Изучено потребление антибактериальных препаратов резерва, назначаемых решением врачебной комиссии с участием врача-клинического фармаколога, в отделениях многопрофильной больницы. К антибактериальным препаратам резерва были отнесены: пиперациллин/тазобактам, цефоперазон/сульбактам, цефепим и цефтазидим, респираторные фторхинолоны, карбапенемы, гликопептиды, оксалидиноны, полимиксины, глицилциклины, а также все инъекционные системные антимикотики. Выявлена зависимость потребления данных препаратов от профиля отделения и характера выделяемой микробиоты. Произведен также анализ микробных патогенов, выделенных в отделениях центра. Для обработки материала использовали программу WHONET 5.4. Намечены пути оптимизации антибиотикотерапии. Намечены пути оптимизации антибиотикотерапии. Анализ потребления лекарственных препаратов проводился с использованием международного стандарта потребления (DDD-анализ-Defined Daily Doseустановленная суточная доза). Отделение трансплантации органов за год потребило более одной трети от всех антибактериальных препаратов резерва. DDD составило 1936, при общем объеме потребленных доз 5015. Наибольшее количество антибиотиков резерва потребляется в отделении трансплантации, где часто выделяются микробные патогены с высоким уровнем устойчивости к препаратам, наименьшее-в терапевтических, гинекологическом отделениях, отделении рентгенохирургических методов диагностики и лечения. Ключевые слова: антибиотики, микробиота, резистентность, потребление лекарственных препаратов.

The article presents the results of a study of potential drug interactions in the treatment of moderate and severe community-acquired pneumonia (CAP) in hospital settings. The study was conducted by analysis of treatment standards and data from real clinical practice regarding antimicrobial therapy. Methods. The study used the lists of drug products for medical use for the treatment of CAP (according to the standards of specialized medical care for moderate and severe CAP with complications). Also, the medical records of patients (n = 165) with CAP, hospitalized in hospitals of medical organizations (Nizhny Novgorod) were used. The study period was 2 years (2015 - 2016). The study included all patients admitted to the hospital during the analyzed period. CAP was treated in accordance with treatment standards. Results. The analysis of potential interactions of drugs used for moderate and severe CAP according to the treatment standards, showed that 27 and 72 drugs can be used, respectively. 325 potential interactions are possible in hospital settings for moderate CAP and 2,485 for severe CAP. According to the treatment standard, the number of minimally clinically significant potential interactions during the pharmacotherapy of moderate CAP in hospital settings is 8, the number moderately clinically significant interactions - 19; undesirable interactions - 7. In case of severe CAP, the number of potential interactions increases and amounts to 27 minimally clinically significant, 105 moderately clinically significant, and 41 undesirable. The analysis of the results of antimicrobial therapy in real clinical practice showed 4 therapeutic duplications (prescribing 2 β-lactam antibacterial drugs simultaneously) and 2 moderately clinically significant interactions during antimicrobial therapy in hospital 1. Only 1 therapeutic duplication was noted during antimicrobial therapy in hospital 2. Therapeutic overlap has been found between β-lactam antibacterial drugs (ceftaroline fosamil and meropenem). It is advisable to prescribe no more than one в-lactam antibacterial drug and it is inappropriate to include > 3 antimicrobial drugs in an antimicrobial regimen. Conclusion. Electronic databases simplify the selection of medicines and thus ensure the safe and effective use of registered drug interactions.

Objective: to conduct pharmacoepidemiological analysis and analysis of the costs of pharmacotherapy, taking into account the actual consumption of drugs in the real inpatient clinical practice at the federal center in Russia. Materials and methods. Data from the medical records of 14 patients with burn injury, who were hospitalized in 2018, was analyzed. Patients’ age was from 23 to 67 years (44,93 ± 14,66). Duration of hospitalization was from 17 to 62 days (35,93 ± 14,17). We calculated rate of prescription foe each drug and its share in general structure of all utilized drug courses (n = 460). We performed frequency analysis of prescription structure, DDD (defined daily doses) analysis, DU90% (Drug Utilization 90%) analysis, ABC-analysis and analysis of average cost of pharmacotherapy. Results. Most frequently used drugs, prescribed in 75-100% of all hospital cases, included 15 names, e.g. 2 antimicrobial drugs (vancomycin and amikacin), 19 were used commonly, including 4 antimicrobial drugs (co-trimoxazole, cefoperazone/sulbactam, tigecyclin and cefepime). Other drugs were used in less than 25% of cases. 33 drugs made 90% of all consumed NDDD, including 5 antimicrobial drugs (vancomycin, amikacin, co-trimoxazole, cefoperazone/sulbactam and tigecyclin). These drugs comprised 70,24% in the prescription structure. The cost of one DDD in DU90% segments (512,33 rubles) is 1,4 higher than in DU10% segment (649,34 rubles). Average cost of drugs included in DU90% group was 4735,89 rubles vs 4966,80 rubles for drugs from DU10% group. This finding shows positive tendency of burn injuries pharmacological treatment. Conclusion. We obtained the data, which can be used for comparison of real clinical practice costs with a current payment rates for medical care.

Формирование клинико-статистических групп для оплаты лечения злокачественных новообразований в модели 2019 года Доступность и фармакоэкономика инсулиновой терапии в странах с наибольшим количеством больных диабетом Российский опыт использования подходов к расчету потребности во врачебных кадрах