Variaciones en el consumo de medicamentos para la salud mental en una unidad de atención primaria brasileña: ¿hay influencia de la pandemia? / Variations in the consumption of mental health medications in a brazilian primary care unit: is there influence of the pandemic?

Introducción: La pandemia de COVID-19 ha generado la necesidad de ajustes y adaptaciones en diversas áreas, desde el comportamiento hasta la normativa, con grandes repercusiones en términos de salud pública. Objetivo: Comparar los consumos promedio mensuales (CPM) de medicamentos de control especial utilizados para la salud mental antes y durante la pandemia en una Unidad Básica de Salud (UBS) en el Distrito Federal, Brasil. Métodos: Los consumos se obtuvieron a través del sistema de gestión de inventarios local y el CPM (±desviación estándar) se calculó sin tener en cuenta los meses de desabastecimiento, considerando el período de 2020 a 2022. Como parámetro comparativo, se utilizó el CPM±DE de 2019. Resultados: Se analizaron los consumos de 32 medicamentos, siendo la mayoría antiepilépticos (N=10; 31,2 %), antidepresivos (N=10; 31,2 %) y antipsicóticos (N=8; 25,0 %). Se observó que más de la mitad de los medicamentos analizados (n=18; 56,3 %) mantuvieron un aumento en el consumo a lo largo de los años de la pandemia. Conclusión: Hubo una variación significativa en el consumo de medicamentos sujetos a control especial en la UBS durante la pandemia. Estos resultados pueden estar asociados a diversos factores, como el aumento de los cuadros clínicos que justifican su prescripción, en línea con la literatura actual sobre el impacto potencial del aislamiento social y las medidas tomadas por las autoridades competentes para contener la propagación del virus SARS-COV-2. (AU)

Introduction: The COVID-19 pandemic has generated the need for adjustments and adaptations in various areas, from behaviour to regulations, with significant repercussions in terms of public health. Objective: To compare the monthly average consumption (MAC) of special control medications used for mental health before and during the pandemic in a Basic Health Unit (UBS) in the Federal District, Brazil. Methods: Consumption data were obtained through the local inventory management system, and the MAC (±stan-dard deviation) was calculated excluding months of stockouts, considering the period from 2020 to 2022. The MAC±SD of 2019 was used as a comparative parameter. Results: Consumption of 32 medications was analyzed, with the majority being antiepileptics (N=10; 31.2 %), anti-depressants (N=10; 31.2 %), and antipsychotics (N=8; 25.0 %). It was observed that more than half of the analyzed medications (n=18; 56.3 %) maintained an increase in consumption throughout the pandemic years. Conclusion: There was a significant variation in the consumption of special control medications at the UBS during the pandemic. These results may be associated with various factors, such as the increase in clinical conditions justi-fying their prescription, in line with current literature on the potential impact of social isolation and measures taken by competent authorities to contain the spread of the SARS-CoV-2 virus. (AU)

Trends in Scientific Production on Pharmaceutical Follow-up andthe Dader Method / Tendencias en la producción científica sobre el seguimiento farmacéutico y el método Dader

Objective: Pharmacotherapeutic Follow-up is the Professional Pharmaceutical Care Service aimed at detecting Drug-Related Problems for the prevention and resolution of negative medicine outcomes. The Dader Method is considered a clear and simple tool to develop Pharmacotherapeutic Follow-up. This research aims to analyze the evolution of the international scientific production related to Pharmacotherapeutic Follow-up and the Dader Method to show the current situation of this Professional Pharmacy Assistance Service. In addition, from the data obtained, we give a critical perspective on the implementation of the Dader Method in Community Pharmacy, considering its advantages and disadvantages based on the published scientific literature. Methods: Using bibliometrics tools, indicators were obtained to analyze the international production of scientific articles on Pharmacotherapeutic Followup and the Dader Method during the period (1999-2022) through the Scopus database. Results: The results showed a growth in the international scientific production of publications on Pharmacotherapeutic Follow-up, obtaining 30,287 papers, placing the United States, the United Kingdom, Australia, Canada and Spain as the five most productive countries. The publication of 83 papers on the Dader Method places Spain with the highest number of publications, followed by other Spanish or Portuguese speaking countries, among which Brazil and Colombia have the most prominent number of published papers in Latin America. The most frequent international journal covering the topic of Pharmacotherapeutic Follow-up was the American Journal of Health- Pharmacy (12.4%), while on the Dader Method, the journal Pharmaceutical Care Spain (21.7%) is in the first position, followed by Farmacia Hospitalaria (8.4%). Conclusion: The publications on the Dader method highlighs the greater productivity of the University of Granada and the author María José Faus Dáder. The inclusion of patients in the PTF service using the Dader Method, is more frequent in the hospital context, and is based on the presence of defined chronic pathologies (mainly diabetes), polymedication or specialized care follow-up, with elderly population being the most represented in all cases.(AU)

Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil.

Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.

Prescription, offer and access to medications for erectile dysfunction: a paradox in public health? / Prescrição, oferta e acesso aos medicamentos para disfunção erétil: um paradoxo na saúde pública?

This is an opinion-based article that aims to reflect on the antagonism established between the National Policy of Integral Attention to Men's Health (PNAISH) with specific focus on ED (Erectile Dysfunction), directed to access to medication. It is well-known that PNAISH presents objectives that go beyond sexual and reproductive health, especially, even after 13 years of its publication, since there was no incorporation of medications to treat ED within the SUS. This article was developed based on the scenario observed in the daily care of patients who undergo treatment in the Men's Health Outpatient Service of a High-Complexity Hospital. According to this perspective, it is important to emphasize, that the prescription of medications within the SUS should faithfully follow the Rename; as recommended by Decree 7,508, observing the Resolution SS-83 of 2015, in the state of São Paulo. This establishes that the cost of dispensing medications not included in the SUS pharmaceutical assistance protocols, through judicialization, prescribed by a physician in the state health network, may be funded by the institution to which this physician is affiliated.

Trata-se de um artigo embasado em opinião que procura refletir sobre o antagonismo estabelecido entre a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH) com o recorte específico para DE (Disfunção Erétil) direcionado ao acesso de medicamentos. É notório que a PNAISH apresenta objetivos que vão além da saúde sexual e reprodutiva, sobretudo, mesmo após 13 anos de sua publicação, não houve incorporação de medicamentos para tratar DE no âmbito SUS. O artigo foi desenvolvido com base no cenário observado no dia a dia de atendimento aos pacientes que recebem cuidados no Serviço Ambulatorial da Saúde Masculina de um Hospital de Alta Complexidade. Isto por constatar a dificuldade dos médicos em prescreverem medicamentos para DE, por ausência de padronização no contexto SUS. Importante ressaltar, nesta perspectiva, que a prescrição de medicamentos no âmbito SUS deve seguir fidedignamente a Rename; conforme preconiza o Decreto 7.508 e, se atentar à Resolução SS-83 de 2015, vigente no estado de São Paulo. Ela estabelece que o custo da dispensação de medicamentos não contemplados na Rename, por meio da judicialização, prescritos por médico da rede estadual de saúde, poderá ser custeado pela instituição ao qual este esteja vinculado.

[Variability in Drug Procurement within Group 1B of the Pharmaceutical Specialized Scheme in Brazil]. / Variabilidade de preços de aquisição de medicamentos do grupo 1B do Componente Especializado da Assistência Farmacêutica.

In the Brazilian Health System (SUS), drugs covered by the Specialized Pharmaceutical Scheme (CEAF) receive federal funding and can be procured either centrally (Group 1A) or by individual states (Federal Units - UF) (Group 1B). Unlike other countries where national procurement prices are negotiated centrally by the government, public procurement in Brazil follows a public auction procedure, potentially resulting in varying purchase prices. To facilitate price comparisons, it is a legal requirement to register public acquisitions in the Health Prices Registry (BPS). This study aimed to assess the variability in the procurement prices for Group 1B drugs across the 27 Brazilian states during 2021. Data on the acquisitions of Group 1B drugs by the 27 Health Secretariats were obtained from the BPS. Drugs with no reported reimbursement prices as of December 2021 were excluded from the analysis. The total reimbursement amount for each state was sourced from the SUS Ambulatory Information System. The findings revealed significant variability in drug procurement prices both across and within states. The study underscored a potential disparity in CEAF access, favoring wealthier states (those with larger populations and higher economic status) by securing lower drug prices.

No Sistema Único de Saúde os medicamentos do grupo 1 do Componente Especializado da Assistência Farmacêutica (CEAF) são financiados pela União e adquiridos de forma centralizada (grupo 1A) ou por cada Unidade Federativa (UF) (grupo 1B). Diferentemente de outros países onde se negocia um preço fixo a ser praticado no sistema público, no Brasil as aquisições são realizadas por licitação, o que pode levar a diferentes preços. Para permitir a comparação de preços, foi pactuada a obrigatoriedade de registro das aquisições públicas no Banco de Preços em Saúde (BPS). O estudo teve como objetivo analisar a variabilidade dos preços de medicamentos do grupo 1B adquiridos pelas UF do Brasil em 2021. Foram obtidas as aquisições de medicamentos do grupo 1B realizadas pelas Secretarias de Estado das 27 UF por consulta ao BPS excluindo-se os medicamentos sem preço de ressarcimento estabelecido em dezembro/2021. Foi obtido do Sistema de Informações Ambulatoriais o ressarcimento para cada UF. Verificou-se grande variabilidade dos preços de aquisição para cada medicamento entre as UF e dentro da mesma UF. O estudo demonstrou potencial iniquidade de acesso ao CEAF, privilegiando com menores preços UF mais favorecidas (maior população e riqueza).

Variabilidade de preços de aquisição de medicamentos do grupo 1B do Componente Especializado da Assistência Farmacêutica / Variability in Drug Procurement within Group 1B of the Pharmaceutical Specialized Scheme in Brazil

Resumo No Sistema Único de Saúde os medicamentos do grupo 1 do Componente Especializado da Assistência Farmacêutica (CEAF) são financiados pela União e adquiridos de forma centralizada (grupo 1A) ou por cada Unidade Federativa (UF) (grupo 1B). Diferentemente de outros países onde se negocia um preço fixo a ser praticado no sistema público, no Brasil as aquisições são realizadas por licitação, o que pode levar a diferentes preços. Para permitir a comparação de preços, foi pactuada a obrigatoriedade de registro das aquisições públicas no Banco de Preços em Saúde (BPS). O estudo teve como objetivo analisar a variabilidade dos preços de medicamentos do grupo 1B adquiridos pelas UF do Brasil em 2021. Foram obtidas as aquisições de medicamentos do grupo 1B realizadas pelas Secretarias de Estado das 27 UF por consulta ao BPS excluindo-se os medicamentos sem preço de ressarcimento estabelecido em dezembro/2021. Foi obtido do Sistema de Informações Ambulatoriais o ressarcimento para cada UF. Verificou-se grande variabilidade dos preços de aquisição para cada medicamento entre as UF e dentro da mesma UF. O estudo demonstrou potencial iniquidade de acesso ao CEAF, privilegiando com menores preços UF mais favorecidas (maior população e riqueza).

Abstract In the Brazilian Health System (SUS), drugs covered by the Specialized Pharmaceutical Scheme (CEAF) receive federal funding and can be procured either centrally (Group 1A) or by individual states (Federal Units - UF) (Group 1B). Unlike other countries where national procurement prices are negotiated centrally by the government, public procurement in Brazil follows a public auction procedure, potentially resulting in varying purchase prices. To facilitate price comparisons, it is a legal requirement to register public acquisitions in the Health Prices Registry (BPS). This study aimed to assess the variability in the procurement prices for Group 1B drugs across the 27 Brazilian states during 2021. Data on the acquisitions of Group 1B drugs by the 27 Health Secretariats were obtained from the BPS. Drugs with no reported reimbursement prices as of December 2021 were excluded from the analysis. The total reimbursement amount for each state was sourced from the SUS Ambulatory Information System. The findings revealed significant variability in drug procurement prices both across and within states. The study underscored a potential disparity in CEAF access, favoring wealthier states (those with larger populations and higher economic status) by securing lower drug prices.

Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications.

BACKGROUND: Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil. METHOD: The study population consisted of 630 pharmacists from the State of São Paulo, who work in community pharmacies. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; guidance about the disposal of household medications; and knowledge regarding the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test and were considered significant when p < 0.05%. RESULTS: Among the participating pharmacists, the majority were women under 60 years old,56 (8.89%) stated that they never orient the customer regarding the disposal of unused and expired household medications, while 574 (91,12%) indicated that they almost provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p = 0.0047), the time they had worked in pharmacies and drugstores (p = 0.0007), and whether or not they had a graduate degree (p = 0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists,516 (80.25%) indicated that they oriented customers to return them to a pharmacy. CONCLUSION: A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.

Pharmaceutical care improves medication adherence and quality of life in type 2 diabetes mellitus

Aims: This study aimed to evaluate whether pharmacotherapeutic follow-up in patients with T2DM in primary care interferes in metabolic control, cardiovascular risk, medication adherence and quality of life. Methods: A prospective clinical study was conducted at two Primary Health Units in Vitória, Espírito Santo, Brazil with 75 patients with T2DM between 40 and 70 years old. The parameters of metabolic control evaluated included fasting blood glucose, HbA1c, triglyceride/HDL-c and total cholesterol/HDL-c ratio. The cardiovascular risk was calculated based on the Framingham risk score. Adherence to medication was measured using the Brief Medication Questionnaire and quality of life was evaluated by applying the World Health Organization Quality of Life-Bref. Results: After the follow-up, there was a significant decreasing in cardiovascular risk (p=0.048) and total cholesterol/HDL-c ratio (p=0.024) and a discrete improvement in fast glucose and HbA1c levels. The quality of life scores increased for all domains (p<0.0001) and the treatment adherence also improved with 12.00% of the patients classified as low adherence in the final time, against 41.33% before the meetings. Conclusion: These results show the proposed pharmacotherapeutic follow-up influenced positively cardiovascular risk, adherence to therapy and quality of life in all domains, and, therefore, may contribute to delay the onset of the main chronic complications of the disease (AU)

Spatial analysis of a case of reverse logistics of medicines in community pharmacies in Brazil - a preliminary study

Background: The reverse logistics of medicines consists of the logistical procedure of collection, transport, storage, treatment and final disposal of post-consumer or expired waste. Medicines can be toxic to the environment and affect the health of citizens of the territory. Community pharmacies, as a health facility, play a key role in this process. Objectives: Define the spatial analysis and cases of reverse logistics of medicines in community pharmacies in Brazil. Methods: This is a cross-sectional study, and the research covered the medicines collected by 400 community pharmacies in the period from 2020 to 2022. To obtain the data, the medicines were collected, weighed, segregated and the weight released on a dedicated waste management platform. All regions of Brazil subject to georeferencing were processed using the free software Geographic Information System (QGIS). Data were expressed as median and range or as frequency of occurrence. Chi-square t-test and Fisher's exact test were used to compare variables. The accepted significance level was 5%. Results: Of the five existing regions in Brazil, only three had records of reverse medication logistics. 4,519.74 Kg of products were collected, and the North region of Brazil was responsible for 69.1% of the collection. In the spatial analysis, it was possible to perceive a difference between the areas of concentration of the RDL, that is, locations where collections were carried out in the period from 2020 to 2022. Conclusion: The present study preliminarily analyzed the reverse logistics of medicines in Brazil. The data obtained can contribute to the knowledge of this area and to the strengthening of the process. Thus, these places must exercise a task force for the educational process of the population about the risks of incorrect disposal of medicines and that this could harm the environment, economic aspects of society, food and the entire context that involves health and well-being. of citizens (AU)

Por que indivíduos saudáveis podem ter escores do Eating Assessment Tool (EAT-10) indicativos de disfagia? / Why healthy individuals may have Eating scores Assessment Tool (EAT-10) indicative of dysphagia?

Contexto: Eating Assessment Tool (EAT-10) é um método clínico de detecção de disfagia, entendida como dificuldade na deglutição. Em pesquisa realizada no Brasil, foi observado que 9,5% de indivíduos saudáveis assintomáticos têm resultados do teste compatível com disfagia. Objetivo: Avaliar os possíveis fatores que influenciam o resultado anormal do teste em indivíduos saudáveis. Método: Estudo transversal realizado na Faculdade de Medicina de Ribeirão Preto (FMRP-USP) em 358 voluntários sem doenças e sem sintomas, nos quais foi aplicado o teste EAT-10. Resultados: Em 316 o resultado nos 10 itens do teste foi zero, e em 42 os resultados da somatória dos 10 itens foi igual ou superior a 3, considerado indicativo de disfagia. O resultado ≥ 3 ocorreu em 10 homens entre 144 (7%) e 32 mulheres entre 214 (15%), (P = 0,01). A mediana (limites) de idades daqueles com resultado zero foi de 39 (20-84) anos, e com resultado ≥ 3 foi de 32 (20-83) anos (P = 0,04). O índice de massa corporal (IMC) não apresentou diferença entre pessoas com e sem indicação de disfagia. O máximo escore possível para o item 5 (dificuldade na ingestão de medicamentos) foi o que obteve o maior percentual (43,9%) de máximo escore possível, sendo o fator mais importante para o resultado anormal. Discussão: Em indivíduos saudáveis, a dificuldade em ingerir medicamentos foi o fator que mais influenciou a ocorrência de resultado do teste EAT-10 indicativo de disfagia. Conclusão: Dificuldade na ingestão de medicamentos sólidos deve ser considerada quando da interpretação do teste.

[Update of triggers for detection of adverse drug events in hematologic patients]. / Atualização dos rastreadores para detecção de eventos adversos a medicamentos em pacientes hematológicos.

The use of triggers for the active search and detection of adverse drug events (ADEs) has been gaining ground within pharmacovigilance services. Thus, the main objective of the study was to propose a new list of triggers to be used in a center specialized in hematology in Rio de Janeiro, Brazil. The update of the list of triggers consisted of revising the current list, with the exclusion and inclusion of new triggers. To verify the performance of the new list of triggers, a cross-sectional study was conducted in which the new triggers were used to investigate the occurrence of ADEs in patients attended in the emergency unit or hospitalized from January to March 2022. For each suspected ADEs, the patient's profile and adverse drug reactions (ADRs) were characterized regarding causality and severity. The performance of the triggers and their ability to capture ADEs were estimated using the following indicators: frequency of the trigger per 100 medical records, frequency of ADEs per 100 records, and positive predictive value (PPV). To evaluate the overall performance of the proposed new list, the PPV was estimated. A total of 374 prescriptions for triggers were identified in 186 medical records. The most efficient in the detection of possible ADEs were: lidocaine, loperamide, bisacodyl, filgrastim and glycerin clyster. The overall PPV of the new suggested list was 48% versus 10% of the previous list. This study demonstrated the importance of an updated list of triggers for the monitoring of ADEs and improvement of the care provided.

A utilização de rastreadores para a busca ativa e detecção de eventos adversos a medicamentos (EAM) tem ganhado espaço nos serviços de farmacovigilância. Assim, o objetivo principal do estudo foi propor uma nova lista de rastreadores para ser empregada em um centro especializado em hematologia do Rio de Janeiro, Brasil. A atualização da lista de rastreadores consistiu na revisão da lista atual, com a exclusão e inclusão de rastreadores. Para verificar o desempenho da nova lista de rastreadores, realizou-se um estudo transversal em que os novos rastreadores foram utilizados para investigar a ocorrência de EAM em pacientes atendidos na emergência ou hospitalizados no período de janeiro a março de 2022. Para cada suspeita de EAM identificada, caracterizaram-se o perfil do paciente e as reações adversas a medicamentos (RAM) quanto à causalidade e gravidade. O desempenho dos rastreadores e sua capacidade de captação de EAM foram calculados por meio dos indicadores: frequência do rastreador por 100 prontuários, frequência de EAM por 100 prontuários e valor preditivo positivo (VPP). Para avaliar o desempenho global da nova lista proposta, calculou-se o VPP. Foram identificadas 374 prescrições de rastreadores em 186 prontuários. Os mais eficientes na detecção de possíveis EAM foram: lidocaína, loperamida, bisacodil, filgrastim e clister de glicerina. O VPP global da nova lista sugerida foi 48% contra 10% da lista anterior. Este estudo demonstrou a importância de uma lista de rastreadores atualizada para o monitoramento dos EAM e o aprimoramento da assistência prestada.

El uso de rastreadores en la búsqueda y detección activa de eventos adversos de medicamentos (EAM) viene ganando espacio dentro de los servicios de farmacovigilancia. Por lo tanto, el objetivo principal de este estudio fue proponer una nueva lista de rastreadores que se utilizarán en un centro de hematología especializado en Río de Janeiro, Brasil. La actualización de la lista de rastreadores consistió en la revisión de la lista actual, con la exclusión e inclusión de rastreadores. Para verificar el desempeño de la nueva lista de rastreadores, se realizó un estudio transversal en el que se utilizaron los nuevos rastreadores para investigar la aparición de EAM en pacientes atendidos en urgencias u hospitalizados en el periodo de enero a marzo de 2022. Para cada sospecha de EAM identificados, el perfil del paciente y las reacciones adversas a medicamentos (RAM) se caracterizaron por su causalidad y gravedad. El desempeño de los rastreadores y su capacidad para capturar EAM se calcularon mediante los indicadores: frecuencia del rastreador por cada 100 registros médicos, frecuencia de EAM por cada 100 registros médicos y valor predictivo positivo (VPP). Para evaluar el desempeño general de la nueva lista propuesta, se calculó el VPP. Se identificaron 374 recetas de rastreadores en 186 registros médicos. Los más eficientes en la detección de posibles EAM fueron lidocaína, loperamida, bisacodilo, filgrastim y enema de glicerina. El VPP general de la nueva lista sugerida fue del 48% frente al 10% de la lista anterior. Este estudio demostró la importancia de una lista actualizada de rastreadores para monitorear EAM y mejorar la atención brindada.

Impact of the national shortage of polymyxin B in critically ill patients during the COVID-19 pandemic / Impacto da escassez nacional de polimixina B em pacientes gravemente enfermos durante a pandemia de COVID-19 / Impacto del desabasto nacional de polimixina B en pacientes críticos durante la pandemia de COVID-19

Background and Objectives: during the COVID-19 pandemic, the number of critical patients requiring intensive care increased considerably, resulting in an increase in infections due to multi-resistant microorganisms. In Brazil, in 2021, due to the high demand for polymyxin B use, there was a national shortage of the medication. One strategy used to overcome this situation was aminoglycoside use. The work aimed to analyze the impact of replacing polymyxin B with amikacin and gentamicin in the final stage of patients. Method: an analytical study with an observational, cross-sectional design, with a quantitative approach, through a retrospective analysis through the analysis of medical records, with the primary stages being discharges or deaths. Results: mortality was similar between the group treated with aminoglycoside and the group treated with polymyxin B. Within the aminoglycoside group, mortality was higher in the group that had bacteria resistant to the drug than in the group that had infection with an organism sensitive to this drug. Mortality was not affected by comorbidities, age, or number of hospital infections. The main factor that led to the need for dialysis was the combination of two nephrotoxic medications. Conclusion: two hypotheses emerged: the first would be that replacing polymyxin B with aminoglycosides did not impact mortality; the other would be that, regardless of the antibiotic group used, patients had a high risk of death. Despite sample limitations, the study corroborates the adoption of strategies for the rational use of antimicrobials.(AU)

Justificativa e Objetivos: durante a pandemia de COVID-19, o número de pacientes críticos que necessitaram de cuidados intensivos aumentou consideravelmente, resultando em aumento de infecções por microrganismos multirresistentes. No Brasil, em 2021, devido à grande demanda pelo uso da polimixina B, houve escassez nacional do medicamento. Uma estratégia utilizada para superar essa situação foi o uso de aminoglicosídeos. O trabalho teve como objetivo analisar o impacto da substituição da polimixina B por amicacina e gentamicina na fase final dos pacientes. Método: estudo analítico com desenho observacional, transversal, com abordagem quantitativa, por meio de análise retrospectiva por meio de análise de prontuários, sendo as etapas primárias as altas ou óbitos. Resultados: a mortalidade foi semelhante entre o grupo tratado com aminoglicosídeo e o grupo tratado com polimixina B. Dentro do grupo aminoglicosídeo, a mortalidade foi maior no grupo que apresentava bactérias resistentes ao medicamento do que no grupo que apresentava infecção por organismo sensível a este medicamento. medicamento. A mortalidade não foi afetada por comorbidades, idade ou número de infecções hospitalares. O principal fator que levou à necessidade de diálise foi a combinação de dois medicamentos nefrotóxicos. Conclusão: surgiram duas hipóteses: a primeira seria que a substituição da polimixina B por aminoglicosídeos não impactou a mortalidade; a outra seria que, independentemente do grupo de antibióticos utilizado, os pacientes apresentavam alto risco de morte. Apesar das limitações amostrais, o estudo corrobora a adoção de estratégias para o uso racional de antimicrobianos.(AU)

Antecedentes y Objetivos: durante la pandemia de COVID-19, el número de pacientes críticos que requirieron cuidados intensivos aumentó considerablemente, resultando en un aumento de infecciones por microorganismos multirresistentes. En Brasil, en 2021, debido a la alta demanda del uso de polimixina B, hubo escasez nacional del medicamento. Una estrategia utilizada para superar esta situación fue el uso de aminoglucósidos. El trabajo tuvo como objetivo analizar el impacto de la sustitución de la polimixina B por amikacina y gentamicina en la etapa final de los pacientes. Método: estudio analítico con diseño observacional, transversal, con enfoque cuantitativo, mediante un análisis retrospectivo mediante el análisis de historias clínicas, siendo las etapas primarias las altas o defunciones. Resultados: la mortalidad fue similar entre el grupo tratado con aminoglucósido y el grupo tratado con polimixina B. Dentro del grupo de aminoglucósido, la mortalidad fue mayor en el grupo que tenía bacterias resistentes al fármaco que en el grupo que tenía infección con un organismo sensible a este. droga. La mortalidad no se vio afectada por las comorbilidades, la edad o el número de infecciones hospitalarias. El principal factor que llevó a la necesidad de diálisis fue la combinación de dos medicamentos nefrotóxicos. Conclusión: surgieron dos hipótesis: la primera sería que la sustitución de polimixina B por aminoglucósidos no impactó la mortalidad; la otra sería que, independientemente del grupo de antibióticos utilizado, los pacientes tenían un alto riesgo de muerte. A pesar de las limitaciones de la muestra, el estudio corrobora la adopción de estrategias para el uso racional de antimicrobianos.(AU)

Shift in hospital opioid use during the COVID-19 pandemic in Brazil: a time-series analysis of one million prescriptions.

The pronounced change in the profile of hospitalized patients during COVID-19 and the severe respiratory component of this disease, with a great need for mechanical ventilation, led to changes in the consumption pattern of some medicines and supplies. This time-series study analyzed the in-hospital consumption of opioids during the COVID-19 pandemic in 24 Brazilian hospitals compared to the pre-pandemic period. Data included 711,883 adult patients who had opioids prescribed. In 2020, the mean consumption was significantly higher compared to 2019 for parenteral fentanyl, enteral methadone, and parenteral methadone. It was significantly lower for parenteral morphine parenteral sufentanil, and parenteral tramadol. For remifentanil, it did not differ. The number of patients in 2020 was lower but the mean consumption was higher for fentanyl, parenteral methadone, and remifentanil. It was lower for enteral methadone and parenteral sufentanil. The consumption of parenteral morphine and parenteral tramadol was stable. There was a relevant increase in hospital consumption of some potent opioids during the COVID-19 pandemic in Brazil. These results reinforce the concern about epidemiological surveillance of opioid use after periods of increased hospital use since in-hospital consumption can be the gateway to the misuse or other than the prescribed use of opioids after discharge.

Panorama da produção local de medicamentos no Brasil: Desafios e vulnerabilidades

A parceria entre a Fiocruz e a OPAS tem uma história longa e produtiva de iniciativas de cooperação na área da saúde pública. Juntos, desenvolvem programas e projetos que buscam melhorar a saúde e o bem-estar das populações das Américas. Existem parcerias estratégicas, como os Centros Colaboradores da OPAS/OMS, em que a Fiocruz/ENSP-NAF atua como “Centro Colaborador da OMS para Políticas Farmacêuticas”. Centros, dessa natureza, visam promover o desenvolvimento de capacidades locais (nacionais), interpaíses, regionais, inter- -regionais e globais. O livro aborda questões estratégicas relacionadas à garantia do acesso universal a medicamentos em nossa Região. A publicação analisa as vulnerabilidades e os desafios do setor, caracterizando a indústria farmacêutica nacional e relacionando as questões/linhas gerais da produção local com as políticas que surgiram a partir de debates internacionais, bem como com as parcerias entre a OMS e OMC que também fazem parte do cenário. Essa publicação também aborda a reorganização da assistência farmacêutica, um tema que pode orientar políticas públicas no futuro governo brasileiro e influenciar a formulação de políticas em outros países da nossa Região. É importante destacar a riqueza que surge dessa cooperação e da publicação conjunta, que estão indissociavelmente ligadas.

Performing rapid metabolite tests (IgG-IgM) for SARS-CoV-2 infection in community pharmacies: A cross sectional-study from Brazil

Background: Immunochromatographic rapid tests in pharmacies allow the discovery of specific antibodies against SARS-CoV-2 or viral antigens and provide a broader and more effective screening of the virus. However, in many countries, this process is still not well defined. In this sense, the perception of pharmacists about these screening practices presents an overview of how the service is being carried out in the country. Objective: This study was to evaluate the performance of rapid immunochromatographic tests and their clinical results in community pharmacies in northern Brazil. Method: A retrospective study was carried out between May 2020 and December 2021 in community pharmacies in the northern region of Brazil. Participants were 18 years of age or older, of both sexes, who spontaneously sought the SARS-CoV-2 rapid testing service at pharmacies located in the municipality of Belem and who had had close contact with the virus or symptoms infection-related. Data were expressed as median and range or as frequency of occurrence. Chi-square t-test and Fisher’s exact test were used to compare variables. The accepted significance level was 5%. This study was approved by the Research Ethics Committee (number: 4,865,206). Results: A total of 78,849 patients were recruited into the study. Most patients, 37,847 (48%), were tested antibody positive for SARS-CoV-2. There were no severe signs and symptoms of the disease. The results showed the great demand for carrying out the rapid test in pharmacies and these places could contribute to the understanding of this health establishment, to curb the speed of SARS-CoV-2 dissemination. (AU)

Pharmaceutical interventions and factors associated with their acceptance in intensive care units in Brazil / Intervenciones farmacéuticas y factores asociados a su aceptación en unidades de cuidados intensivos en Brasil

Objetivo: El propósito de este estudio es evaluar las intervenciones farmacéuticas (IF) realizadas sobre PRM y los factores asociados a su aceptación. Método: Se trata de un estudio descriptivo y transversal que analizó las IF realizadas a pacientes adultos de dos UCI de Fortaleza, Brasil, en 2019. Las IF se analizaron en las categorías cantidad de fármaco y estrategia farmacológica, utilizando la clasificación propuesta por Sabater et al. Los fármacos se clasificaron además por el Sistema de Clasificación Anatómica, Terapéutica, Química y por la clasificación de Fármacos de Alta Vigilancia (FAV). Resultados: Se incluyeron 305 pacientes, siendo la mayoría del sexo masculino (55,1 %), ancianos (52,8 %) y atendidos en la UCI quirúrgica (51,4 %). Se analizaron 1.317 IF y se aceptaron el 88,0 %, siendo la sustitución de uno o más fármacos (28,0 %) y la adición de uno o más fármacos (27,7 %) las más frecuentes. La clase terapéutica más prevalente fue antiinfeccioso de uso sistémico (24,1 %) y los FAV estuvieron implicados en el 21,7 % de las IF. Se observó asociación entre las IF aceptadas e ingreso en UCI clínica (p<0,0001), FAV (p=0,0013), sustitución de uno o más fármacos (p=0,0062) y la clase sustitutos sanguíneos y soluciones de perfusión (p= 0,0187). Conclusiones: Se realizaron y aceptaron un elevado número de IF, lo que refuerza la importancia del farmacéutico en la revisión de las prescripciones médicas en UCI. (AU)

Objective: The purpose of this study is to evaluate the pharmaceutical interventions (PI) performed in PRM and the factors associated with their acceptance.Method: This is a descriptive and cross-sectional study that analyzed PIs performed on adult patients from two ICUs in Fortaleza, Brazil, in 2019. PIs were analyzed in the categories quantity of drug and pharmacological strategy, using the classification proposed by Sabater et al. The drugs were also classified by the Anatomical, Therapeutic, and Chemical Classification System and by the High Surveillance Drugs (FAV) classification.Results: 305 patients were included, most of them male (55.1 %), elderly (52.8 %) and treated in the surgical ICU (51.4 %). 1,317 PIs were analyzed and 88.0 % were accepted, being to replace one or more drugs (28.0 %), to add one or more drugs (27.7 %) and to change the dose (24.8 %) the most frequent types. The most prevalent therapeutic class was anti-infectives for systemic use (24.1 %) and AVFs were involved in 21.7 % of the PIs. An association was observed between PIs accepted and admission to the clinical ICU (p<0.0001), AVF (p=0.0013), substitution of one or more drugs (p=0.0062) and the class of blood substitutes and perfusion solutions. (p= 0.0187).Conclusions: A high number of PIs were performed and accepted, which reinforces the importance of the pharma-cist in the review of medical prescriptions in the ICU. (AU)

Temporal profile of adverse drug reactions and associated clinical factors: a prospective observational study in a neonatal intensive care unit.

OBJECTIVE: Although adverse drug reactions (ADRs) are quite common in hospitalised neonates, pharmacovigilance activities in this public are still incipient. This study aims to characterise ADRs in neonates in a neonatal intensive care unit (NICU), identifying causative drugs, temporal profile and associated factors. DESIGN: Prospective observational study. SETTING: NICU of a public maternity hospital in Natal/Brazil. PARTICIPANTS: All neonates admitted to the NICU for more than 24 hours and using at least one medication were followed up during the time of hospitalisation. PRIMARY OUTCOME MEASURES: Incidence rate and risk factors for ADRs. The ADRs were detected by an active search in electronic medical records and analysis of spontaneous reports in the hospital pharmacovigilance system. RESULTS: Six hundred neonates were included in the study, where 118 neonates had a total of 186 ADRs. The prevalence of ADRs at the NICU was 19.7% (95% CI 16.7% to 23.0%). The most common ADRs were tachycardia (30.6%), polyuria (9.1%) and hypokalaemia (8.6%). Tachycardia (peak incidence rate: 57.1 ADR/1000 neonates) and hyperthermia (19.1 ADR/1000 neonates) predominated during the first 5 days of hospitalisation. The incidence rate of polyuria and hypokalaemia increased markedly after the 20th day, with both reaching a peak of 120.0 ADR/1000 neonates. Longer hospitalisation time (OR 0.018, 95% CI 0.007 to 0.029; p<0.01) and number of prescribed drugs (OR 0.127, 95% CI 0.075 to 0.178; p<0.01) were factors associated with ADRs. CONCLUSION: ADRs are very common in NICU, with tachycardia and hyperthermia predominant in the first week of hospitalisation and polyuria and hypokalaemia from the third week onwards.

Perfil do consumo dos benzodiazepínicos nos anos de 2019 e 2020 no brasil e regiões / Profile of the benzodiazepines in the years 2019 e 2020 in Brazil and regions / Perfil de consume y hospitalizaciones de los benzodiacepinas en los años 2019 y 2020 enBrasil y regiones

Os benzodiazepínicos estão entre os medicamentos mais prescritos, principalmente em países ocidentais, onde estimativas mostram um consumo anual de 1% a 3% da população.Objetivo:Estudar o perfil do consumo dos benzodiazepínicosnos anos de 2019-2020. Metodologia:Foram estudadas a taxa de desocupação segundo o Instituto Brasileiro de Geografia e Estatística, consumo dos benzodiazepínicosa partir do Sistema Nacional de Gerenciamento de Produtos Controlados da Agencia de Vigilância Sanitáriae quantidade de internações por envenenamento com exposição (acidental ou proposital), auto-intoxicação e efeitos adversos aos anticonvulsivantes, sedativos, hipnóticos, antiparkinsonianos e psicotrópicos segundo o Departamento de Informática do Sistema Único de Saúde no Brasil. Resultados:A região Norte e Nordeste apresentou um aumento na taxa de desocupação. O rendimento nominal mensal domiciliar per capitada população residente nas regiões Norte e Nordeste se manteveabaixo de 01 salário-mínimo nos anos de 2019 e 2020. De 2019 para 2020, o princípio ativo mais utilizado dos benzodiazepínicos industrializados foi o Clonazepam com incremento de 9,81% no Brasil e 22,52% na região Nordeste. Todas as formas farmacêuticas manipuladas apresentaram umaredução no consumo de 2019 para 2020, com exceção da forma em mililitros que apresentou um incremento para o bromazepam (42,1%), clonazepam (8,76%) e diazepam (5,27%). De 2020 em relação a 2019, ocorreu um incrementode 119,05% e 25% nas regiões Nordeste e Centro-Oeste, respectivamente, nasinternações por envenenamento [intoxicação] por exposição, a anticonvulsivantes (antiepilépticos), sedativos, hipnóticos, antiparkinsonianos e psicotrópicos não classificados em outra parte, intenção não determinada. Conclusões:Ocorreu um aumento no consumo de benzodiazepínicosindustrial no ano de 2020 sendo o envenenamento [intoxicação] umadas principais causasde internação. Há necessidade de um controle do consumo e vigilância aos psicotrópicos visto que estes fármacos estão dentre aqueles com risco de internações devido àexposição acidental ou não, autointoxicaçãoou efeitos adversos (AU).

Benzodiazepines are among the most prescribed drugs, especially in Western countrieswhere estimates show an annual consumption of 1% to 3% of the population.Objective: To study the profile of benzodiazepinesconsumptionfrom the National Controlled Products Management System of the Sanitary Surveillance Agencyin the years 2019 and 2020.Methodology:The unemployment rate,according to theBrazilian Institute of Geography and Statistics,benzodiazepines consumptionfrom the National Controlled Products Management System of the Sanitary Surveillance Agency, and the number of hospitalizations due to poisoning with exposure (accidental or intentional), self-intoxication, and adverse effects to anticonvulsants, sedatives, hypnotics, antiparkinsonian drugs and psychotropic drugs according to the Department of Informatics of the Unified Health System in Brazil were studied.Results:The North and Northeast regions showed an increase in the unemployment rate. The nominal monthly household income per capita of the population residing in the North and Northeast regions remained below 01 minimum wage in the years 2019 and 2020. From 2019 to 2020, the most used active substanceof industrialized benzodiazepines was Clonazepam with an increase of 9.81% in Brazil and 22.52% in the Northeast region. All compounded pharmaceutical forms showed a reduction in consumption from 2019 to 2020, with the exception of the form in milliliters which showed an increase for bromazepam (42.1%), clonazepam (8.76%) and diazepam (5.27%). In 2020 compared to 2019, there was an increase of 119.05% and 25% in the Northeast and Midwest regions, respectively, in hospitalizations for poisoning[intoxication] due to exposure toanticonvulsants (antiepileptics), sedatives, hypnotics, antiparkinsonian drugs,and psychotropic drugs not elsewhere classified with intent undetermined.Conclusions:There was an increase in the consumption of industrial benzodiazepines in 2020, with poisoning [intoxication] being one of the main causes of hospitalization. There is a need to control the consumption andincrease the surveillance of psychotropic drugs becausethese drugs are among those that involverisk of hospitalization due to accidental or non-accidental exposure, self-intoxication or adverse effects (AU).

ntroducción: Las benzodiacepinas se encuentran entre los fármacos más recetados, especialmente en los países occidentales, donde se estima que de 1% al 3% de la poblaciónde estos países los consumen. Objetivo: Estudiar el perfil del consumo de benzodiacepinas en los años 2019-2020.Metodología: Se midieron la tasa de desempleo según elInstituto Brasileño de Geografía y Estadística, el consumo de benzodiacepinasdel Sistema Nacional de Gestión de Productos Controlados de la Agencia de Vigilancia Sanitariay el número de hospitalizaciones por intoxicación con exposición (accidental o intencional), además se estudiaron autointoxicaciones y efectos adversos a los anticonvulsivos, sedantes, hipnóticos, drogas contra el mal de Parkinsony psicotrópicossegún elDepartamento de Informática del Sistema Único de Salud de Brasil.Resultados: Las regiones Norte y Nordeste presentaron aumento de la tasa de desempleo. El ingreso nominal mensual de los hogares per cápita de la población residente en las regiones Norte y Nordeste se mantuvo por debajo de 01 salario mínimo en los años 2019-2020. De 2019 a 2020, el principio activo más utilizado de las benzodiacepinas industrializadas fue el clonazepam con un aumento de 9,81% en Brasil y de22,52% en la región Nordeste. Todas las formas farmacéuticas compuestas mostraron una reducción en su consumo de 2019-2020, a excepción de la forma en mililitros que mostró un aumento para bromazepam (42,1%), clonazepam (8,76%) y diazepam (5,27%). En 2020 respecto a 2019, hubo un aumento del 119,05% y 25% en las regiones Noreste y Medio Oeste, respectivamente, en las hospitalizaciones por intoxicación por exposición aanticonvulsivos (antiepilépticos), sedantes, hipnóticos, drogas contra el mal de Parkinsony psicofármacos no clasificados en otra parte conintención indeterminada.Conclusiones: Hubo un aumento en el consumo de benzodiacepinas industriales en 2020, siendo las intoxicaciones una de las principales causas de hospitalización. Existe la necesidad de controlar el consumo y vigilancia de los psicofármacos, ya que estos fármacos se encuentran entre los de riesgo de hospitalización por exposición accidental o no accidental, autointoxicación o efectos adversos (AU).

Nível de conhecimento do profissional de educação física sobre prescrição de exercício de aeróbio e doenças crônicas / Nivel de conocimiento de los profesionales de la educación física sobre la prescripción del ejercicio aeróbico y las enfermedades crónicas / Level of knowledge of physical education professionals about aerobic exercise prescription and chronic diseases

Objetivo: A prática regular de exercício aeróbio é fundamental para a saúde de adultos saudáveis, idosos e no controle de doenças crônicas e agravos nãotransmissíveis. Entretanto, deve ser prescrito segundo as diretrizes mundiais específicas para cada população. o objetivo era investigar o conhecimentodos profissionais de Educação Física atuantes em academias de ginástica em relação aos critérios que compõe a prescrição de exercício aeróbio parapessoas com diagnóstico de doenças crônicas e agravos não transmissíveis. Métodos: 610 profissionais de Educação Física atuantes em academias de São Paulo foram avaliados. O nível de conhecimento sobre as recomendações daprescrição do exercício aeróbio foi avaliado por meio de questionário construído para esse estudo. A análise dos dados foi realizada por meio do testeQui-Quadrado com significância de 5%. Resultados: O maior percentual de acerto ocorreu para prescrição do exercício aeróbio para Obesidade (49.2%) seguido por Diabetes tipo 2 (41.5%). Poroutro lado, o conhecimento sobre o Câncer (6.9%) apresentou o menor percentual de acerto. Outro resultado que merece destaque foi que, exceto paraSíndrome Metabólica (21%), o maior percentual de acerto foi observado para os critérios frequência semanal e duração do exercício aeróbio. Conclusão: O conhecimento dos profissionais de Educação Física em relação à recomendação para prescrição do exercício aeróbio foi significativamentemaior para obesos comparado a câncer, Diabetes tipo 2 e síndrome metabólica.(AU)

Objective: Regular practice of aerobic exercise is critical to control of chronic non-communicable diseases and injuries. However, the world-specificguidelines for each population must be prescribed second. The aim was to investigate the knowledge of physical education professionals working ingymnasiums in relation to the criteria that make up the prescription of aerobic exercise for people diagnosed with chronic non-communicable diseasesand injuries. Methods: 610 Physical Education professionals working in academies in São Paulo were evaluated. The knowledge of the recommendation of the aerobicexercise prescription was evaluated through a questionnaire built for this study. The chi square test was used to analyze data with significance of p <0.05.Results: The highest values for correct answers was found to prescription of aerobic exercise for obesity (49.2%) followed by type 2 diabetes (41.5%). Onthe other hand, knowledge about Cancer (6.9%) had the lowest percentage of correct answers. Another result worth mentioning was that, except forMetabolic Syndrome (21%), the highest percentage of correct answers was observed for the weekly frequency and duration criteria. Conclusion: The knowledge of Physical Education professionals regarding the recommendation to prescribe aerobic exercise was significantly higher forobese compared to cancer, type 2 diabetes and metabolic syndrome.(AU)

Objetivo: La práctica regular de ejercicio aeróbico es fundamental para la salud de adultos sanos, ancianos y para el control de enfermedades crónicas yenfermedades no transmisibles. Sin embargo, debe prescribirse de acuerdo con pautas globales específicas para cada población. El objetivo fue investigarel conocimiento de los profesionales de Educación Física que actúan en los gimnasios en relación a los criterios que componen la prescripción delejercicio aeróbico para personas diagnosticadas con enfermedades crónicas y enfermedades no transmisibles.Métodos: Fueron evaluados 610 profesionales de Educación Física que actúan en gimnasios de São Paulo. El nivel de conocimiento sobre lasrecomendaciones de prescripción de ejercicio aeróbico se evaluó mediante un cuestionario construido para este estudio. El análisis de datos se realizómediante la prueba Chi-Cuadrado con una significación del 5%.Resultados: El mayor porcentaje de aciertos se presentó para la prescripción de ejercicio aeróbico para la Obesidad (49.2%) seguido de Diabetes Tipo 2(41.5%). Por otro lado, el conocimiento sobre Cáncer (6.9%) tuvo el menor porcentaje de aciertos. Otro resultado digno de mención fue que, conexcepción del Síndrome Metabólico (21%), el mayor porcentaje de respuestas correctas se observó para los criterios frecuencia semanal y duración delejercicio aeróbico.Conclusión: El conocimiento de los profesionales de Educación Física sobre la recomendación de prescripción de ejercicio aeróbico fue significativamentemayor para obesos en comparación con cáncer, Diabetes tipo 2 y síndrome metabólico.(AU)

Increase in veterinary prescriptions of azithromycin during the COVID-19 pandemic in Brazil.

INTRODUCTION: With the advent of the pandemic in 2020 and the lack of perspectives on the treatment of COVID-19, numerous therapeutic proposals have emerged, including hydroxychloroquine and azithromycin. Therefore, some studies have shown that in many countries, the demand for azithromycin has increased during the pandemic. In Brazil, antibiotics can only be purchased with a medical, dental, or veterinary prescription. This study aimed to determine whether the number of prescriptions made by veterinarians (which could be used by humans) has increased during the pandemic. METHODOLOGY: Data on the purchase of antibiotics made under veterinary prescriptions in Brazilian pharmacies between 2014 and 2021 were collected. To assess the changes in monthly trends in the use of the selected antibiotics, we applied the Joinpoint regression. RESULTS: The most prescribed antibiotic in all years was cephalexin (35%), followed by amoxicillin (24%). During the pandemic, sales of azithromycin substantially increased. Regression analysis showed that since 2014, azithromycin prescriptions grew by an average of 0.67% per month. At the beginning of the pandemic, the monthly growth rate became 12.64%. When comparing azithromycin sales during the pandemic with the historical average (2014-2019), the increase was 41%. CONCLUSIONS: During the pandemic, there was no animal health situation in Brazil that required the use of this antibiotic. Veterinary prescriptions may have been an instrument for human access to azithromycin for the treatment of COVID-19. Stricter enforcement policies are needed to address this problem to avoid antimicrobial resistance.