A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital.

Antimicrobial stewardship programmes promote excellence in the use of antimicrobials by selecting the appropriate antimicrobial agent and the correct dose, route of administration and duration of treatment. However, there is limited experience with such programmes targeting antifungal treatments. We present the results of a non-compulsory programme for the control of antifungals. For 12 months, prescriptions of oral voriconazole or intravenous voriconazole, caspofungin and liposomal amphotericin B were reviewed, and non-compulsory recommendations were made. The incidence and outcome of fungal infections were examined. The results for the dispensed defined daily doses (DDDs) and expenditure on antifungals were compared with those for the previous 12 months. The number of antifungal treatments reviewed was 662. A recommendation to change treatment was made in 29% of the cases, including a change from intravenous to oral treatment (15%), cessation of antifungal treatment (8%), and a change to fluconazole (6%). The DDDs of intravenous voriconazole and caspofungin were reduced by 31.4% and 20.2%, respectively. The DDDs of oral voriconazole and dispensed vials of liposomal amphotericin B were increased by 8.2% and 13.9%, respectively. Expenditure on antifungals was reduced by US$370681.78 (11.8% reduction). The programme was not related to significant increases in the incidence of candidaemia, percentage of persistent/relapsing candidaemia cases, percentage of fluconazole-resistant Candida species, incidence of infections by filamentous fungi, or 12-month mortality in patients with filamentous fungal infections. In conclusion, a stewardship programme targeting antifungals achieved a reduction in antifungal expenditure without reducing the quality of care provided.

[Concomitant therapies in the clinical trial in Alzheimer's disease]. / Medicación concomitante en los ensayos clínicos de la enfermedad de Alzheimer.

Existing information has been revised regarding the accompanying medication (permitted medication) for patients suffering from Alzheimer's disease (AD) who have been treated in a clinical study. Information obtained shows a highly variable attitude in the various clinical studies carried out on this illness. This fact, together with our limited knowledge of the psychotropic effects of many drugs frequently used on elderly patients with Alzheimer's disease has resulted in the impression that there are no unanimously agreed-upon guidelines as regards the prescription of this type of medication. The data afforded by the revision suggests certain guidelines for the suitable prescription of accompanying medication in clinical studies of Alzheimer's disease.

[Epidemiology of parenteral nutrition during 5 years of follow-up by a nutrition team]. / Epidemiología de la nutrición parenteral a lo largo de cinco años de seguimiento por parte de un equipo de nutrición.

The purpose of this retrospective study is to ascertain the physiopathological characteristics of patients on parenteral nutrition (PN), the types of diet used and duration of treatment. Presentation of epidemiological results and evolution of 637 adults receiving PN after a five-year period of nutritional follow-up, conducted by a Nutrition Team (NT) in hospital. For the purpose of this study, we used the Follow-Up charts of all the patients treated with PN from 1986-1990. The results obtained lead us to affirm that most patients suffered a malignant gastrointestinal process, that the duration of the PN was reduced significantly during the five-year term, mainly using dietary protocols, and that there was a gradual increase in preparations of nutrient units subjected to controls compared to the total prepared by the Pharmacy Department.