Effect of clinical pharmacists in the antimicrobial management: a systematic review and meta-analysis
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摘要: 目的 评价临床药师参与医院抗菌药物管理的方式及效果,为临床药师更好的开展药学服用提供参考。 方法 计算机系统检索PubMed、Cochrane、Embase、CNKI、Wanfang、VIP、CBM数据库,检索时限均为建库至2017年6月,收集临床药师干预抗菌药物管理的随机对照试验,由2名研究员独立地按照事先制定好的纳入排除标准进行文献筛选、数据提取与文献质量评价,并采用Revman 5.3软件进行Meta分析。 结果 本研究共纳入8个RCT,包括2 737例患者。Meta分析结果显示,临床药师干预组患者的平均住院时间[WMD=-1.96,95%CI(-3.39,-0.52),P=0.007]、抗菌药物应用合理率[RR=2.09,95%CI(1.15,3.79),P=0.021]和抗菌药物费用[WMD=-125.51,95%CI(-172.49,-78.52),P<0.001]均优于常规治疗组,但2组间抗菌药物用药时间[WMD=-1.3,95%CI(-2.77,0.17),P=0.082]的差异无统计学意义。 结论 临床药师干预抗菌药物管理能明显缩短患者住院时间、提高抗菌药物应用合理率以及减少抗菌药物费用。Abstract: Objective To investigate the effectiveness of pharmacists' interventions on antibiotic use, so as to provide reference for the development of pharmaceutical care by clinical pharmacists. Methods We searched PubMed, the Cochrane Library, Embase, CNKI, Wanfang, VIP, CBM to June in 2017 for RCTs about pharmacists' interventions on antimicrobial management. Relevant data and carried out risk-of-bias assessments were extracted by two reviewers working independently. The Meta analysis was performed by using RevMan 5.3 software. Results Total 8 RCTs involving 2 737 patients were analyzed. The meta-analysis indicated that the pharmacists' intervention teams may shorten length of hospitalization[WMD=-1.96, 95% CI(-3.39, -0.52), P=0.007], improve the proportion of appropriate antimicrobial prescriptions[RR=2.09, 95% CI(1.15, 3.79), P=0.021], reduce the cost of antibiotics[WMD=-125.51, 95% CI(-172.49, -78.52), P<0.001], compared with the control teams. But there was no significant difference in the duration of antibiotics therapy between the two teams[WMD=-1.3, 95% CI(-2.77, 0.17),P=0.082]. Conclusion pharmacists' intervention may significantly shorten length of hospitalization, improve the proportion of appropriate antimicrobial prescriptions, and reduce the cost of antibiotics.
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Key words:
- Clinical pharmacists /
- Antimicrobial management /
- Antibiotics /
- Meta-analysis
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