Estudio de utilización de fenazopiridina en la atención médica ambulatoria en la seguridad social / Phenazopyridine: A drug utilization research in the Costa Rican Social Security

Justificación: fenazopiridina es un medicamento analgésico urinario oral; cuenta con una amplia experiencia histórica de uso y, bajo el paradigma de medicina basada en evidencia, tiene poco fundamento de alta calidad para sustentar su valor terapéutico. Objetivo: analizar el perfil de la utilización de la fenazopiridina en la práctica clínica habitual dentro de la Seguridad Social, a nivel de consulta ambulatoria, en los tres niveles de atención y por un periodo de 30 días. Procedimientos: en enero de 2011, en una unidad de cada nivel de atención: Área de Salud de Santa Bárbara, Clínica Dr. Carlos Durán y Hospital Dr. Calderón Guardia, se analizó el reporte de despacho por farmacia de la fenazopiridina, con el fin de preparar un perfil cuantitativo. En el análisis cualitativo de la prescripción, se revisó una muestra al azar de 30 expedientes de pacientes atendidos durante ese periodo en cada unidad, con un formulario prediseñado para el efecto. Resultados: durante 1 mes, tres unidades despacharon 381 prescripciones a los pacientes, mayormente mujeres. La prescripción varió entre 3 y 90 tabletas; la mayoría (60,43%) con solo 10 tabletas para tratamiento. Se documentó la anotación del medicamento y la dosis en un 54,55% de los expedientes. La dosis diaria prescrita (DDP) fue 100 mg TID, equivalente a 300 mg/d, en la mitad de los pacientes, y en las unidades del primer y segundo nivel de atención; seguida de 100 mg BID (33,33%). Un 54,55% de los pacientes tenían diagnóstico de infección del tracto urinario (89% mujeres); de estos, un 89,89% recibió también antibióticos. La duración varió entre 1 y 30 días, y se prolongó más en unidades del segundo y tercer nivel. Conclusión: la utilización es parcial y razonablemente adecuada, apoya el supuesto de efectividad seguridad, sobre todo en el contexto de la atención médica en el primero y segundo niveles de atención. La diversidad en los hábitos de prescripción requiere mejorar su empleo y desarrollar ...

Background: Phenazopiridine is an oral urinary tract analgesic; an extensive historical experience of use and, under the paradigm of evidence-based medicine, its therapeutic value is not supported by high quality explanations. Aim: To analyze the use of phenazopiridine in everyday clinical practice, at an ambulatory level, in the three different levels of attention in the Costa Rican social security during a period of 30 days. Methods: In January 2011, electronic pharmacy records from a first, second and third level health center; Health Area of Santa Barbara, Dr. Carlos Durán Clinic and Dr. Calderón Guardia Hospital, respectively, were obtained to establish the quantitative characteristics of the prescription of phenazopiridine. For the qualitative analysis of the prescription, a random sample of 30 medical records of patients treated during that period in each unit was considered using an instrument previously designed for said task. Results: During one month, three study units prescribed phenazopiridine to 381 patients, mostly females. Prescription varied from 3 to 90 tablets; most patients (60.43%) received only 10 tablets for their treatment regime. In 54.55% of the medical records, the diagnosis and prescription was documented. The daily-prescribed dose (DPD) was 100mg thrice a day, equivalent to 300mg per day in half of the patients; and in the first and second level of attention followed by 100mg twice a day (33.3%). A total of 55.4% of the patients had been diagnosed with urinary tract infection (89% female); of these an 89.9% received also antibiotic treatment. The duration of treatment varied between 1 to 30 days, with more prolonged use in the second and third level of attention. Conclusion: The use of phenazopiridine is partial and reasonably adequate, thus supporting the efficacy-safety criteria in the context of first and second level attention centers. The diversity in the prescription patterns requires improvement in ...

Falla renal aguda por fenazopiridina / Acute renal failure caused by phenazopyridine

A 27 years old woman was admitted due to abdominal cramps, jaundice and oligoanuria, starting 48 hours after eating Chinese food. Hepatic biochemical tests, abdominal ultrasound and retrograde pyelography were normal. The urine was intensely orange colored and microscopic analysis was normal. The serum creatinine and urea nitrogen on admission were 4.59 and 42.5 mg/dl and rose to 13.5 and 72.4 mg/dl, respectively, at the 6th hospital day. Oliguria lasted only 48 hours. Dialysis was not used, since the patient was in good general condition and uremic symptoms were absent. On the 7th day, azotemia began to subside and at the 14th day, serum creatinine was 1.0 mg/dl. Before hospital discharge, she confessed the ingestion of 2.000 mg of phenazopyridine, during a nervous breakdown, aiming to sleep deeply. Remarkable was the persistence of the orange color of her urine during several days and the dissociation between the rate of increase of serum creatinine with respect to urea nitrogen. This is an unusual case of acute renal failure caused by an overdose of a drug, commonly prescribed for urinary tract infections.

Estudo comparativo entre a associaçäo sulfametoxazol-trimetoprim-fenilazopiridina (Uro Bactrim F) e o norfloxacin no tratamento de infecçöes urinárias agudas / Comparative study between the association of sulfamethoxazole-trimethoprim-phenazopyridine (Uro Bactrim F) and norfloxacin in the treatment of urinary tract infections

Foram selecionados para um estudo aberto, paralelo, comparativo e randomizado 40 pacientes portadores de infecçöes agudas do trato urinário inferior. Cada grupo foi composto de 20 pacientes sendo o primeiro tratado com a associaçäo sulfametoxazol-trimetoprim-fenilazopiridina (Uro Bactrim FR) e o segundo com norfloxacin. O objeto principal deste estudo foi o de avaliarmos o tempo necessário para analgesia com a fenilazopiridina, um dos componentes ativos do Uro Bactrim FR, assim como avaliarmos a eficácia e tolerância de ambos os tratamentos. As avaliaçöes clínicas foram realizadas diariamente, durante os cinco primeiros dias e no final do tratamento (10§ dia). O exame simples de urina assim como cultura e antibiograma foram realizados antes e no 3§ ou 5§ dias após o tratamento. A urinocultura prévia do tratamento revelou 17 casos de E. coli, um caso de P. mirabilis, um caso de S. epidermidis e um caso de S. faecalis no primeiro grupo; no grupo tratado com norfloxacin, observou-se 10 casos de E. coli, dois casos de S. faecalis, um caso de S. aureus, seis casos de Proteus sp. e um caso de Enterobacter. Todos os pacientes obtiveram negativaçäo bacteriológica após o tratamento. O estudo estatístico dos parâmetros clínicos demonstrou diferença estatisticamente significativa nos parâmetros referentes a estrangúria e disúria em favor do grupo tratado com a associaçäo sulfametoxazol-trimetoprim-fenilazopiridina. Conclui-se que o menor tempo necessário para analgesia, aliado à boa eficácia e tolerância da associaçäo sulfametoxazol-trimetoprim-fenilazopiridina indicam esse medicamento como uma boa opçäo terapêutica para o tratamento de infecçöes urinárias agudas