| Background:As a major tool for the prevention and treatment of infectious diseases, the antibacterial drugs are commonly used in hospitals. But over the past twenty years, the irrational administration of antibacterial drugs become more and more serious around the world, which not only leads to heavier economic and health burden on inpatients, but also increases bacterial resistance, worsens the global environment and results in other serious social problems. Irrational administration of antibacterial drugs has become a major global public health problem.Understanding the current situation of the clinical use of antibacterial drug and analyzing the influence factors of the clinical use of antibacterial drugs are the basis for promoting the rational use of antibacterial drugs. Existing literatures reports that most domestic studies are limited to the research of using antibacterial drugs within a certain group or on a certain date, while there is no such a detailed study for the antibacterial use and utility trends of a relatively fixed population, let alone the lack of study about antibacterial drugs use before and after implementation of the "Guiding Principles of clinical use of antibiotics". So it is difficult to accurately and fully reflect the antibacterial drugs use of inpatients under the circumstances.Objective:The objectives of this study are to investigate the situation and trends of antibacterial drugs use from 2003 to 2009, fully reveal the current constitution, changes and economic burden of antibacterial drugs administration, analyze the main factors affecting the current situation, and develop proper interventions to reduce the irrational administration of antibacterial drugs. Specific objectives are:(1) To employ a comprehensive analysis on the situation and trends of prescription rate, combination administration, administration route, bacterial culture, drug type of antibacterial drugs of inpatients in 102 hospitals from 2003 to 2009.(2) To evaluate the economic burden of antibacterial drugs on inpatients, and the composition of the economic burden of various antibacterial drugs on patients as well as its trend of change. (3) By analyzing the value of various types of DDDs of antibacterial drugs, to describe the total usage, composition and change trends of antibacterial drugs, calculate DDDc (medication daily price), evaluate the economic burden, analyze DDDs value per thousand inpatients, and compare those data with international data.(4) By analyzing the antibacterial drugs administration of patients with simple goiter and puerperal to the administration of antibiotics of patients with reflect antibiotics administration of patients with clearing operation. By analyzing antibacterial drugs administration of acute simple appendicitis patients with different types of payment to reveal how medical insurance payment influences antibacterial drugs administration.(5) To analyze the administration status of levofloxacin which is most frequently prescribed and Cefoperazone Sulbactam which costs patients most.Methods:A retrospective study is applied to conduct a full-sample analysis.(1) Subjects:the subjects of this study are in-patients which are hospitalized from January 1,2003 to December 31,2009; those patients are covered by Hunan provincial basic medical insurance which is managed by Medical Insurance Bureau of Hunan Province. The number of the insured staff is 200?300 thousand per year; 7-year cumulative insured staffs are 1.8041 million. Using full sample analysis, the antibiotics administration situation of 245322 in-patients are studied in this study.(2) Data sources and its composition:Data from this paper comes from the management information system database of Medical Insurance Bureau of Hunan Province. This system is directly connected with the hospital information system (HIS) system, and automatically access data from the HIS system to settle on medical insurance expenses. As for those hospitals which has no hospital HIS system, medication administration, medical services and expenses are faithfully recorded into system. The research data was directly exported from the medical insurance management information system by software developers.Coding systems introduced into this study are:disease coding-ICD-10 International Classification of Diseases; fees and payment code are defined by software development company (Chuangzhi Company); other codes, such as gender, therapeutic effect is national standard codes.Data include:general data (name, gender, age, nationality, civil servants level, work status, nature of one's work, visiting hospital, the level of visiting hospital, clinical diagnosis ICD-10 classification, admission date, discharge date, length of hospitalization stay and therapeutic effect), medical expense (including medicine fees, surgery fees), name, dosage forms, specifications, quantities, administration methods of antimicrobial drug, antimicrobial drug costs, time and cost of clinical microbiological examination (including pathogenic microorganisms microscopy, culture, identification and drug sensitivity test).(3) Authenticity:including routine Authenticity and research sampling principles.?Medical insurance staff do sampling check on the medical records of 5%-10% inpatients every month, matching the actual inpatient treatment programs, drug amounts and costs of medical insurance. Only data in medical record is in accordance with the medical insurance system, accounts can be settled;?In this study, the researchers took 1‰data to match with the hospital medical records one by one for data verification, so as to make sure the accuracy of the data, then statistical analysis was conducted?(4) Selection criteria:the data of insured inpatients was cleaned up; data that fits with one of the following conditions should be deleted:?The absence of the main variables in the analysis (such as:discharge time, age, diagnosis, ICD-10 antimicrobial drug administration, etc.);?Hospitalization outside Changsha city;?hospitalization costs less than 100 Yuan;?Hospital stay is less than 1 day;?The sum of every hospital expense is not equal to the total cost;?The payment of fees and not equal to the total cost.?The patient is younger than 18 years old;?The sum of the cost of antimicrobial agents is negative.(5) Data processing:?Delete data in accordance with the screening criteria.?Focus on translating the name and specifications of antibiotics. Before "Prescription Management Principles" took into effect in 2008, hospital prescription drugs were recorded in their trade names, which have brought great difficulties to the statistical analysis. Thus each brand name was changed into a common name in this study, and each drug was coded in accordance with the chemical structure and classification of the World Health Organization (i.e., ATC code), while specification was conversed to unified international units in accordance with the ATC/DDD, then statistical analysis was conducted.(6) Analysis methods:Hospital cost data, often on positively skewed distribution, should be described with its central tendency and dispersion tendency using the median and interquartile range respectively. Considering the regulations of the Ministry of Health and the health sector's long-term habits, and the median of the non-additive, the median and arithmetic mean were given when described the cost in this study. Statistical methods include descriptive statistics, t test, ANOVA,?2 test, multiple regression analysis. Application of Kolmogorov-Simonov measurement data and Levine test to determine the normal distribution and the overall homogeneity of variance. Normal distribution was analyzed by Student's t test, non-normal distribution was analyzed by Mann-Whitney U test to compare the mean. Administration?2 test to analyze Count Data. Two-tailed P value, P< 0.05 was considered significant difference. DBF was administration for data conversion, SPSS17.0 software for data processing and statistical analysis.(7) Quality control:The data comes from the management information system database of Medical Insurance Bureau of Hunan Province. Data capacity is abundant; its content is true and reliable; data was screened rigorously to ensure data accuracy and integrity. Data acquisition and conversion were monitored by a specific staff person who is responsible for Oracle database technology to ensure accurate data conversion process.Results:(A) General situation:A total of 240,2 thousand insured people had received treatment in 102 hospitals from 2003 to 2009, who participated in Hunan Province's basic medical insurance for urban workers. Among them,138 thousand were (57.45%) male patients,102.2 thousand (42.55%) were female patients, whose age ranged from 59.8 plus or minus 14.9 years old, and their hospitalized time almost 20.8 plus or minus 18.2 days on average. There are 130 thousand (54.12%) inpatients in 20 tertiary hospitals,68.3 thousand (28.46%) in 32 Second-level hospitals, and 41.8 thousand (17.43%) inpatients in First-level hospitals.88.1 thousand inpatients were occupied personnel, made up 36.70% of the total number, while 152 thousand retired inpatients which made up 63.30%.39,981 inpatients received operation, which accounted for 16.65% of all research numbers in this study. The number of receiving bacterial culture and sensitivity test were 33,772, which made up 14.06% of all research numbers.(B) The situation of using antimicrobial drugs1. The general situation of using antimicrobial drugs(1) The general situation:The number of using antimicrobial was 168,3 thousand, and the prescription rate is 70.07%. The main administration method is injection, which made up 92.19%. The inpatients who received treatment with antimicrobial agents administration average 2.66 kinds antimicrobial drugs. As for the prescription rate of Antimicrobial drugs, male patients was 71.02%, much higher than female patients whose prescription rate was 68.78%; for different age, the group of 20-30 year-old was the highest, whose prescription rate was 84.28%.While the group of 50-60 year-old was the lowest, whose prescription rate was 65.39%.Prescription rate of Antimicrobial drugs of occupied people was 72.89%, slightly higher than retired people (68.43%). The prescription rate of the people with lowest income levels (0-1000 Yuan per month) and those with the highest income levels (?5000 Yuan per month) were 72.65% and 72.39% respectively, slightly higher than people with other income level.(2) Situations in different levels of hospitals:The prescription rate in first-class hospitals was the highest (73.15%). The second-class hospitals were in the middle (71.36%). The third-class hospitals were the lowest (68.39%). The prescription rate of antimicrobial drugs of non-operational patients was 64.65%, obviously lower than operational patients (97.16%). Among 168,3 thousand clients using antibacterial drugs,33.8 thousand people had done bacterial cultivation (20.07%). Nearly 80% of the patients using antibacterial drugs did not have any bacterial cultivation or drug sensitive test. Doctors prescribe antibacterial drugs mainly based on their clinical experiences. The bacterial cultivation rate in first-class hospitals was the lowest (only 3.84%).the bacterial cultivation in the second-class hospital was the highest (30.09%), the third-class hospitals was in the middle (20.16%).(3) Situation of combination drugs:Hospitalized patients who apply antibacterial drugs apply 2.69 kinds'antibacterial drugs per inpatient. Among them,47.6 thousand patients use only one kind antibacterial drug, accounting for 28.29% of the total people of antibacterial drugs usage.71.71% of patients practice two or more kinds of antibacterial drugs.43.24% of the patients use three or more kinds of antibacterial drugs.60.09% of injective drugs patients administered two or more than two injective antibacterial drugs. There were 43.9 thousand patients who received there or more injective antibacterial drugs, accounting for 28.31%.2. Trends of antibacterial drugs administration:(1) Trends of the total prescription rate. The total prescription rate of antibacterial drugs decreased year by year between 2003 and 2009. The total prescription rate was 78.96% in 2003, decreased to 66.17% in 2008 and 66.26% in 2009.(2) Trends of administration route:the administration rate of oral drugs rose from 2003 to 2009. The administration n rate increased from 35.63% in 2003 to 38.72% in 2009, while the administration rate of injecting drugs fell from 73.91% in 2003 to 59.13% in 2009.(3) Trends of antibacterial drugs species:the antibacterial drugs species of per capita declined from 2003 to 2009, from 2.79 kinds per capita in 2003 per capita fell to 2.57 kinds in 2009. The injective antibacterial drugs species of per capita also significantly decreased from 2.22 kinds per capita in 2003 per capita fell to 1.71 kinds in 2009. During this period the species of oral antimicrobial drugs increased slightly, from 0.57 kinds in 2003 to 0.86 kinds in 2009.Combination administration rate of two and more than two kinds antibacterial drugs reduced from 70.64% to 74.36%, Combination administration rate of four and more than four kinds antibacterial drugs fell from 14.44% in 2003 to 10.74% in 2009.(4) Trends of the total prescription rate with different levels hospitals:the total prescription rate in the first-level hospitals decreased from 79.78% in 2003 to 71.61% in 2009. This declined trend also presented in the second-level hospitals, from 80.54% in 2003 to 67.80% in 2009. The most obvious decline was in tertiary hospitals, fell down from 78.24% in 2003 to 63.03% in 2009.(5) Trends of the bacterial cultivation rate:the bacterial cultivation rate increased slightly from 17.25% in 2003 to 21.86% in 2009.3. Antibacterial drugs constitution analysis:(1) The overall constitution of antibacterial drugs:The prescription rate of antibiotics was 64.6% (cephalosporin antibiotics was 45.72% and penicillin antibiotics was 25.48%), the prescription rate of synthetic antibacterial drugs was 36.57%. the prescription rate of Antifungal drugs and the drugs resisted of Mycobacterium were 4.93% and 1.82% respectively. The drugs which the prescription rates were in top three were levofloxacin (13.34%), cefotaxime (8.14%) and cefoperazone -sulbactam (8.03%).(2) The constitution of cephalosporin:the prescription rate of cephalosporin was 45.72%. The prescription rate of third-generation cephalosporin was the highest (36.64%). The administration frequency of cephalosporin was 156.7 thousand times. The patient's administration cephalosporin administrated 1.43 kinds cephalosporin. (3) The constitution of penicillin antibiotics:the prescription rate of penicillin was 25.48%, from 38.91% in 2003 decreased to 20.23% in 2009. The prescription rate of Narrow-spectrum penicillin was 4.76%, from 12.53% in 2003 decreased to 2.83 in 2009. the prescription rate of penicillin-resistant mold was 4.85%, down 2 percentage points; the highest prescription rates was broad-spectrum and compound penicillin (22.54%),which was 5 times of that of narrow spectrum penicillin and penicillin-resistant mold.(4) The constitution of synthetic antibacterial drugs:fluoroquinolones had the highest prescription rate (29.71%). There was a downward trend between 2003 and 2009, from 38.89% in 2003 down to 24.28% in 2009. Nitroimidazole (11.89%) followed fluoroquinolones. the prescription rate of other types of synthetic antibacterial drugs was low (1.29%).(5) The constitution of broad spectrum antibacterial drugs:the prescription rate of broad spectrum antibacterial drugs was 59.37%, from 62.43% in 2003 to 57.21% in 2009.2.19 kinds broad spectrum antibacterial drugs were administrated by patients who received broad spectrum antibacterial drugs therapy.4. Expense analysis of antibacterial drugs(1) The total expense of antibacterial drugs:the total expense of antibacterial drugs was 287 million Yuan from 2003 to 2009, which accounting for 17.53% of the total expense (1637 million Yuan) of inpatients who administrated antibacterial drugs, accounts for 41.17% of the medicine expense (679 million Yuan), and both the proportions decreased. The expense of antibiotics was 240 million Yuan, accounting for 83.03% of the total expense of antibacterial drugs. The expense of synthetic antibacterial drugs was 44 million Yuan, accounting for 15.23% of the total expense of antibacterial drugs. The expense of antifungal drugs and the drugs resisted of Mycobacterium respectively accounted for 0.24% and 1.49% of the total expense of antibacterial drugs.The proportion of antibacterial drugs expense in the medical expense decreased from 19.07% in 2003 down to 17.71% in 2009. The proportion of Antibacterial drugs expense in medicine expense also fell from 42.3% in 2003 to 40.62% in 2009.The expense of injective antibacterial drugs was 276 million Yuan, accounting for 95.25% of the total expense (287 million Yuan) of antibacterial drugs.(2) The expense of antibacterial drugs for different levels hospitals:per captia expense of antibacterial drugs (on average 2139.05yuan) in tertiary hospitals was highest. Second-class hospitals followed tertiary hospitals with on average 1445.36 Yuan. First-class hospitals were lowest with 863.30yuan. However, the rate of per captia expense of antibacterial drugs in medical expense was 27.24% in first-class hospitals, which was the highest rate. Second-class hospitals followed first-class hospitals (19.28%). tertiary-class hospitals was lowest with 16.29%.(3) The expense of different antibacterial drugs:The expense of Cephalosporin was 157 million Yuan, accounting for 65.7% of the expense of antibiotics and 54.37% of the expense of antibacterial drugs. The expense of penicillin was 47.95 million Yuan, accounting for 19.97% of the expense of antibiotics and 16.58% of the expense of antibacterial drugs. The expense of synthetics antibacterial drugs was 44.05 million Yuan, accounting for 15.23% of the expense of antibacterial drugs.According to expense, the top three antibacterial drugs are Cefoperazone sulbactam, levofloxacin, ceftazidime. Cephalosporins accounted 8 kinds in the top 10 drugs, in addition to second-generation cephalosporin---cefuroxime; others are three-generation cephalosporin. The top 10 antibacterial drugs were all broad-spectrum antibacterial drugs.(4) The expense of broad-spectrum antibacterial drugs:The total expense of broad-spectrum antibacterial drugs was 229 million Yuan, accounting for 79.15% of the expense of antibacterial drugs, which proportion declined from 83.56% in 2003 to 6.07% in 2009.(5) Antibacterial drugs expense of the population:every insured people consumed antibacterial drugs 160.32 Yuan every year, this expense increased from 130.22yuan in 2003 to 212.39 Yuan per person per year. The expense of injective antibacterial drugs every insured people consumed increased from 124.23 Yuan in 2003 to 196.73 Yuan per person per year. The expense of oral antibacterial drugs was 7.59yuan per person per year.5. Changes of antibacterial drugs DDDs(1) General situation:drug specifications can be got from only 1690 thousand patients in this study. The average DDDs of antibacterial drugs was 7.39. The DDDs of every kind antibacterial drug per time was 9.17 in the first-class hospitals, significantly higher than the secondary hospitals (6.9) and tertiary hospitals (6.81).(2) DDDs constitution of antibacterial drugs:cephalosporin DDDs (562.9 thousand) was the highest in all antibacterial drugs, which accounting for 45.10%total antibacterial drugs DDDs. Penicillin DDDs (264.0 thousand) followed cephalosporin, which accounting for 21.25%.the proportion of cephalosporin DDDs in total antibacterial drugs DDDs raised year by year, from 37.54% in 2003 to 51.03% in 2009.The broad spectrum and the compound penicillin DDDs (202.4 thousand) were the highest in Penicillin DDDs, accounting for 76.79% of Penicillin DDDs. the third-generation cephalosporin DDDs (440.9 thousand) were the highest in cephalosporin DDDs, accounting for 78.25% of Penicillin DDDs.According to DDDs, the three top antibacterial drugs were levofloxacin (127.2thousand DDDs, accounting for 10.19%of all antibacterial drugs DDDs), cefotaxime sodium (9.61%), and cefoperazone sulbactam sodium (6.57%).(3) DDDs of broad spectrum antibacterial drugs:the DDDs of broad spectrum injective antibacterial drugs were 257.2 thousand, which accounted for 82.25% of total antibacterial drugs DDDs in the same period. This proportion increased from 77.87% in 2003 to 84.39% in 2009.(4) Antibacterial drugs DDDs of the population:injective antibacterial drug DDDs per insured person per year was 1.39, which lightly rose from 1.2 in 2003 to 1.55 in 2009. Injective antibacterial drug DDDs per 100 bed-days was 57.58, which declined from 68.74 in 2003 to 54.11 in 2009.6. Antibacterial drugs administration in some diseases(1) Antibacterial drugs administration for patients with tuberous strums surgery: 665 inpatients with tuberous strums surgery administration antibacterial drugs, the prescription rate was 99.3%.665 inpatients received Injective antibacterial drugs therapy, the prescription rate was 97.90%. The species of antibacterial drugs were 1.92±0.90 on average. The expense of antibacterial drugs was 928 thousand Yuan, accounting for 18.76% of the total medical expense. The per capita expense of antibacterial drugs was 1374.87±841.79 Yuan, median was 1,407 Yuan. The expense of cephalosporin was 620.4 thousand Yuan, accounting for 67.16% of antibacterial drugs expense. The expense of penicillin antibiotics was 227.2 thousand Yuan, accounting for 22.72% of antibacterial drugs expense. The top three of prescription rate of antibacterial drugs were cefdinir (14.24%), penicillin (13.64%) and Cefonicid (11.24%). The top three of expense were Cefonicid, Bangladesh mezlocillin sulbactam and cephalosporins more esters.(2) Antibacterial drugs administration of inpatients with acute simple appendicitis in different medical insurance payment Antibacterial drugs prescription rate of 206 patients with appendicitis was 100%, average species of antibacterial drugs per patient were 2.83±1.19. injective antibacterial drugs prescription rate also was 100% and average species were 2.50. antibacterial drug average species of patients with single DRGS (diseases related groups) was 2.43±1.18, average species of patients with fee for service was 3.05±1.14. Average expense of patients with acute simple appendicitis was 1055.43±894.35 Yuan, accounting for 61.88% of per captia medical expense (1705.61yuan). The average expense of patients with fee for service was 1374.72±959.73 Yuan and that of patients with single DRGS was 485.78±283.08 Yuan. Frequency expense of cephalosporin, penicillin, Fluoroquinolones and nitroimidazole of patients with fee for service was higher than that of patients with single DRGS. Frequency expense of cephalosporin of patients with fee for service was 675.94 Yuan, which was 1.71 multiple high than that of patients with single DRGS.(3) Antibacterial drugs administration of parturient with fertility insurance during parturition:The total administration rate of antibacterial drugs was 99.84%.2.48±1.19 kinds of antibacterial drugs were administration on average as for parturient who administrated antibacterial drugs. The main administration route was injection; the rate of drug combination was 75.23%. prescription rate of antibacterial drugs of parturient with vaginal delivery was 90.4%,which was slightly lower than that of parturient with cesarean section(98.72%).1.95±1.06 kinds of antibacterial drugs on average were administrated by parturient with vaginal delivery, this number was much lower than that of parturient with cesarean section (2.84±1.13 kind of antibacterial drugs were administrated). The expense of antibacterial drugs accounts for 12.84% of the total medical expense of parturient who administrated antibacterial drugs, accounts for 55.92% of the medicine expense.7. Administration situation of levofloxacin and cefoperazone sulbactam(1) Levofloxacin:Prescription rate of levofloxacin on average was 13.34%, which was the highest prescription rate in all antibacterial drugs. Prescription rate of levofloxacin increased year by year in the first-class hospitals, which was 17.36% between 2003 and 2009. However, prescription rate was decreased year by year in the second-class and tertiary hospitals, which were 15.28% and 11.03% respectively on average. The total expense of levofloxacin was 16.12 million Yuan. The expense of injective levofloxacin was 14.70 million Yuan, accounting for 91.15% of the total expense of levofloxacin. Attendance expense of injective levofloxacin was 691.38 Yuan in 2003, which was declined year by year, the expense was 342.62 Yuan in 2009.every insured person consumed 8.15 injective levofloxacin on average.The DDD of levofloxacin was 7.34 on average between 2003 and 2009. The DDD is the largest in first-class hospitals (8.97), followed by the second-class hospitals (7.43). The DDD is the lowest in tertiary hospitals (5.92). DDDc is the daily dose price, reflecting the economic burden of the drug. The DDDc of levofloxacin was 64.54 Yuan on average between 2003 and 2009, this number decreased from 116.29 Yuan in 2003 to 42.06yuan in 2009. The DDDc of levofloxacin was. the highest in tertiary hospitals (91.37yuan), followed by that of the second-class hospitals (63.84yuan). The DDDc was the lowest in the first-class hospitals (30.41 Yuan).(2) Cefoperazone sulbactam:the total expense of cefoperazone sulbactam was the highest in all antibacterial drugs in this study. Prescription rate of cefoperazone sulbactam was 8.03% on average. The total expense of this drug was 20.63 million Yuan, accounting for 7.49% of the expense of injective antibacterial drugs. Attendance expense of cefoperazone sulbactam was 1828.13 Yuan in 2003, which was declined year by year; the expense was 794.27 Yuan until 2006. After that the expense was increased,342.62 Yuan in 2009.The DDD of cefoperazone sulbactam was 7.97 on average between 2003 and 2009. The DDD is the largest in tertiary hospitals (8.59), followed by the second-class hospitals (7.93). The DDD is the lowest in the first-class hospitals (7.03). The DDDc of cefoperazone sulbactam was 134.14 Yuan on average between 2003 and 2009, and this number decreased from 222.57yuan in 2003 to 124.83 Yuan in 2009.Conclusion(1) Prescription rate of antibacterial drugs was 70.7%; The high rate of injection administration, The high rate of combination drugs, The low rate of bacterial cultivation and drug sensitive test, Prescription rate of broad spectrum antibacterial drugs was 59.37%, njective antibacterial drug DDDs per 100 bed-days was 57.58.(2) Prescription rate of antibiotics, synthetic antibacterial drugs were 64.40%, 36.57% respectively. Prescription rate of levofloxacin on average was 13.34%, which was the highest prescription rate in all antibacterial drugs. The total expense of cefoperazone sulbactam was the highest in all antibacterial drugs in this study, accounting for 7.49% of the expense of injective antibacterial drugs.(3) The medical expense and medicine expense per captia who administrated antibacterial drugs were higher than these of who didn't administrated antibacterial drugs. Every insured people consumed antibacterial drugs 160.32 Yuan every year on average in this study.(4) The trend of prescription of antibacterial drugs between 2003 and 2009 includes:Prescription rate of antibacterial drugs, the rate of injection administration, the kinds'antibacterial drugs per inpatient, the prescription rate of broad spectrum antibacterial drugs, the antibacterial drugs DDDs per captia and DDDc decreased year by year;(5)Medical insurance payment, salary, operation, age and hospitalization period are main factors influencing antibacterial drugs administration.The major innovative points(1) This study analyzes and assesses the trend of prescription rate of anti-bacterial drugs and the constitution of anti-bacterial drugs of inpatients from 2003-2009.(2) For the first time in China, the study depicts the changing trend of DDDs per capita, DDDs per 100 bed-days, and DDDs per inhabitant per year of antibacterial drug of inpatient during 7 years.(3) This study researches the cost burden of inpatient using antimicrobial drugs and reports the financial burden and its trend of antimicrobial drug of the whole population for the first time in china.(4) This study analyzes the impact of the different medical insurance payment on antimicrobial drugs administration and cost burden... |
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