Influencia de la pandemia COVID-19 en la tasa de vacunación antigripal / Impact of the COVID-19 pandemic on the flu vaccination

Introducción: En la temporada 2020-2021 se realizaron campañas mayores de vacunación antigripal, primordialmente en pacientes inmunocomprometidos y sus convivientes. Objetivos: Principal: determinar el impacto de la pandemia COVID-19 en la tasa de vacunación antigripal en la temporada 2020-2021 en pacientes con patologías con carácter inmunosupresor, pacientes pertenecientes a grupos de riesgo y las personas convivientes. Secundarios: porcentaje de vacunas administradas, incidencia de infección del virus de la gripe y la influencia del Servicio de Farmacia sobre la decisión de los pacientes a vacunarse. Metodología: Estudio observacional, prospectivo, de ocho meses de duración, realizado en un hospital comarcal de 125 camas, en pacientes con patologías con carácter inmunosupresor y pacientes que solicitaban la vacunación y estaban incluidos en los grupos de riesgo. Resultados: En la campaña de vacunación 2020-2021 hubo un aumento de pacientes vacunados en un 44,1% (89) con respecto a la vacunación 2019-2020. En el 2019-2020 el 5,3% (6/113) presentaron cuadro de gripe y de los que no recibieron la vacuna el 7,9% (7/89). En la campaña 2020-2021 ningún paciente presentó cuadro de gripe, el 56,4% (114/202) de los pacientes refirieron que fueron influenciados por el servicio de farmacia para vacunarse. Conclusiones: La pandemia por COVID-19 aumentó las tasas de vacunación antigripal en la temporada 2020-2021 ayudando a disminuir la mortalidad en pacientes que sufrieron la enfermedad por la COVID-19. El Servicio de Farmacia influyó positivamente en la tasa de vacunación. (AU)

Introduction: In the 2020-2021 season larger vaccination campaigns were carried out, primarily in immunocompromised patients and their partners. Objectives: Primary end point: determine the impact of the COVID-19 pandemic on the influenza vaccination rate in the 2020-2021 season, in patients with immunosuppressive pathologies, people living with risk groups and patients who requested it and belonged to risk groups. Secondary end point: percentage of vaccines administered, incidence of influenza virus infection and the influence of the Pharmacy Service on the decision of patients to be vaccinated. Methodology: An eight-month prospective, observational study conducted in a 125-bed regional hospital in patients with immunosuppressive pathologies and patients who requested vaccination and were included in risk groups. Results: In the 2020-2021 vaccination campaign, there was an increase in vaccinated patients by 44.1% (89 patients) compared to the 2019-2020 vaccination. In 2019-2020 5.3% (6/113) presented flu symptoms and of those who did not receive the vaccine 7.9% (7/89). In the 2020-2021 campaign, no patient had flu symptoms, 56.4% (114/202) of the patients reported that their decision to get vaccinated was because it was offered at the hospital pharmacy. Conclusions: The COVID-19 pandemic increased flu vaccination rates in the 2020-2021 season, causing lower mortality in patients who suffered from the COVID-19 disease. The Pharmacy Service positively influenced the vaccination rate. (AU)

Remote pharmaceutical care for patients with rheumatoid arthritis and psoriasis.

BackgroundAccess to drugs with hospital-restricted dispensation, such as those for patients with rheumatoid arthritis or psoriasis, is regulated by healthcare policy. These drugs have the greatest cost-effective impact on the healthcare system. This is why a model for Pharmaceutical Care based on follow-up teleconsultations was defined in our hospital to improve patient well-being. Objective To evaluate clinical changes on patients when our remote Pharmaceutical Care model is applied and describe the work carried out by pharmacists when applying it. Setting Pharmacy Department of a Hospital in Barcelona, Spain. Method Cross-sectional observational study of the remote Pharmaceutical Care model developed by Clinical Pharmacists. All patients diagnosed with psoriasis or rheumatoid arthritis who were receiving active treatment with Hospital/Specialist only drugs, during the period from May to December 2018, were included. Main outcome measures The corresponding healthcare activity was recorded and to determine the utility of the model, the clinical response to treatment of patients included in the study was recorded. Results The implementation of teleconsultation is statistically related to the biological treatment response of patients with psoriasis (p = 0.006) and rheumatoid arthritis (p = 0.019). In those patients the healthcare activity of calculating and/or recording clinical variables of effectiveness/safety is statistically associated to biological treatment response (65.62% vs 35%, p = 0.015 and 73.14% vs 53.26%, p = 0.003). Conclusions The implementation of the model described lends added value to traditional pharmacotherapeutic management of biological treatments in patients with rheumatoid arthritis and psoriasis since response is improved but patient well-being is not diminished.

Pharmacokinetic parameters from data relating to the plasma and biliary excretion kinetics of cefmetazole in rats.

The plasma disposition kinetics and the biliary excretion kinetics of cefmetazole after i.v. administration to rats anaesthetized with pentobarbital sodium were studied. Parametric estimation was carried out using non-linear regression methods with uni- and bivariate analyses. On the basis of statistical criteria a two-compartment model was chosen as the most appropriate for fitting the plasma concentration data, establishing a mean half-life value of the slow disposition phase at around 13 min. Analysis of the plasma and biliary data revealed a mean value for the biliary excretion constant of 0.049 l/min and 0.113 l/min for the urinary excretion constant. The cumulative biliary excretion data showed a mean value of 36.25% of the dose administered. The relationship between the biliary excretion rates and plasma concentrations seems to point to a saturable mechanism of excretion.

Pharmacokinetics, hepatic biotransformation and biliary and urinary excretion of bromosulfophthalein (BSP) in an experimental liver disease mimicking biliary cirrhosis.

We studied the hepatic handling of bromosulfophthalein in healthy rabbits with hepatic coccidiosis 28 days after an experimental infection with sporulated oocysts of Eimeria stiedai, an experimental model of liver disease histopathologically resembling primary biliary cirrhosis in man. A pharmacokinetic study of the results was performed following a multicompartmental model with 7 transfer constants to describe the physiological disposition of the dye. The study showed that the plasma disappearance, distribution volume (Vi), hepatic biotransformation and the biliary and urinary elimination of conjugated (BSPc) and unconjugated (BSPu) bromosulfophthalein were markedly altered. Whereas Vi and urinary excretion of the dye were significantly increased, the hepatic clearance, biotransformation and biliary excretion of BSPc and BSPu were drastically reduced in infected rabbits. Satisfactory agreement was obtained between the experimental and estimated data, particularly those relating to biotransformation clearance and biliary and urinary excretion of the dye. These results demonstrate that severe liver disease in rabbits with histopathological liver alterations resembling several hepatic dysfunctions in man markedly reduce hepatic uptake, metabolism and biliary excretion of a xenobiotic such as BSP.

Discrimination of kinetic models in heteroscedastic parametric estimation of bentazepam following multiple dosing.

The aim of the present study was to attempt to discriminate between single- and two-compartment kinetic models used for calculating the pharmacokinetic parameters of bentazepam when the plasma concentrations of different administrations are used as initial data during multiple dosage regimes. Determination of the best estimated pharmacokinetic parameters was performed using non-linear regression analysis, weighting the data as a function of the error of the analytical technique. Bentazepam was administered at a dose of 25 mg orally at intervals of 8, 12 or 24 h to a total of 9 patients. The mean values of the parameters established for the single-compartment model were Ka = 2.024 h-1; Vd = 2.198 l/kg and Ke = 0.130 h-1. For the two-compartment model these values were: Ka = 2.134 h-1, Vc = 2.049 l/kg, K10 = 0.154 h-1, K12 = 0.042 h-1 and K21 = 0.103 h-1. By application of the MAICE test mean AIC values of 41.62 and 42.52 were obtained for the single- and two-compartment models, respectively. The most suitable kinetic model was determined for each patient according to the predictive nature of the individual parameters of the two kinetic models and by analysis of the residuals of the non-linear regressions of the parametric estimation.

Simulation of plasma bentazepam levels in multiple dosage regimens from parameters established by non-linear regression and bayesian estimation.

In the present study, a simulation was made of the time-course of the plasma levels of bentazepam, administered orally at a dose of 25 mg with dosage intervals of 8, 12 and 24 h over 5 days of treatment. The pharmacokinetic parameters corresponding to a single-compartment model were calculated in a previous study with 10 patients who received the drug in a multiple dosage regimen, using all the data relating to plasma levels even though they corresponded to different administrations, by non-linear regression employing programs based on homoscedastic, heteroscedastic and bayesian estimation methods. The mean values of the kinetic parameters obtained previously and used in the present study were as follows: for the absorption constant, mean values of 2.33, 2.18 and 2.75 h-1 were used; for the elimination constant, the values used were 0.10, 0.09 and 0.22 h-1 and for the apparent distribution volume, the values used were 1.89, 2.89 and 0.80 l/kg, with each of the above-mentioned calculation programs, respectively. The highest value for the maximum concentration at steady state proved to be 313.2 ng/ml for a dosage interval of 8 h according to the parameters established with the program using homoscedastic estimation. In the same case (homoscedastic estimation) the highest value of the minimum at steady state was 168.7 ng/ml. By contrast, the lowest value of the maximum value at steady state--129.3 ng/ml--was obtained with a dosage interval of 24 h using the parameters of the heteroscedastic estimation method, while the lowest value of the corresponding minimum was also observed for an interval of 24 h but using the parameters of the bayesian estimation; this was 2.8 ng/ml.

Parametrization by non-linear regression and bayesian estimation of bentazepam in a multiple dosage regimen in humans.

The plasma levels of bentazepam were determined by an HPLC technique in a total of 10 patients receiving the drug orally in pill form who were on a dosage regimen with the drug administered every 8, 12 or 24 h. Blood samples were taken three times following the administration of the first and last dose and at times, immediately after the administration of intermediate doses. The parameters corresponding to a one-compartment kinetic model were calculated in each patient by using all the data on plasma levels still corresponding to different administrations by non-linear regression and applying programs with homoscedastic, heteroscedastic and bayesian estimation. The absorption constant had mean values of 2.33, 2.18 and 2.75 h-1. The elimination constant proved to be equal to 0.10, 0.09 and 0.22 h-1 while for the apparent distribution volume mean values of 1.89, 2.89 and 0.80 l/kg were found with each of the estimation programs employed, respectively. The values found for each of the kinetic parameters and with each of the programs were subjected to the non-parametric Kruskal-Wallis test with a view to detecting the presence or absence of statistically significant differences. The discrimination of the program that yielded the best fit was performed by linear regression between the values found for the plasma calculations and those calculated theoretically at the same time with each of the programs.

Phosphomycin levels in serum and interstitial tissue fluid in a multiple dosage regimen in rabbits.

The evolution of phosphomycin (Fosfocina), levels in serum and experimentally induced interstitial tissue fluid and the access of the drug to different organs were studied in rabbits after the administration of a single dose of 60 mg/kg and during a multiple dosage regimen of 60 mg/kg/6 h over three days. Following the administration of a single dose a Cmax value of phosphomycin in interstitial tissue fluid of 80.4 micrograms/ml was reached at 1.2 h. The elimination half-life of the drug from the systemic circulation after a single dose had a value of 1.6 h, and was not significantly different from the value found for the same parameter in the multiple dosage regimen. The disappearance half-life of phosphomycin from interstitial tissue fluid, with a value of 1.9 h for the single dose schedule, was not significantly different from the value of the disappearance half-life of the drug from interstitial tissue fluid in the multiple dosage regimen. Finally, the results of the present study confirm the linearity of phosphomycin kinetics, at least in the conditions studied, and show that the drug is not accumulated in the organs considered.

Disposition and excretion of cefoperazone in rabbits.

The pharmacokinetics of cefoperazone were studied after i.v. administration of a single 30 mg/kg dose in a total of 40 New Zealand rabbits. Determination of the plasma levels of the drug revealed a slow elimination half-life of 0.48 h. The disappearance half-life of cefoperazone in interstitial tissue fluid shows a mean value of 1.9 h, being statistically higher than the value found for the half-life of the slow phase of elimination from the systemic circulation. 12 h after i.v. administration, 32.1% of the drug was seen to be excreted by the kidney and a further 15.2% in bile. The urinary excretion constant had a mean value of 0.29 h-1, whereas that of biliary excretion was 0.12 h-1.

Linearity of the pharmacokinetics of phosphomycin in serum and interstitial tissue fluid in rabbits.

A study was carried out on the access and residence of (-)(1R,2S)-1,2-epoxypropylphosphonic acid (phosphomycin) in interstitial tissue fluid produced experimentally by subcutaneous implantation of spiral steel cages after administration of doses of 20, 30 and 60 mg/kg of the antibiotic to rabbits. The levels reached by the drug in serum and interstitial tissue fluid (ITF) were determined by a microbiological plate diffusion method. The elimination half-lives of phosphomycin ranged between 1.16 and 1.57 h. These values are similar to those found for the disappearance half-lives from ITF. Phosphomycin reached maximum concentrations in ITF between 31.95 and 80.37 micrograms/ml. Linear relationships were established between the (AUC) 0 infinity in serum, the (AUC) 0 infinity in ITF and Cmax in ITF and the doses studied, revealing the non-dose-dependent kinetics of phosphomycin. The linearity of phosphomycin kinetics was checked in serum and ITF by applying the superposition principle.

Pharmacokinetics of phosphomycin during haemofiltration.

The pharmacokinetics of phosphomycin were studied in 10 adult patients with terminal renal impairment during a 4 h haemofiltration session. A single i.v. dose of 30 mg/kg of the antibiotic was administered to each patient at the beginning of the haemofiltration session. The half-life of the slow disposition phase (t 1/ 2z ) showed an average value of 4.05 +/- 1.77 h, much lower than that established in patients who did not undergo any purification techniques. Serum phosphomycin concentrations at the input and the output of the haemofilter at the end of the session were, respectively, 26.65 and 19.13 micrograms/ml. During haemofiltration, 64.90% of the original dose was eliminated. In this kind of patient we recommend a dose of 30 mg/kg at the beginning and at the end of each haemofiltration session for interfiltration periods of 48 h.

The influence of uremia on the accessibility of phosphomycin into interstitial tissue fluid.

The entry and persistence of phosphomycin in interstitial tissue fluid (ITF) were studied in 9 patients with normal renal function and 8 patients with varying degrees of renal impairment, all of whom received a single i.v. dose of 30 mg/kg. ITF was obtained from skin blisters produced by suction. The antibiotic followed a two-compartment open kinetic model. In patients with normal renal function, phosphomycin is incorporated rapidly into the ITF reaching a level of 60.4 micrograms/ml 60 min after administration. There was no statistically significant difference between the elimination rates from serum and ITF. The serum half-life of the slow disposition phase was 1.75 h in patients with normal renal function. There was a linear correlation between the elimination half-life of phosphomycin in serum and ITF in subjects with differing degrees of renal impairment.