were 36 treatment courses combined with antifungal agents or vancomycin due to the concern of multiple infections. The average regimen was 13±9 days. The outcome in numbers of treatment courses as successful, failure, intermediate, re-infection were 32, 5, 3 and 9. There were 5 deaths among 9 patients whose gestational age was less than 28 weeks. The concern of dug accumulation under the q8h regimen remains to be followed and identified in prematurities. Conclusion: Carbapenem usage mostly meet the guideline in pediatric inpatients, however the dosage used in our study needs to be studied further.
