ABSTRACT
BACKGROUND: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.
ABSTRACT
Background: At the beginning of the COVID-19 pandemic many drugs were used with an uncertain benefit/risk profile that needed to be evaluated. The goal of this study was to analyse the incidence of adverse drug reactions (ADRs) and describe the drugs used in COVID-19 hospitalised patients at the beginning of the COVID-19 pandemic through the minimum basic data set (MBDS). Methods: Retrospective observational study that included hospitalised patients with COVID-19 at our centre between March and May 2020 who had ADRs coded in discharge/death medical reports according to the International Classification of Diseases (ICD-10). Those patients with ADRs ascribed to COVID therapy were selected and the causal relationship was evaluated using the Naranjo algorithm. Descriptive statistical analysis was used. Results: We identified 141 ADRs in 110 cases of hospitalisation due to COVID-19 that entailed an incidence of 9.66% (141/1459), CI95% 8.25-11.29. From the ADRs analysed, 60.3% (85/141) were ascribed to COVID therapy. Lopinavir/ritonavir represented 38.8% (33/85) of ADRs, glucocorticoids 23.5% (20/85) and hydroxychloroquine 9.4% (8/85). Out of the ADRs, 31.8% (27/85) were gastrointestinal disorders (probable lopinavir/ritonavir), 27.0% (23/85) blood glucose disorders (probable glucocorticoid) and 17.6% (15/85) hypertransaminasaemia (probable azithromycin, possible lopinavir/ritonavir, possible hydroxychloroquine, possible interferon). Regarding intensity, 64.7% (55/85) were mild cases, 29.4% (25/85) moderate and 5.9% (5/85) severe. The percentage of ADRs that did not require intervention were 24.7% (21/85), 32.9% (28/85) required pharmacological treatment, 40.0% (34/85) suspension of the drug, 1.2% (1/85) close monitoring and 1.2% (1/85) dose reduction. Conclusions: The incidence of ADR in COVID population that required admission at the beginning of the pandemic seems to be higher than in the general population. The MBDS proves to be a useful tool to trace ADRs. (AU)
Introducción: La llegada de la pandemia de COVID-19 supuso la utilización de muchos fármacos con un perfil de riesgo/beneficio incierto que debe ser evaluado. El objetivo de este estudio fue analizar la incidencia de reacciones adversas a medicamentos (RAM) y describir los medicamentos utilizados en pacientes hospitalizados por COVID-19 al comienzo de la pandemia a través del conjunto mínimo básico de datos (CMBD). Materiales y métodos: Estudio observacional retrospectivo que incluyó pacientes hospitalizados por COVID-19 en nuestro centro entre marzo y mayo de 2020 que presentaban RAM codificadas en los informes médicos de alta/exitus según la Clasificación Internacional de Enfermedades (CIE-10). Se seleccionaron los pacientes con RAM atribuidas a la terapia COVID-19 y se evaluó la relación causal mediante el algoritmo de Naranjo. Se realizó un análisis estadístico descriptivo. Resultados: Identificamos 141 RAM en 110 casos de hospitalización por COVID-19 lo que supone una incidencia del 9,66% (141/1459), IC95% 8,25-11,29. De las RAM analizadas el 60,3% (85/141) se atribuyeron a la terapia COVID. Lopinavir/ritonavir representó el 38,8% (33/85) de las RAM, los glucocorticoides el 23,5% (20/85) y la hidroxicloroquina el 9,4% (8/85). De todas las RAM, el 31,8% (27/85) fueron trastornos gastrointestinales (probable lopinavir /ritonavir), el 27,0% (23/85) trastornos de la glucemia (probable glucocorticoide) y el 17,6% (15/85) hipertransaminasemia (probable azitromicina, posible lopinavir /ritonavir, posible hidroxicloroquina, posible interferón). En cuanto a la intensidad, el 64,7% (55/85) de las RAM fueron casos leves, el 29,4% (25/85) moderados y el 5,9% (5/85) graves. El porcentaje de RAM que no requirió intervención fue 24,7% (21/85), 32,9% (28/85) requirió tratamiento farmacológico, 40,0% (34/85) suspensión del fármaco, 1,2% (1/85) seguimiento estrecho y 1,2% (1/85) reducción de dosis... (AU)
Subject(s)
Humans , Drug-Related Side Effects and Adverse Reactions , Coronavirus Infections/epidemiology , PandemicsABSTRACT
Objetivo: Evaluar la efectividad de icatibant en el tratamiento del angioedema inducido por IECA (AII), en un centro sin protocolización previa del manejo.Método: Estudio observacional retrospectivo y descriptivo. Se incluyeron pacientes diagnosticados de AII y tratados con icatibant 30 mg entre mayo 2015-diciembre 2017. Las variables de resultado principal y secundaria fueron: tiempo hasta resolución completa y tiempo hasta primera mejoría; respectivamente.Resultados: Cinco pacientes, mediana de edad 76 años (46-81); cuatro mujeres y un varón. Todos caucásicos. Medianas de tiempo hasta resolución completa y hasta primera mejoría: 23 horas (IQR 20,0-25,0) y 3 horas (IQR 3,0-6,0); respectivamente.Conclusiones. El inicio temprano del tratamiento anti-bradicinérgico puede resultar clave para la evolución del cuadro. Para alcanzar la máxima efectividad, se reduzcan las morbilidades asociadas, los ingresos en UCI y el tiempo de estancia hospitalaria, resulta primordial la elaboración de protocolos locales que tengan en cuenta las particularidades de cada centro. (AU)
Objetive: To assess the effectiveness of icatibant in the management of angiotensin-converting enzyme inhibitor-induced angioedema (AII) in a hospital without a treatment guidance.Methods: Observational, retrospective and descriptive study. All patients diagnossed with AII and treated with icatibant 30 mg between May 2015-December 2017 were included. The primary and secondary end-points were: time to total resolution and time to first improvement; respectively.Results: Five patients, median age 76 years (46-81). Four women and a man. All of them Caucasian. Median time to total resolution and to first improvement: 23 hours (IQR 20.0-25.0) and 3 hours (IQR 3.0-6.0); respectively.Conclusion: The early start with the anti-bradicinergic therapy may be key to the AII evolution. To achieve the maximum effectiveness and to get reduced the associated morbidity, the ICU admission and the time to discharge, the development of local protocols considering the particularities of each center is highly necessary. (AU)
Subject(s)
Humans , Male , Female , Aged , Angioedema/therapy , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Retrospective Studies , Epidemiology, Descriptive , Treatment OutcomeABSTRACT
OBJECTIVE: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. METHOD: The automated program, ALTOMEDICAMENTOS® version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. RESULTS: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. CONCLUSIONS: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals.
Objetivo: Analizar las intervenciones farmacéuticas realizadas con el apoyo de un sistema automático de validación de tratamientos vs. el método tradicional sin apoyo informático. Metodos: El programa automatizado, ALTOMEDICAMENTOS ® version 0, cuenta con 925.052 celdas con información de aproximadamente 20.000 medicamentos, analizando dosis, vías de administración, días de tratamiento, dosificación en insuficiencia renal y hepática, control de interacciones, de medicamentos semejantes y de medicamentos por vía enteral. Durante ocho días distribuidos en cuatro hospitales diferentes (alta complejidad con más de 1.000 camas, intermedio de 400 camas, geriátrico y monográfico), los mismos pacientes y tratamientos se analizaron mediante los dos sistemas. Resultados: Se han analizado 3.490 pacientes diferentes con 42.155 tratamientos. Por el sistema tradicional se han realizado 238 intervenciones (0,56% intervenciones/posibles intervenciones) vs. 580 (1,38%) con el automatizado. Las intervenciones farmacéuticas muy significativas fueron 0,14 vs. 0,46%, las significativas 0,38 vs. 0,90%, las no significativas 0,05 vs. 0,01%. Las intervenciones fueron del 1,85% al utilizar los dos sistemas vs. 0.56% usando solo el sistema tradicional. El sistema tradicional detectó el 30,5% de las posibles intervenciones, sin embargo con el sistema automático se detectaron el 84% de dichas intervenciones. Conclusiones: La automatización multiplica entre 2,43 a 3,64 veces las intervenciones farmacéuticas. En base a los resultados de este estudio el sistema tradicional de validación debería ser modificado, apoyándose en sistemas automatizados. El programa automático funciona en diferentes hospitales.
Subject(s)
Drug Therapy/methods , Drug Therapy/standards , Adult , Automation , Child , Cross-Over Studies , Drug Administration Schedule , Drug Interactions , Humans , Inpatients , Liver Failure/chemically induced , Liver Failure/diagnosis , Medical Records Systems, Computerized , Medication Systems, Hospital , Prospective Studies , Renal Insufficiency/chemically induced , Renal Insufficiency/diagnosisABSTRACT
OBJECTIVE: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. METHOD: The automated program, ALTOMEDICAMENTOS(R) version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. RESULTS: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. CONCLUSIONS: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals
OBJETIVO: Analizar las intervenciones farmacéuticas realizadas con el apoyo de un sistema automático de validación de tratamientos vs. el método tradicional sin apoyo informático. MÉTODOS: El programa automatizado, ALTOMEDICAMENTOS(R) version 0, cuenta con 925.052 celdas con información de aproximadamente 20.000 medicamentos, analizando dosis, vías de administración, días de tratamiento, dosificación en insuficiencia renal y hepática, control de interacciones, de medicamentos semejantes y de medicamentos por vía enteral. Durante ocho días distribuidos en cuatro hospitales diferentes (alta complejidad con más de 1.000 camas, intermedio de 400 camas, geriátrico y monográfico), los mismos pacientes y tratamientos se analizaron mediante los dos sistemas. RESULTADOS: Se han analizado 3.490 pacientes diferentes con 42.155 tratamientos. Por el sistema tradicional se han realizado 238 intervenciones (0,56% intervenciones/posibles intervenciones) vs. 580 (1,38%) con el automatizado. Las intervenciones farmacéuticas muy significativas fueron 0,14 vs. 0,46%, las significativas 0,38 vs. 0,90%, las no significativas 0,05 vs. 0,01%. Las intervenciones fueron del 1,85% al utilizar los dos sistemas vs. 0.56% usando solo el sistema tradicional. El sistema tradicional detectó el 30,5% de las posibles intervenciones, sin embargo con el sistema automático se detectaron el 84% de dichas intervenciones. CONCLUSIONES: La automatización multiplica entre 2,43 a 3,64 veces las intervenciones farmacéuticas. En base a los resultados de este estudio el sistema tradicional de validación debería ser modificado, apoyándose en sistemas automatizados. El programa automático funciona en diferentes hospitales
Subject(s)
Humans , Child , Adult , Drug Therapy/methods , Drug Therapy/standards , Inpatients , Medication Systems, Hospital , Automation , Drug Administration Schedule , Cross-Over Studies , Drug Interactions , Medical Records Systems, Computerized , Renal Insufficiency/chemically induced , Renal Insufficiency/diagnosis , Prospective Studies , Liver Failure/chemically induced , Liver Failure/diagnosisABSTRACT
Introducción: La conciliación de la medicación (CM) es el proceso que compara el tratamiento farmacológico previo del paciente con el prescrito tras una transición asistencial. En el ámbito hospitalario, es una estrategia que permite minimizar errores de medicación. Nuestro objetivo es analizar el impacto de la implantación de un circuito de CM entre neumología y farmacia al ingreso y al alta. Pacientes y métodos: Se incluyeron pacientes polimedicados ingresados en neumología entre mayo-2012 y diciembre-2013. Se evaluaron: número de discrepancias al ingreso y alta, tipos de discrepancias no justificadas, gravedad, grado de aceptación del neumólogo, número de fármacos. Resultados: Se conciliaron al alta 507 pacientes de 818 altas (61,8%). En 2012 se conciliaron al alta 134 pacientes, detectándose 134 discrepancias en 63 pacientes (47%), con una media de 2,12 discrepancias/paciente. Se entregaron 161 medicamentos de uso limitado. En 2013 se conciliaron al ingreso 318 pacientes. Se detectaron 226 discrepancias en 130 pacientes (40,9%). Se conciliaron al alta 373 pacientes de 554 altas (67,32%), detectándose 139 discrepancias en 96 pacientes (25,7%) con una media de 1,4 discrepancias/paciente. Se entregaron 520 medicamentos de uso limitado. El análisis comparativo al alta entre mayo-diciembre 2012/2013, mostró un aumento en el número de pacientes conciliados (50,8% vs 62,9%) y disminución significativa del número de pacientes con discrepancias del 47% al 22,4% (p=0,001). Conclusiones: El descenso en el número de discrepancias por paciente demuestra que la CM es una eficaz herramienta al ingreso y al alta, obteniéndose con la misma una racionalización del uso de fármacos. La perspectiva futura es fomentar la colaboración atención primaria-especializada. Sería necesario realizar estudios para evaluar el impacto sobre los reingresos
Introduction: Medication conciliation (MC) is the process of comparing the previous pharmaceutical treatment of the patient with the prescribed treatment after transitional medical assistance. It´s a strategy to minimize medicational errors within the hospital.Our goal is to analyze the impact of the implementation of a circuit of MC between pulmonology and pharmacy at admission and discharge. Methods: Polymedicated patients that were hospitalized in pulmonology between May 2012 and December 2013 were included. There were evaluated: number of discrepancies at admission and discharge, different types of not justified discrepancies, severity, acceptability of the pulmonologist and number of drugs. Results: There were 818 patients admited, 507 of which were conciliated at time of discharge (61.8%). In 2012, 134 patients were conciliated at the time of discharge detecting 134 discrepancies in 63 patients (47%), with an average of 2.12 discrepancies/patient. 161 drugs were distributed for limited use. In 2013, 318 patients were conciliated at the time of admission. There were 226 discrepancies detected in 130 patients (40.9%). At the time of discharge 373 patients were conciliated from 554 patients (67.32%), 139 discrepancies detected in 96 patients (25.7%) with a mean of 1.4 discrepancies/patient. 520 drugs were distributed for limited use. The comparative analysis of admissions between May 2012 and December 2013 showed an increase in the number of conciliated patients (50.8% and 62.9%) and a significant decrease in the number of patients with discrepancies of 47% to 22.4% (p=0,001). Conclusions: The decrease in the number of discrepancies per patient demonstrates that MC is an effective tool at admission and discharge, obtaining there in a rational use of drugs. The future vision is to foster the collaboration between primary and specialized care. Further studies would be necessary to evaluate the impact on readmissions
Subject(s)
Female , Humans , Male , Medication Reconciliation/methods , Medication Reconciliation/classification , Pulmonary Medicine/education , Pulmonary Medicine , Drug Therapy/classification , Drug Therapy/methods , Ambulatory Care , Medical Record Linkage/instrumentation , Societies/ethics , Prospective Studies , Medication Reconciliation/organization & administration , Medication Reconciliation , Pulmonary Medicine/methods , Drug Therapy/standards , Drug Therapy , Ambulatory Care/methods , Drug Control for Patient in Transit , Medical Record Linkage/standards , Societies/policies , Cross-Sectional Studies/methodsABSTRACT
El linezolid es un antibiótico perteneciente al grupo de las oxazolidinonas que tiene actividad frente a cocos gram positivos aerobios. Su empleo resulta útil en infecciones complicadas por patógenos multirresistentes. Aunque está indicado para el tratamiento de la neumonía e infecciones de la piel y tejidos blandos, ha demostrado eficacia en la tuberculosis multirresistente y en otras enfermedades infecciosas. Dentro de los efectos adversos del linezolid, destacan: cefalea, trastornos gastrointestinales, anemia, trombopenia, leucopenia, pancitopenia, acidosis láctica y neuropatía. Se presenta el caso de una mujer de 42 años con tuberculosis multirresistente tratada con etambutol, estreptomicina, ofloxacino y linezolid, que presentó meses después del inicio del tratamiento, anemia, leucopenia leve, trastornos gastrointestinales y neuropatía. Tras la suspensión del linezolid y transfusión de concentrados de hematíes, se objetivó mejoría clínica y analítica. La toxicidad hematológica del linezolid suele ser reversible y su gravedad depende de la duración del tratamiento
Linezolid is an antibiotic from the group of the oxazolidinone that has activity against aerobic gram -positive cocci. Its use is useful in complicated infections by multiresistant pathogens. Although it is indicated for the treatment of pneumonia and infections of the skin and soft tissues, it has shown efficacy in MDR-TB and other infectious diseases. The adverse effects of linezolid includes: headache, gastrointestinal distress, anemia, thrombocytopenia, leukopenia, pancytopenia, lactic acidosis, and neuropathy. The case of a 42 year old woman with MDR-TB treated with ethambutol, streptomycin, ofloxacin is presented, and linezolid show, months after the start of treatment, anemia, mild leukopenia, gastrointestinal disorders and neuropathy. After suspensionof linezolid and transfusion of packed red blood cells, clinical and analytical improvements were observed. The haematological toxicity of linezolid is usually reversible and its severity depends on the duration of treatment