Antimicrobial stewardship programs in emergency departments: how do we measure antimicrobial use? A systematic review.

OBJECTIVE: The implementation of antimicrobial stewardship programs (ASPs) has become a usual practice in hospital settings. However, the method for monitoring antimicrobial use in accident and emergency departments (ED) is not yet adequately defined. Thus, the objective of this review is to describe antimicrobial use indicators used by ASPs implemented in ED. METHODS: A systematic review was performed based on studies found in the following academic research databases: MEDLINE, EMBASE, Web of Science, and Scopus (Period: January 2000 to December 2019). Controlled clinical trials, before-and-after studies, interrupted time series, and repeated measures studies assessing the impact of ASPs on antimicrobial use in ED were included; studies published in languages other than English or Spanish were excluded from this review. RESULTS: Twenty-six studies met the inclusion criteria and were included in this systematic review. In total, 15 (62.5%) studies described the ASP team members who collaborated with the ED staff. Most (21; 80.8%) studies used the percentage of patients with an antibiotic prescription as an indicator. Four (15.4%) studies included defined daily dose data. The antibiotic treatment duration was reported in four (15.4%) studies. Only two studies assessed the impact of the ASP using microbiological indicators, both of which used the incidence of infection with Clostridioides difficile as the indicator. CONCLUSIONS: The reports of experiences in implementing ASPs in ED show heterogeneous antimicrobial use indicators, which makes it difficult to compare results. Therefore, antimicrobial use indicators for ASPs must be standardised between hospital units.

The efficacy of a medication review programme conducted in an emergency department.

Background Older age and inappropriate prescribing is related to a greater rate of emergency department visits and hospitalisations. Objective To assess the efficacy of an interprofessional collaboration programme in which a review of the medication of older patients seen in the emergency observation unit was carried out. Setting Emergency departments at four Spanish hospitals. Method Randomised, controlled study. Patients over 65 years of age presenting to the emergency department were randomised to a control or an intervention group. In the intervention group, a pharmacist reviewed the patients' chronic medication and identified any potentially inappropriate prescriptions based on the STOPP/START criteria. Each case was discussed with the emergency specialist and a recommendation to modify the treatment was sent to the general practitioner. Main outcome measure Rate of emergency visits and hospital admissions. Results The adjusted rate ratio of emergency visits and hospital admissions was 0.808 (95% CI 0.617 to 1.059) at 3 months, 0.888 (95% CI 0.696 to 1.134) at 6 months and 0.954 (95% CI 0.772 to 1.179) at 12 months. There was a statistically significant reduction at 3 months in two of the hospitals that participated in the study [adjusted rate ratio at 3 months was 0.452 (95% CI 0.222 to 0.923) in hospital 3 and 0.567 (95% CI 0.328 to 0.983) in hospital 4]. Conclusion Overall, the intervention did not reduce the number of emergency visits and hospital admissions. However, a significant effect was observed in centres were a high acceptance rate of treatment recommendations was achieved.

Adherencia subóptima al tratamiento en la esclerosis múltiple / Adherence to treatment in multiple sclerosis

Objetivo Conocer la adherencia al tratamiento con interferón beta y acetato de glatirámero de pacientes con esclerosis múltiple, así como el porcentaje de discontinuación y sus causas. Método Estudio observacional, longitudinal prospectivo y multicéntrico de ámbito nacional en el que se seleccionaron pacientes con esclerosis múltiple que acudieron a los servicios de farmacia hospitalarios para recoger medicación. La variable principal de valoración fue el porcentaje de adherencia durante un año, medido como la relación entre las dosis de fármaco dispensadas y las necesarias. Secundariamente se midieron las discontinuaciones de tratamiento y sus causas. Resultados Se incluyeron, durante un periodo de seis meses, 543 pacientes en 39 servicios de farmacia. El tiempo medio de exposición a los fármacos durante el estudio fue de 312 días y la adherencia media en ese periodo del 61,5% (IC 95%: 59,4-63,5). De los 543 participantes en el estudio, 34 (6,26%) discontinuaron el tratamiento, en la mayoría de los casos por criterio médico. Conclusiones La adherencia terapéutica durante un año en los pacientes con esclerosis múltiple ha sido inferior a la óptima. Es necesario analizar las causas y establecer medidas correctoras (AU)

Objective To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. Methods Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. Results Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. Conclusions Multiple sclerosis patients’ treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established (AU)

Adherence to treatment in multiple sclerosis.

OBJECTIVE: To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. METHODS: Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. RESULTS: Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. CONCLUSIONS: Multiple sclerosis patients' treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established.

[Error detection in the administration of antiretroviral therapy to out-patients]. / Detección de errores en la administración del tratamiento antirretroviral en pacientes externos.

OBJECTIVE: To describe medication errors in the administration of antiretroviral drugs in HIV patients involved in a pharmaceutical care program. METHODS: A retrospective review has been carried out on pharmaceutical care records for HIV patients who picked up medication at the Hospital Pharmacy Service between July 1999 and April 2002. Medication errors, median time to error detection and percentage of patients with written information supplied were measured. Medication errors were classified according to the terminology and the taxonomy of the Spanish Ruiz-Jarabo Group 2002. RESULTS: 513 patients' pharmaceutical care records were analysed (68% of total HIV outpatients). Forty medication errors were recorded (0.27 errors/100 patients dispensed per month). The median time to error detection was 35.5 days. Written information was supplied in 63% of the cases. Errors reached patients but did not cause any damage in most cases. Incorrect doses was the most frequent type of error detected, followed by food and drug interaction. CONCLUSIONS: Pharmaceutical care programs allow us to detect drug administration errors. The frequency of monitoring visits may influence time to error detection.

[Phlebitis due to intravenous administration of macrolide antibiotics. A comparative study of erythromycin versus clarithromycin]. / Flebitis relacionada con la administración intravenosa de antibióticos macrólidos. Estudio comparativo de eritromicina y claritromicina.

BACKGROUND: To know and to compare the incidence of phlebitis due to intravenous administration of macrolide antibiotics erythromycin and clarithromycin. PATIENTS AND METHOD: Non-randomized prospective study of consecutive patients who were diagnosed of community pneumonia and treated with intravenous macrolides (19 with erythromycin and 25 with clarithromycin). RESULTS: The cumulative incidence of phlebitis in patients treated with erythromycin was 78.9% (incidence rate of 0.40 episodes/patient-day) and in those treated with clarithromycin 76% (incidence rate of 0.35 episodes/patient-day). CONCLUSIONS: The risk of phlebitis is high and similar with intravenous administration of both macrolides.

Toxicidad de dos pautas posológicas de indinavir. Estudio de cohortes retrospectivo / Toxicity of two indinavir dosage regimens. A retrospective cohort study

Indinavir a dosis de 1.200 mg en dos administraciones al día (bid) es una pauta posológica más sencilla que la administración de 800 mg en tres administraciones al día (tid), pero existe riesgo de aumento de toxicidad. Se ha realizado un estudio de cohortes retrospectivo de dieciséis meses de duración con el fin de evaluar si la administración de indinavir 1.200 mg bid se asocia a un mayor número de interrupciones de tratamiento por toxicidad que la administración de 800 mg tid. Se incluyen un total de 127 pacientes que iniciaron tratamiento con indinavir en 1998 (78 con indinavir 800 mg tid y 49 con indinavir 1.200 mg bid). El 32,7 por ciento de los pacientes con indinavir 1.200 mg bid interrumpen tratamiento por toxicidad frente al 15,4 por ciento que tomaban 800 mg tid (p = 0,022) (RR = 2,1; C195 por ciento = 1,1-4,1).Se concluye que indinavir a dosis de 1.200 mg bid se asocia a mayor toxicidad que requiere interrupción de tratamiento que indinavir a dosis de 800 mg tid (AU)