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This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.
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Background: The importance of access to medicines in promoting global health cannot be overstated, particularly as an estimated 2 billion people lack access to basic medicines, particularly in developing nations. While over-the-counter (OTC) medications are relatively safe and cost-effective, there is a risk of misuse due to factors such as inaccurate self-diagnosis, inadequate dosing, addiction, adverse drug reactions, and drug interactions. To ensure proper use and prevent irrational self-medication, pharmacists can play a crucial role in guiding patients. However, the legislation in Costa Rica only covers OTC and prescription drugs, and health authorities are proposing a new decree to include a list of drugs that can be recommended by pharmacists without a prescription to treat minor ailments, which would be classified as behind-the-counter (BTC). Objective: Characterize the pharmaceutical consultation, compare the medications recommended by pharmacy professionals for minor ailments with the legislation in force in Costa Rica, and determine whether the current OTC medications are sufficient to treat minor ailments. Material and methods: This study is a descriptive, observational, cross-sectional study that focuses on a sample of the Costa Rican population that comes to consult with a pharmacist in one of the four pharmacies of the Hospital Clínica Bíblica (HCB) in San José, Costa Rica. Consultations included users over 18 years of age or caregivers of underage patients seeking advice or assistance from publicly accessible pharmacies, excluding consultations that involved information related to other hospital departments. This study aims to analyze the pharmaceutical consultation for minor ailments and compare the medications recommended by pharmacists with the list of medications allowed in Costa Rica. The study also aims to determine if the current OTC medications are adequate for treating minor ailments. Results: A total of 1537 consultations were gathered, which were divided into four categories: pharmaceutical recommendation (48%), medication information (31%), other consultations (18%), and referrals to another health professional (3%). Among the consultations classified as pharmaceutical recommendations, 90% were related to minor ailments. Prescription drugs accounted for 75.3% of the medications recommended and consulted. However, when the BTC category was included, the percentage of recommended prescription drugs decreased to 29.6%, while BTC drugs constituted 45.7%. Finally, the chi-square test rejected the null hypothesis that there was no association between the availability of OTC drugs and the minor ailments for which patients sought consultation. Conclusions: Most cases of pharmacy consultations involve minor illnesses such as digestive symptoms, joint pain, and respiratory issues. The proposed decree by health authorities in Costa Rica is noteworthy as it establishes standardized protocols for the prescription of BTC medications to ensure the safety of patients.
RESUMEN
Resumen: Introducción: Los opioides se han utilizado para el alivio del dolor en diversos contextos. Su uso puede favorecer efectos indeseables. Actualmente los países industrializados viven una crisis de opioides. Objetivos: Caracterizar los opioides mayores despachados en términos de especialidad médica y de dosis total en miligramos equivalentes a morfina (MME) en un Hospital General Latinoamericano. Material y métodos: Se realizó un estudio retrospectivo y observacional de prescripciones de opioides mayores despachadas en las Farmacias de un Hospital General Latinoamericano entre el año 2017 y 2020. Se tomó información de la base de datos del Ministerio de Salud. Se excluyeron las recetas que contenían estupefacientes no opioides y fentanilo inyectable. Se realizó una estandarización a MME para analizar la distribución de la prescripción según médicos y pacientes. Resultados: La cantidad total de recetas despachadas correspondientes a opioides mayores fue de 5,366 prescripciones. La morfina inyectable fue el medicamento más prescrito (46%) y como principio activo obtuvo 54% de todas las recetas estudiadas (considerando todas las vías de administración). Medicina general prescribió la mayoría de las recetas con un 48%, lo que representó 42% del total de MME. Conclusiones: La morfina es el principio activo preferido por los médicos evaluados en este estudio, la vía de administración parenteral es la más utilizada. Medicina general es el área que más prescribe opioides. Es pertinente crear políticas educativas en materia de opioides; por ello, resulta conveniente caracterizar la prescripción de manera cualitativa considerando información como el diagnóstico y las dosis diarias utilizadas.
Abstract: Introduction: Opioids have been used for pain relief in various settings. Its use can promote undesirable effects. Industrialized countries are currently experiencing an opioid crisis. Objective: To characterize the prescription of major opioids considering the medical area that made the prescription and total dose in milligrams morphine equivalents (MME) at a general hospital in Latin America. Material and methods: A retrospective and observational study was carried out. The number of prescriptions for major opioids dispensed in the pharmacies of a general hospital in Latin America, between 2017 and 2020, were documented. Information was taken from the database of the Ministry of Health. Prescriptions containing non-opioid narcotic drugs and injectable Fentanyl were excluded. A standardization to MME was carried out to analyze the distribution of prescriptions. Results: The total number of prescriptions filled for major opioids was 5,366 prescriptions. Injectable morphine was the most prescribed drug (46%) and as an active principle it obtained 54% of all the prescriptions studied (considering all routes of administration). General medicine prescribed most prescriptions (48%), which represented 42% of the total MME. Conclusions: Morphine is the substance preferred by the doctors evaluated in this study, the parenteral route of administration is the most used. General medicine is the area that prescribes most of the opioids. It is pertinent to create educational policies on opioids; therefore, it is convenient to characterize the prescription qualitatively considering information such as the diagnosis and the daily doses used.