抗生素管理計畫概論

Revisiting Antimicrobial Stewardship Program

10.6526/ICJ.202408_34(4).0003

賴昭誠(Chou-Cheng Lai)

抗生素管理計畫 ； 抗藥性 ； Antimicrobial stewardship programs

感染控制雜誌

34卷4期（2024 / 08 / 01）

237 - 246

繁體中文;英文

門診或是住院期間不當的使用抗生素，是造成社區抗藥性菌株以及多重抗藥性菌株出現的主要原因。抗生素管理計畫（antimicrobial stewardship program）應運而生，其目的在於維繫當前抗生素的效力，並且增進病人安全。本文首先探討最重要的兩項策略：事先審查（prior approval program）和事後審查（post-prescription review program）計畫，並分析其優缺點，與建議可以根據機構屬性、資源，考慮兩項策略並用。其次，門診抗生素使用其實占所有抗生素使用的最大宗。多面向策略包括教育、快篩及延遲處方等都已證明可以讓第一線門診醫師更合理使用抗生素。本文也探討了幾種抗生素管理計畫的成效評估指標，包括“定義每日劑量”（defined daily dose, DDDs），“治療天數”（days of therapy, DOTs），還有最近幾年發展更客觀的“結果排序和依據抗生素使用長短調整後之抗生素風險”（desirability of outcome ranking and response adjusted for duration of antibiotic risk, DOOR/RADAR）。最後提出對於國外實施抗生素管理計畫的觀察，以供參考。

The inappropriate use of antibiotics in outpatient or hospital settings is the main reason for the emergence of many community-acquired antibiotic-resistant bacteria and multidrug-resistant strains. Antimicrobial stewardship programs (ASP) have been developed to maintain the effectiveness of current antibiotics and improve patient safety and outcomes. This article discusses the two most important ASP strategies, the prior approval program and post-prescription review program, and analyzes their advantages and disadvantages in detail. This study also suggests that the two strategies can be implemented together based on different organizational settings and resources. Outpatient antibiotic use accounts for the largest proportion of all human antibiotic uses. Multifaceted strategies, including education, rapid screening, and delayed prescription enable first-line outpatient physicians to use antibiotics more appropriately. This article discusses several indicators for evaluating the effectiveness of antibiotic stewardship programs, including "defined daily doses" (DDDs), "days of therapy" (DOTs), and more recently developed, more objective "desirability of outcome ranking and response adjusted for duration of antibiotic risk " (DOOR/RADAR). Finally, the observations of the author regarding the implementation of ASP in the U.S. are provided.