Drug Use Evaluation of Tenofovir/Lamivudine/Dolutegravir (TLD) Fixed-Dose Combination for Initiation and Transition Among HIV-Infected Individuals Attending Lumame Primary Hospital, North West Ethiopia.

Background: A key strategy for quality improvement is drug use evaluation, which looks at the safe, appropriate use of medication principles. Tenofovir/Lamivudine/Dolutegravir (TLD-FDC) usage has not yet been sufficiently examined in published literature. The purpose of this study was to assess how TLD were used by HIV-positive patients Using WHO drug use evaluation standards in Lumame Primary Hospital, North West Ethiopia. Methods: Using WHO drug use evaluation standards, a retrospective study design was used to evaluate the appropriateness of TLD use. Systematic random sampling was utilized to gather patient medical records containing TLD. Accordingly, 100 records that met the inclusion criteria were selected and reviewed between April 1 and 15, 2021. Five criteria, namely, indication, dose, contraindication, drug interaction, and TLD safety monitoring were used to evaluate the appropriateness of TLD utilization. Results: 80% of patients were transited to TLD from other regimens. The median time on TLD was found to be 13 months with 9 months to 18 months IQR. The latest CD4 count as well as CD4 count at the initiation or transition of TLD was not done for 75% and 89% of the patients, respectively. 3/4 (75%) of the patients were found to have a scheduled medication refill history. TLD dosing, indications, and contraindications were found to be 100% appropriate. No, TLD safety monitoring tests were done for 21% of the patients in this study. However, viral load, liver/kidney function, and serum creatinine tests were done for 77% (95% CI: 74%-79%), 5% (95% CI: 2%-8%), and 14% (95% CI: 11%-17%) of the patients, respectively. More over, In 93% (95% CI: 91%-95%) of the patients, the TLD interaction was appropriate; in 7%, it was not. All recording, documenting, and reporting technologies were available and used efficiently, except for the Electronic Dispensing Tool. Conclusion: Generally, good adherence to national and WHO guidelines was obtained regarding dose, indication, and contraindications. However, improvement in safety monitoring tests and CPT utilization is recommended. Drug interactions satisfied the majority of the criteria's threshold, while certain standards were not followed.

Establishment and application of drug utilization evaluation applying the weighted TOPSIS method: A study based on real-world data of tislelizumab.

BACKGROUND: How to comprehensively evaluate the rationality of drug use is a challenging issue. OBJECTIVE: To establish the evaluation index of the effective use of tislelizumab, so as to ensure its higher rationality and normalization in clinical application. METHODS: Based on the indications, drug instructions, and relevant guidelines of the National Basic Medical Insurance Restriction Catalogue, a retrospective analysis and evaluation of 286 cases of using tislelizumab injection in our hospital from January to December 2022 were conducted using the weighted technique for order of preference by similarity to ideal solution (TOPSIS) method. RESULTS: Among the 286 medical records evaluated, the main irrational manifestations were inappropriate indications (90 cases, 31.47%), auxiliary examination and laboratory examination did not meet the minimum requirements of combination chemotherapy drugs (40 cases, 13.99%), the drug course was not standard (39 cases, 13.64%). Among the included cases, 57.34% were reasonable cases (Ci⩾ 0.8), 10.84% were basic reasonable cases (0.6 ⩽Ci< 0.8), and 31.82% were unreasonable cases (Ci< 0.6). CONCLUSION: The TOPSIS method, with its attribute hierarchical model (AHM)-weighted approach, can be employed as the rational assessment technique for the injection of tislelizumab. The clinical application of tislelizumab in our hospital is still insufficient, which needs to be further improved management.

Establishment and application of drug use evaluation criteria of argatroban / 药物流行病学杂志

Objective To establish the argatroban drug use evaluation(DUE)criteria and provide reference for the rational use of argatroban in clinical practice.Methods Based on the domestic and foreign drug instructions of argatroban,referring to relevant guidelines and literature,the DUE standard rules were established by expert consultation.Using the established standard rules,the medical records of argatroban in the Fuzhou First Hospital Affiliated with Fujian Medical University from August 2020 to August 2022 were evaluated for the rationality of medication.Results A total of 368 medical records were included,the rational rate of drug use was 48.64％,and the irrational drug use was mainly without indications(46.19％)and inappropriate combination of drugs(4.35％).Conclusion The rational rate of argatroban clinical use in the hospital is not high,and the problems mainly include off-indication drug use and unreasonable combination drug use.Through the establishment and clinical application of DUE standard rules,the clinical use of argatroban can be further standardized and the ability of rational drug use can be improved.

Drug use evaluation of ozagrel sodium based on weighted TOPSIS method / 药物流行病学杂志

Objective To establish evaluation of ozagrel sodium by weighted TOPSIS method so as to provide a reference for improving the rational use of ozagrel sodium.Methods Based on the drug instructions,guidelines,relevant literatures and Delphi method,the evaluation criteria for the clinical rationality of ozagrel sodium were formulated.Attribute hierarchical model(AHM)was used to assign weights to the indicators,the weighted TOPSIS method was employed to analyze and evaluate the rationality of 108 patients that discharged from the Third People's Hospital of Henan Province from January 2021 to April 2022.Results The reponse rates of two rounds of expert advice questionnaires were 100％,the authoritative coefficients(Cr)were 0.85,0.83(＞0.70),and the experts fully affirmed the items of the standard.Among the 108 cases evaluated,37 cases(34.26％)were judged to be reasonable,52 cases(48.15％)were judged to be basically reasonable and 19 cases(17.59％)were judged to be unreasonable.The main unreasonable problems were manifested in indications,the timing of administration,drug course and monitoring of efficacy and laboratory parameters.Conclusion The method of DUE of ozagrel sodium based on weighted TOPSIS is more comprehensively and intuitively.The application of ozagrel sodium in the hospital is relatively standardized,but there are problems in the course of medication,indications,and timing of administration.So it is necessary to promote the rational use by strengthening the cooperation between pharmacists and physicians,and improving pharmaceutical intervention.

Establishment and application of drug use evaluation criteria of fibrinogenase for injection / 药物流行病学杂志

Objective To establish the drug use evaluation(DUE)standard of fibrinogenase for injection and provide a reference for the rational clinical application of fibrinogenase for injection.Methods Based on the specification of fibrinogenase for injection,the DUE standard was established from three aspects:drug indication,drug process and drug results,with reference to relevant guidelines and literature,and through discussion with clinical experts.A retrospective survey was conducted to evaluate the inpatients using fibrinogenase for injection from January 2021 to December 2021 in Ningde Hospital of Traditional Chinese Medicine,Fujian Province.Results A total of 256 patients were included,with a medication reasonable rate of 61.72％.The irrational use of drugs was mainly including the inappropriate usage and dosage(3.91％),off-label medication(1.95％),no skin test(8.98％),too long or inadequate course of medication(25.00％).Conclusion The DUE standard established of fibrinogenase for injection is scientific,practical and feasible.The use of fibrinogenase for injection in contraindications and high blood coagulation state,and off-label medication can be further optimized.

Estudio de utilización de nirmatrelvir/ritonavir en tres centros de atención primaria durante 2022 / Drug use evaluation of nirmatrelvir/ritonavir in three primary care centres during 2022

Introducción: Nirmatrelvir/ritonavir (Paxlovid®) es el único tratamiento oral autorizado en Europa para tratar la enfermedad por COVID-19 en adultos que no requieren aporte de oxígeno suplementario y que tienen un riesgo alto de progresar a COVID-19 grave. Está disponible en España previa validación debido al perfil de interacciones y advertencias de uso. El objetivo es determinar efectividad, seguridad y manejo de interacciones. Método: Estudio retrospectivo de todos los pacientes con tratamiento validado de nirmatrelvir/ritonavir en tres centros de salud urbanos durante 2022. La efectividad fue la proporción de participantes sin hospitalización relacionada con COVID-19 o muerte por cualquier causa hasta el día 28. Resultados: Se analizaron 24 pacientes. Se consideró efectivo en 23 (95,8 %). Más del 80 % de pacientes presentaban interacción potencial con la medicación concomitante, recomendándose la suspensión temporal de medicamentos destacando simvastatina y metamizol. Conclusiones: Nirmatrelvir/ritonavir se ha considerado efectivo pero con difícil manejo en pacientes pluripatológicos polimedicados. (AU)

Introduction: Nirmatrelvir/ritonavir (Paxlovid®) is the only oral treatment authorized in Europe to treat COVID-19 disease in adults who do not require supplemental oxygen and who are at high risk for progression to severe COVID-19. It is available in Spain after validation due to the profile of interactions and warnings for use. The objective is to determine effectiveness, safety and management of interactions. Method: Retrospective study of all patients on validated nirmatrelvir/ritonavir treatment at three urban health cen-tres during 2022. Effectiveness was the proportion of participants without COVID-19-related hospitalization or death from any cause through day 28. Results: 24 patients were analyzed. It was considered effective in 23 (95.8 %). More than 80 % of patients presented potential interaction with the concomitant medication, recommending the temporary suspension of medications, highlighting simvastatin and metamizole. Conclusions: Nirmatrelvir/ritonavir has been considered effective but difficult to manage in polymedicated poly-pathological patients. (AU)

A wastewater-based evaluation of the effectiveness of codeine control measures in Australia.

BACKGROUND AND AIM: From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. METHODS: We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. RESULTS: Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. CONCLUSION: Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.

Establishment and application of DUE criteria of Dolasetron / 药学实践与服务

Objective To establish the drug use evaluation ( DUE) of Dolasetron, evaluate the rationality of the clinical use of Dolasetron and provide a reference for the rationally clinical use of Dolasetron．Methods On the basis of Dolasetron DUE criteria, a retrospective analysis was made in 794 hospitalized patients from January 2021 to June 2021. Results The drug use evaluation criterion on Dolasetron consisted of drug indications, drug use process, the result of drug use and indication management. Conclusion There are some inappropriate medication problems in Dolasetron utilization in the hospital. The DUE criterion is very practical which could be used to standardize the clinical utilization of Dolasetron.

Drug use evaluation of tranexamic acid and sodium chloride injection based on weighted TOPSIS method / 药物流行病学杂志

Objective To establish the rules of drug use evaluation(DUE)of tranexamic acid and sodium chloride injection,and to provide a basis for clinical rational drug use.Methods Based on the drug instruction and referring to relevant guidelines and literature,the DUE criteria were established,and the weighted TOPSIS method was used to evaluate the rationality of medical records discharged from the First Hospital of Shanxi Medical University from February to August 2022.Results Among the 171 cases of medication regimen,there are were 66 cases(38.60%)close to the optimal regimen(Ci≥0.8)(reasonable);Ci was between 0.6 and 0.8(basically reasonable)in 73 cases(42.69%);and Ci<0.6(unreasonable)in 32 cases(18.71%).The unreasonable phenomenon mainly appeared in adverse reaction monitoring,medication administered,indications and so on.Conclusion The weighted TOPSIS method is used to evaluate the rationality of tranexamic acid and sodium chloride injection,and its evaluation results are more intuitive and convenient.

Establishment and application of drug use evaluation criteria for aminocaproic acid injection / 药物流行病学杂志

Objective To establish drug use evaluation(DUE)criteria for aminocaproic acid injection,and to evaluate and analyse clinical use of aminocaproic acid injection.Methods Based on the aminocaproic acid injection drug label,DUE of aminocaproic acid injection from three aspects(indications,medications and medication results)were established with reference to relevant literature.A retrospective survey was conducted to evaluate the rationality of medication for inpatients who used aminocaproic acid injection from July 1,2021 to June 30,2022 in Fuding Hospital of Fujian University of Traditional Chinese Medicine.Results A total of 143 midical records were included.73 cases fully met the DUE criteria,70 cases did not fully meet the DUE criteria,and the unreasonable rate was 48.95%.The most common types of irrational using of aminocaproic acid injection were inappropriate timing of perioperative prevention of medication(26.57%),overcourse in perioperative prevention of medication(23.08%),and contraindications(7.69%).Conclusions The aminocaproic acid injection DUE standard established is scientific,practical,the irrational rate of aminocaproic acid injection use is relatively high in this hospital,and the management of rational use of aminocaproic acid injection needs to be strengthened.

Drug use evaluation of prothrombin complex concentrate based on weighted TOPSIS method / 药物流行病学杂志

Objective To establish the detailed rules for the drug use evaluation(DUE)of prothrombin complex concentrate(PCC),and evaluate the use of PCC by weighted TOPSIS method to provide references for its clinical rational application.Methods Based on the instructions of PCC and referring to relevant data,the DUE standard rules were established,and weighted TOPSIS method was used to evaluate the rationality of medication in the cases of in patients who used PCC from January 2021 to December 2021 in the Affiliated Hospital of Xuzhou Medical University.Results A total of 121 cases were included,the relative weights of the three indicators were as follows:coagulation function,dosage,interval,course of treatment and,diagnosis,progress notes drug interaction,with the weights of 0.095 2,0.0913,0.091 3,0.091 3,0.089 7,0.084 1 and 0.081 7 respectively.There were 21 cases(17.36%)with reasonable medical records,39 cases(32.23%)with basically reasonable medical records,and 61 cases(50.41%)with unreasonable medical records.The main unreasonable problems were manifested in indications,usage and dosage,and drug interaction.Conclusion The DUE criteria of PCC established is more scientific,practical and feasible.The indications,usage,dosage,and drug interaction of PCC remain unreasonable criteria,and pharmaceutical intervention should be carried out to promote its rational use.

Drug use evaluation of etamsylate based on weighted TOPSIS method / 药物流行病学杂志

Objective To establish drug use evaluation(DUE)standard of etamsylate and to evaluate the use of etamsylate by weighted superior and inferior solution distance(TOPSIS)method,so as to provide a basis for promoting its clinical rational use.Methods Based on the instructions of etamsylate for injection,the DUE criteria of etamsylate were established according to the relevant guidelines of hemostasis at home and abroad,evidence-based literature and expert consultation.The weighted TOPSIS method based on the attribute hierarchy model was used to evaluate the utilization of etamsylate in Beijing Beiya Orthopaedic Hospital.Results Among the 119 cases,2 cases(1.68%)were with the relative closeness degree between each case and the optimal regimen(Ci)no less than 0.8,which was evaluated as reasonable;70 cases(58.82%)were with the Ci ranging between 0.8 and 0.6,which was evaluated as basically reasonable;47 cases(39.50%)were with the Ci less than 60%,which was evaluated as unreasonable.The top three unreasonable rates were dose and frequency(66.39%),configuration method(49.58%),and drug interaction(24.37%).Conclusion The method of DUE of etamsylate based on weighted TOPSIS method can synthesize several evaluation indexes,and the evaluation method is simple and flexible.The rational rate of use of etamsylate in this hospital is low,especially there are problems in configuration method,administration dose and frequency,drug interaction,treatment course and so on,and the management still needs to be strengthened.

Impact of Antibiotic Authorisation at Three Provincial Hospitals in Thailand: Results from a Quasi-Experimental Study.

Implementing antimicrobial stewardship (AMS) at non-university hospitals is challenging. A quasi-experimental study was conducted to determine the impact of customised antibiotic authorisation implementation on antimicrobial consumption and clinical outcomes at three provincial hospitals in Thailand. Customised pre-authorisation of selected restricted antibiotics and post-authorisation of selected controlled antibiotics were undertaken and implemented at each hospital by the local AMS team with guidance from the AMS team at the university hospital. From January 2019−December 2020, there were 1802 selected patients (901 patients during the pre-implementation period and 901 patients during the post-implementation period). The most commonly used targeted antimicrobial was meropenem (49.61%), followed by piperacillin/tazobactam (36.46%). Comparison of the outcomes of the patients during the pre- and post-implementation periods revealed that the mean day of therapy of the targeted antimicrobials was significantly shorter during the post-implementation period (6.24 vs. 7.64 days; p < 0.001), the favourable clinical response (the improvement in all clinical and laboratory parameters at the end of antibiotic therapy) was significantly higher during the post-implementation period (72.70% vs. 68.04%; p = 0.03) and the mean length of hospital stay was significantly shorter during the post-implementation period (15.78 vs. 18.90 days; p < 0.001). In conclusion, implementation of antibiotic authorisation at provincial hospitals under experienced AMS team's guidance was feasible and useful. The study results could be a good model for the implementation of customised AMS strategies at other hospitals with limited resources.

Evaluation of antibiotic prophylaxis for gastrointestinal surgeries in a teaching hospital: An interventional pre-post study.

Surgical site infections are related to a high morbidity, mortality and healthcare costs. Despite ample evidence demonstrating the effectiveness of antimicrobials to prevent surgical site infections, inappropriate timing, antibiotic selection and excessive continuation of antibiotics are common in practice. In this study, we compare the appropriateness of antibiotic prophylaxis in gastrointestinal surgery, before and after an evidence-based guideline implementation. One hundred patients were evaluated in each group. The implementation of the guideline resulted in significant reduction of incorrect use of antibiotics from 55% to 18% (P = 0.002). It also reduced duration of prophylactic antibiotics (43% vs. 23%, P = 0.025). Inappropriate doses diminished but not significantly (8% vs. 5%, P = 0.321). Based on our results, in more than half of of these cases patients received incorrect antibiotic prophylaxis regimens for gastrointestinal surgery in this hospital. Local guideline implementation can result in reduction of antibiotic use, dose and duration errors.

The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice.

INTRODUCTION: Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town. METHODS: A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22. RESULTS: From the 271 medical records reviewed majority of patients were from surgical ward (n = 85, 31.4%) followed by gynecology and obstetrics ward (n = 67, 24.7%). Demographically, the majority of the patients were female (n = 142, 52.4%). Patients in the age group of 20-29 years were dominant (n = 98, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n = 6), warfarin (n = 5), and enoxaparin (n = 1) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n = 80, 27.5%) followed by for the management of pneumonia (n = 62, 21.3%). The result of ceftriaxone use evaluation showed that majority (n = 190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n = 114, 60.0%) followed by wrong duration (n = 54, 28.4%). CONCLUSION: Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.

Evaluation of drug prescription pattern using World Health Organization prescribing indicators in public health facilities found in Ethiopia: systematic reviews and meta-analysis.

BACKGROUND: Drug use evaluation is a structured, methodological, and criteria-based drug assessment system that helps to evaluate the actual trend of drug use in a particular setting. If drug prescription practices are inappropriate, need to examine the patterns of drug use is necessary to change prescribing patterns accordingly. Therefore, this review aimed to determine the drug prescription pattern in public health facilities found in Ethiopia using prescribing indicators developed by the World Health Organization. METHODS: This review was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Extensive searching to identify articles was conducted in PubMed, Medline, Web of Science, Research Gate, Africa Journal of Online, and Google scholar. Finally, 10 eligible articles were selected for analysis based on inclusion and exclusion criteria. The median value, as well as the 25th and 75th percentiles for each WHO prescribing indicator, were computed. RESULT: The pooled median value of WHO prescribing indicators was reported as follows: the average number of drugs prescribed per encounter = 2.14 (IQR 1.79-2.52), the percentage of encounters with antibiotics prescribed = 43.46% (IQR 30.01-58.67), the percentage of encounters with an injection prescribed = 13.20% (6.47-40.7), percentage of drugs prescribed by generic name = 93.49% (89.13-97.96), and the percentage of medicines prescribed from essential medicines list = 92.54% (85.10-97.7). The forest plots determined for each prescribing indicator indicated that there is a high degree of heterogeneity across articles. CONCLUSION: All of the prescribing indicators were not consistent with the standard values recommended by the World Health Organization. Therefore, public health facilities should take appropriate measures for improving the prescription patterns as per the recommendation set by the World Health Organization.

Establishment and application of DUE criteria for human albumin in pediatric patients / 中国临床药理学与治疗学

AIM: To provide reference for rational application of human albumin in pediatrics. METHODS: On the basis of the human albumin instructions, refer to the relevant guidelines and literature on the use of human albumin in pediatrics, draft the first draft of the Drug Use Evaluation standard and list it into an expert consultation questionnaire, which is finalized through two rounds of expert discussions. This standard was used to retrospectively evaluate the medical records of hospitalized children who used human albumin in the Pediatric Department of our hospital from June 2019 to January 2020. RESULTS: The standards established in this study included three primary indicators of medication indications, medication process, medication results and 6 secondary indicators of indications, contraindications, treatment process monitoring, drug application, efficacy, and adverse reactions. A total of 269 medical records of hospitalized children were included in this evaluation, of which newborns accounted for the highest proportion (56.88%). 229 cases met the indications, accounting for 85.13%; 251 cases were tested for serum albumin concentration before medication, accounting for 93.31%; after medication, the relevant indicators reached the standard, and the symptoms improved significantly in 226 cases, accounting for 84.01%. CONCLUSION: The Drug Use Evaluation criteria for pediatric human albumin established by our hospital has strong practicability, which is conducive to discovering problems or deficiencies in clinical medication and promoting rational clinical use of medication.

Drug Use Evaluation of Ceftriaxone in Ras-Desta Memorial General Hospital, Ethiopia.

BACKGROUND: Ceftriaxone is one of the most commonly used antibiotics due to its availability, wide spectrum of activity and low toxicity. However, irrational use of ceftriaxone is one of the current issues in most countries, especially developing ones. OBJECTIVE: The aim of this study was to evaluate ceftriaxone utilization in different wards of Ras-Desta Memorial General Hospital (RDMGH) in Ethiopia. METHODS: An institution-based retrospective cross-sectional study was conducted on randomly selected 1,079 patients who were admitted to RDMGH from May 2017 to April 2018. A structured data abstraction format was used to collect data from patients' medical chart. Micromedex® drug interaction checker was used to identify significant drug-drug interactions, and national and international guidelines were used to evaluate the appropriateness of ceftriaxone use. The data were analyzed by using SPSS version 20.0. RESULTS: Among the 1,079 patients enrolled, ceftriaxone was utilized by 601 (55.7%) patients, and these patients were considered for evaluation of appropriateness and subsequent analysis. Among 601 patients, ceftriaxone was used for therapeutic purpose in 362 (60.2%) patients; of which, 359 (99.2%) were for empiric therapy and the rest 239 (39.8%) were for prophylaxis. In the majority of the patients, the dose of ceftriaxone was 2g/day 472 (78.6%) and for a duration of 2-7 days 409 (68.1%). Inappropriate use of ceftriaxone was observed among 237 (39.4%) patients with regard to indication, dose/frequency and duration. About half (49.3%) of the deviation from the guidelines was observed from surgical and gynecologic/obstetrics wards. Among the co-prescribed medications with ceftriaxone, ringer lactate, warfarin and heparin were found to have a significant drug-drug interaction. CONCLUSION: This study revealed that inappropriate use of ceftriaxone was high in RDMGH. This may increase the emergence of resistant pathogens which may lead to treatment failure and increase cost of therapy. Therefore, adherence to current evidence-based guidelines is recommended.

Use of analgesics following rescheduling of codeine in Australia: An interrupted time series analysis in the veteran population.

BACKGROUND: The Australian medicines regulator, the Therapeutic Goods Administration (TGA), rescheduled all codeine-containing medicines to be available only on prescription on 1 February 2018. This study was conducted to determine whether use of analgesics changed following codeine re-scheduling to prescription only status, and whether there was a change in the use of codeine preparations and a therapeutic shift to stronger opioids or other analgesics in the Australian veteran population following the change. METHODS: Interrupted time series analysis using Repatriation Pharmaceutical Benefits Scheme (RPBS) claims data from the Australian Government Department of Veterans' Affairs (DVA) for clients with dispensing of opioid and non-opioid analgesics between January 2015 and April 2019. Trends in the monthly rate of analgesic dispensings (opioid and non-opioid) were compared for the period between January 2015 and January 2018 with the period February 2018 to April 2019. RESULTS: Paracetamol with codeine 8mg was the only analgesic with an increased rate of dispensing following the February 2018 codeine scheduling changes. Prior to codeine re-scheduling, the rate of dispensing of paracetamol with codeine 8mg was decreasing by 0.9% each month. Immediately after the scheduling changes, dispensing of paracetamol with codeine 8mg increased by 45% (95%CI=1.282-1.676, p<0.001) and in the fifteen month period thereafter (February 2018 to April 2019), the rate of dispensing increased by 4% each month (95%CI=1.027-1.054, p<0.001). Therapeutic shift from over-the-counter codeine products to other opioids was not observed, with no increase in the rate of dispensing of any of the other opioid (or non-opioid) analgesics following the codeine scheduling changes. CONCLUSION: A significant increase in prescription use of paracetamol with codeine 8mg was observed after the February 2018 codeine re-scheduling. Therapeutic shift to stronger opioid analgesics was not observed in the study population.

Drug use evaluation (DUE) of ceftriaxone: A quality metric in a pediatric hospital.

Background: Ceftriaxone is frequently used as empiric therapy because of its broad spectrum and dosing characteristics. The purpose of this study was to evaluate the appropriateness of ceftriaxone therapy among hospitalized children using drug use evaluation (DUE) methodology. Methods: Hospitalized patients who received one or fewer dose of intravenous ceftriaxone at Children's Hospital of Eastern Ontario between January 1, 2018, and June 30, 2018, were identified. Duration was defined as empiric if 72 or less and definitive if more than 72 hours. Two infectious disease physicians reviewed the charts and rated appropriateness using a previously developed scale. Results: A total of 276 ceftriaxone courses in 248 patients (mean age 6.0 y) were reviewed. Of these, 153 (55.4%) were assessed as definitively or possibly indicated. The most common reason for inappropriate empiric use was an overly broad spectrum. Of the 120 courses given empirically for which there was no indication, the three most common reasons were lower respiratory infections (51; 42.5%), head and neck infections (18; 15.0%), and intra-abdominal infections (15; 12.5%). Of the 39 (14.1%) courses of ceftriaxone that were given for more than 72 hours, 14 (35.9%) met criteria for a definitive or possible indication. Conclusion: Ceftriaxone is still overused as empiric therapy. Although 85% of courses were discontinued after three doses, 14% were continued for longer than 72 hours, with approximately one-third ultimately meeting an indication. DUE using Canadian pediatric and local guidelines criteria is useful to identify clinical presentations for which narrower spectrum antimicrobials should be used.

Historique: La ceftriaxone est souvent utilisée comme traitement empirique en raison de son large spectre et de ses caractéristiques posologiques. La présente étude visait à évaluer la pertinence d'un traitement à la ceftriaxone chez les enfants hospitalisés, à l'aide de la méthodologie d'évaluation de la consommation des médicaments (ÉCM). Méthodologie: Les chercheurs ont recensé les patients hospitalisés qui ont reçu un maximum d'une dose de ceftriaxone par voie intraveineuse au Centre hospitalier pour enfants de l'est de l'Ontario entre le 1er janvier 2018 et le 30 juin 2018. La durée était définie comme empirique si elle était de 72 heures ou moins et comme décisive si elle était supérieure à 72 heures. Deux infectiologues ont examiné les dossiers et classé la pertinence au moyen d'une échelle déjà existante. Résultats: Au total, les chercheurs ont examiné 276 traitements de ceftriaxone chez 248 patients (d'un âge moyen de 6,0 ans). De ce nombre, 153 (55,4 %) ont été évalués comme définitifs ou possibles. Un trop large spectre était la principale raison d'en faire un usage empirique inapproprié. Les trois principales raisons d'administrer les 120 traitements empiriques sans indication étaient les infections des voies respiratoires inférieures (51; 42,5 %), les infections de la tête et du cou (18; 15,0 %) et les infections intra-abdominales (15; 12,5 %). Des 39 traitements de ceftriaxone (14,1 %) administrés pendant plus de 72 heures, 14 (35,9 %) avaient respecté les critères d'une indication définitive ou possible. Conclusion: La ceftriaxone demeure surutilisée comme traitement empirique. Même si 85 % des traitements ont été abandonnés après trois doses, 14 % se sont poursuivis plus de 72 heures, et au bout du compte, environ le tiers répondait à une indication. L'ÉCM faisant appel aux critères des directives canadiennes locales en pédiatrie est utile pour déterminer les présentations cliniques qui justifient l'utilisation d'antimicrobiens à spectre plus étroit.