Vancomycin utilization review in patients undergoing bone marrow transplantation

Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus [MRSA]. In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation [BMT] patients. In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation [56.9%, 43.1%]. About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network [NCCN] guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0 +/- 11.9 microg/mL. Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug

Evaluation of febrile neutropenia in patients undergoing hematopoietic stem cell transplantation

The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation [HSCT] and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematologyoncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient's outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded [mean 1.5 episodes per patient]. About 222 episodes [82%] were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes [P<0.0001].The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type [P<0.05].It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection

Penicillin allergy and cross-reactivity with other beta-lactams

Beta-lactams are a group of antibiotics with a broad spectrum of both Gram-negative and Gram-positive coverage. The goal of this study is to evaluate the results from studies regarding Ig-E mediated hypersensitivity to Penicillin and cross-reactivity with other beta-lactams. Review was conducted of both retrospective and prospective studies by searching in PubMed and Medline for the original and systematic review articles by using the keywords: penicillin allergy, beta-lactams and cross-reactivity. The rate of true Penicillin allergy is about 10% of reported cases by the patients. The rate of Ig-E mediated cross-reactivity between Penicillin and Cephalosporins is less than 10% for the first and second generations and less than 5% for the third and fourth generations. According to the reviewed studies, Imipenem has between 9.2% to 25.6% cross-reactivity with Penicillin. Recent studies have shown safe use of Meropenem in patients with penicillin allergy even with positive skin test. The only member of Monobactam family, Aztreonam, has no cross-reactivity with any of Penicillins, Cephalosporins [with the exception of Ceftazidime] and Carbapenems. Due to the low rate of true Penicillin allergy, the patient's self report of this adverse reaction must be justified carefully before avoiding beta-lactams. Even in the cases of true penicillin allergy, Meropenem appears to be safe, if indicated. There are also a few case reports regarding hypersensitivities to Clavulanate itself and also its cross-reactivity with Penicillin.

Medication errors in an emergency department in a large teaching hospital in Tehran

Medication errors have important effects on increased length of hospitalization, increased mortality and costs. We assessed the incidence of medication errors and characterize the error types in an emergency department in a large teaching hospital in Tehran. We also investigated the effect of Emergency Department pharmacists on patient safety with regard to recovery of potentially harmful medication errors. The study was conducted in the 24 bed emergency department from February to March, 2010 at a 600-bed teaching hospital. Two hospital pharmacists and two clinical pharmacy residents observed care provision and collected data on medication errors. Demographic data, type of medication error, the recorded stage of error, date and time of occurrence and report, who made the error, probability of error were recorded from medical records. We used chi-squared and independent sample t- tests for analyzing the data. We recorded 203 medication errors during 180 hours. The incidence of medication errors was 50.5% at various levels in the emergency department. Significant difference in age means was seen between the patients with and without medication errors. Seventy four point nine percent of errors were recorded as definitely an error. Most recorded errors were made by nurses [44.5%] and occurred in administrating stage [63.6%]. Given that the rate of the errors was relatively high, it seems that the presence of clinical pharmacist can be beneficial

Knowledge, attitudes and practice of nurses regarding adverse drug reaction reporting

Adverse drug reactions [ADR] are ranked as some of the major causes of patient morbidity and mortality. Spontaneous reporting of ADRs has remained the cornerstone of pharmacovigilance and is important in maintaining patient safety. This study was conducted to assess the nurses' knowledge and attitude towards pharmacovigilance, reasons for not reporting ADRs, and their pharmacovigilance practice. A questionnaire was prepared to investigate knowledge, attitude and practice [KAP] of nurses regarding ADR reporting. In November 2009, the questionnaires were given to 500 nurses of a teaching hospital in Tehran. Knowledge and practice of participants were not satisfying; however, their attitude towards pharmacovigilance was at a high level. About 91% of the nurses had never reported an ADR. Most nurses liked to report the ADRs to the physicians [87.1%] and pharmacists in hospital's ADR center [1.8%] rather than the ADR National Center. The main cause of under-reporting of the suspected ADRs was unawareness about the existence of such a national center. Among nurses who had reported ADR for at least once, the majority preferred using phone [10 out of 50] or Yellow Cards [7 out of 50]. Only 1 person out of 50 preferred using internet for submitting the reports. Since the nurses in this study had little knowledge and poor practice regarding the pharmacovigilance and spontaneous reporting system, interventions such as holding pharmacovigilance workshops in the hospitals focusing on the aims of pharmacovigilance, completing the Yellow Card and clarifying the reporting criteria are strongly recommended.

Efficacy of generic granisetron vs kytril[registered] for PONV in major gynecological operations: a randomized, double-blind clinical trial

Background Granisetron is a first-generation 5-HT3-receptor antagonist that has shown efficacy in preventing postoperative nausea and vomiting [PONV]. In this randomized double-blind parallel-group clinical trial, we assessed the efficacy of generic granisetron versus Kytril[registered], in the prevention of PONV in patients undergoing general anesthesia for gynaecological surgeries. Method One hundred and twenty patients who were supposed to undergo major gynaecological surgeries [myomectomy and hysterectomy] in Dr. Shariati Teaching Hospital, Tehran, Iran were randomly assigned to either single dose generic granisetron [40 mcg/kg], or Kytril[registered] [40 mcg/kg] at the end of the surgery. Two episodes of emetic symptoms [nausea and vomiting] were recorded by a gynaecologist who had no knowledge of which treatment each patient had received. This gynaecologist observed the patients at three different intervals: 6, 12 and 18 h post surgery. At the end of the observation period each patient evaluated the satisfaction with the study drug, and the gynaecologist evaluated sedation of the patients. Results In the generic granisetron group 47 and 13 patients, and in the Kytril[registered] group 45 and 15 patients underwent hysterectomy and myomectomy respectively. No difference was observed between two treatment groups regarding postoperative nausea and vomiting control during 18 hours after the drugs administration. Also there were no differences in the satisfaction with the study drug between the generic granisetron and Kytril[registered]. No difference in sedation scores was observed between two groups. Conclusion Generic granisetron exerts efficacy against PONV after gynaecological surgeries which is non-inferior to that of Kytril[registered]

Iranian pharmacists' knowledge, attitude and practice regarding counterfeit drugs

Background Awareness of pharmacists about counterfeit drugs is necessary for health improvement in community. The purpose of the present study is to assess the knowledge and measure the professional attitude and practice of Iranian pharmacist about counterfeit drugs. In August 2008, a knowledge, attitude and practice [KAP] study was performed in a national s sample of 794 pharmacists who participated in an Iranian Pharmacist Association congress. A questionnaire was prepared to collect Demographic and professional characteristics, Knowledge, attitude and practice of pharmacists regarding counterfeit drugs. The mean percent of participants who answer each practice questions correctly is 13.62% and none of questions have more than 14.7% of correct answer, while the participants' attitude towards the subject is at high level. None of demographic factors represented a significant relationship with knowledge and the only related parameters with attitude, were age and gender. Increasing age of pharmacists resulted in attitude improvement [p = 0.013] and womems attitudes were better than men [p = 0.05].The only related parameters with practice, were the number of working hours per a week and attitude. Increasing the number of working hours per a week, resulted in decreasing the desirable practice [p = 0.041] and attitude also had a direct relationship with practice [p = 0.011]. Conclusion The most important finding in the present study was the pharmacists low knowledge and practice level about counterfeit drugs, while their attitude towards this subject was at a high level. The results point out the need for designing and implementing educational programs

Evaluation of knowledge and expectations of Dr. shariati Hospital health care professionals regarding the services of the Hospital's Drug and Poison Information Center

This study was conducted to clarify the expectations of the health care professionals [professors, residents, interns, nurses and head nurses] in Dr. shariati Hospital regarding the services of the Drug and Poison Information Center in this Hospital. Data was collected from a questionnaire which was distributed among 400 people in April 2009. Only 157 respondents fulfilled the questionnaire. So a return rate of 39% was achieved. According to the results, medical reference books and drug information textbooks [36.7%] and expert colleagues [29.7%] were the [most commonly] used drug information resources. 77.8% of respondents [almost never] use DPICs. According to the results, 77.5% of respondents were non- acquainted with these centers' activities. 44.4% of respondents included [adverse drug reactions] and 33.3% included [availability of drugs in pharmacy] in the blank space considered for them to mention any expectation [s] they rank as the most important. In addition, 74% of them rank [incompatibility of injectable drugs] and [70.1% rank] drug interactions [as the [extremely important] issues. Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Even after 13 years of opening of the first DPIC in IRAN, the health care professionals are not familiar with these centers' services and activities yet. It shows an urgent need for culture building activities to introduce them these centers services