OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

A 32-year-old male patient with hyperplasia of mammary glands took 5 Rupishu tablets (乳癖舒片) orally thrice daily by himself for about 2 years. Due to the poor treatment effect, he received additional 7 Xiaojin capsules orally twice daily according to the doctor′s advice. The patient′s liver function was normal during the monotherapy with Rupishu tablets. After 50 days of medication with the 2 drugs, the patient developed dark urine and yellowish skin and pruritus. Twelve days later, laboratory tests showed alanine aminotransferase (ALT) 1 068 U/L, aspartate aminotransferase (AST) 562 U/L, total bilirubin (TBil) 106.9 μmol/L, direct bilirubin (DBil) 84 μmol/L, and alkaline phosphatase (ALP) 175 U/L. He was diagnosed as having severe drug-induced liver injury, which was considered to be associated with Xiaojin capsules. Then both drugs were discontinued. Magnesium isoglycyrrhizinate injection and adenosylmethionine for injection were given for liver protection. Twelve days later, laboratory tests showed ALT 163 U/L, AST 52 U/L, TBil 36.1μmol/L, DBil 21.7μmol/L, and ALP 142 U/L. After that, the patient took the above 2 drugs by himself again. Twenty days later, the symptoms above-mentioned and abnormal liver function recurred. Xiaojin capsules were stopped and anti-inflammatory and liver-protective treatments were given. Twenty-three days later, laboratory tests showed ALT 25 U/L, AST 19 U/L, TBil 14.3 μmol/L, DBil 3.6 μmol/L, and ALP 76 U/L.

A 32-year-old male patient with hyperplasia of mammary glands took 5 Rupishu tablets (乳癖舒片) orally thrice daily by himself for about 2 years. Due to the poor treatment effect, he received additional 7 Xiaojin capsules orally twice daily according to the doctor′s advice. The patient′s liver function was normal during the monotherapy with Rupishu tablets. After 50 days of medication with the 2 drugs, the patient developed dark urine and yellowish skin and pruritus. Twelve days later, laboratory tests showed alanine aminotransferase (ALT) 1 068 U/L, aspartate aminotransferase (AST) 562 U/L, total bilirubin (TBil) 106.9 μmol/L, direct bilirubin (DBil) 84 μmol/L, and alkaline phosphatase (ALP) 175 U/L. He was diagnosed as having severe drug-induced liver injury, which was considered to be associated with Xiaojin capsules. Then both drugs were discontinued. Magnesium isoglycyrrhizinate injection and adenosylmethionine for injection were given for liver protection. Twelve days later, laboratory tests showed ALT 163 U/L, AST 52 U/L, TBil 36.1μmol/L, DBil 21.7μmol/L, and ALP 142 U/L. After that, the patient took the above 2 drugs by himself again. Twenty days later, the symptoms above-mentioned and abnormal liver function recurred. Xiaojin capsules were stopped and anti-inflammatory and liver-protective treatments were given. Twenty-three days later, laboratory tests showed ALT 25 U/L, AST 19 U/L, TBil 14.3 μmol/L, DBil 3.6 μmol/L, and ALP 76 U/L.