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РАЦИОНАЛЬНОЕ ПРИМЕНЕНИЕ АНТИБИОТИКОВ
Антимикробные препараты – лекарственные средства, основу которых составляют химические со-
единения природного или искусственного происхождения, обладающие избирательной активностью
в отношении микроорганизмов (бактерий, вирусов, грибов и простейших) [1]. Наибольшее значение в
контексте ИСМП имеют антибактериальные препараты – антибиотики, которым в данном разделе уде-
лено основное внимание.
Цель рационального применения антибиотиков – оптимизация назначения антимикробных средств
для снижения антибиотикорезистентности, улучшения исходов и безопасности лечения пациентов, а
также повышения экономической обоснованности терапии.
Даже в одной стране между медицинскими учреждениями существуют значительные различия в под-
ходах к назначению антибиотиков, особенно антибиотиков широкого спектра действия [2]. Результаты
исследований показывают, что почти в 50% случаев назначение антибиотиков не оправданно, при этом
расходы на антибиотики поглощают 30% от всех расходов на медикаменты [3–6]. Особенно важно внед-
рение рационального использования антибиотиков в отделениях интенсивной терапии и реанимации.
В этих отделениях пациентам, особенно новорожденным, часто и длительно назначаются антибиотики,
нередко без обоснованных показаний.
Анализ эффективности назначений антибиотиков проводится в медицинских учреждениях на осно-
вании данных историй болезни, электронного контроля назначений лекарственных средств и опроса па-
циентов. Оцениваются частота назначений антибиотиков, выбор препаратов, дозы, продолжительность
терапии.
С позиций эпидемиологического контроля в акушерских стационарах особенно важно рассмотреть
вопросы антибиотикопрофилактики у женщин и детей.
Антибиотикопрофилактика при проведении кесарева сечения
Послеродовые инфекционные осложнения являются одной из главных причин материнской заболе-
ваемости и смертности. Кесарево сечение наиболее часто по сравнению с другими хирургическими про-
цедурами приводит к послеоперационным инфекционным осложнениям [8–10]. В настоящее время при
85
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АНТИБИОТИКОВ И
АНТИБИОТИКОРЕЗИСТЕНТНОСТЬ
Раздел
5
Стратегия рационального использования антибиотиков у женщин и новорожденных включает
следующие компоненты [7]:
•
разработку и внедрение протоколов назначения антибиотиков и регулярное их обновление
по мере получения данных доказательной медицины с привлечением врачей различных спе-
циальностей (клинических фармакологов, инфекционистов, микробиологов);
•
обучение врачей рациональному использованию антибиотиков;
•
внедрение электронных формуляров в стационарах с обоснованными ограничениями назначе-
ния антибиотиков;
•
назначение антибиотиков только по показаниям и в соответствии с инструкциями;
•
преимущественное назначение антибиотиков первого ряда;
•
ограничение использования антибиотиков резерва;
•
использование в первую очередь оральных форм антибиотиков;
•
оценку чувствительности патогенов к антибиотикам;
•
информирование женщин о назначении антибиотиков им и/или их детям;
•
регулярный мониторинг и контроль назначения антибиотиков.