Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.545
Filtrar
1.
BMC Surg ; 21(1): 69, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522909

RESUMEN

BACKGROUND: Elective implant removal (IR) after fracture fixation is one of the most common procedures within (orthopedic) trauma surgery. The rate of surgical site infections (SSIs) in this procedure is quite high, especially below the level of the knee. Antibiotic prophylaxis is not routinely prescribed, even though it has proved to lower SSI rates in other (orthopedic) trauma surgical procedures. The primary objective is to study the effectiveness of a single intravenous dose of 2 g of cefazolin on SSIs after IR following fixation of foot, ankle and/or lower leg fractures. METHODS: This is a multicenter, double-blind placebo controlled trial with a superiority design, including adult patients undergoing elective implant removal after fixation of a fracture of foot, ankle, lower leg or patella. Exclusion criteria are: an active infection, current antibiotic treatment, or a medical condition contraindicating prophylaxis with cefazolin including allergy. Patients are randomized to receive a single preoperative intravenous dose of either 2 g of cefazolin or a placebo (NaCl). The primary analysis will be an intention-to-treat comparison of the proportion of patients with a SSI at 90 days after IR in both groups. DISCUSSION: If 2 g of prophylactic cefazolin proves to be both effective and cost-effective in preventing SSI, this would have implications for current guidelines. Combined with the high infection rate of IR which previous studies have shown, it would be sufficiently substantiated for guidelines to suggest protocolled use of prophylactic antibiotics in IR of foot, ankle, lower leg or patella. Trial registration Nederlands Trial Register (NTR): NL8284, registered on 9th of January 2020, https://www.trialregister.nl/trial/8284.


Asunto(s)
Antibacterianos , Huesos de la Extremidad Inferior/cirugía , Cefazolina , Remoción de Dispositivos/efectos adversos , Fracturas Óseas/cirugía , Infección de la Herida Quirúrgica , Adulto , Tobillo , Antibacterianos/administración & dosificación , Antibacterianos/economía , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/economía , Profilaxis Antibiótica/métodos , Huesos de la Extremidad Inferior/lesiones , Cefazolina/administración & dosificación , Cefazolina/economía , Cefazolina/uso terapéutico , Análisis Costo-Beneficio , Remoción de Dispositivos/economía , Método Doble Ciego , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/economía , Fijación Interna de Fracturas/instrumentación , Humanos , Infusiones Intravenosas , Pierna , Extremidad Inferior , Rótula , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/economía , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control
2.
PLoS One ; 15(9): e0239873, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32976542

RESUMEN

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.


Asunto(s)
Antibacterianos/provisión & distribución , Utilización de Medicamentos/estadística & datos numéricos , Medicamentos sin Prescripción/provisión & distribución , Autoadministración/estadística & datos numéricos , Antibacterianos/administración & dosificación , Antibacterianos/economía , Abuso de Medicamentos/estadística & datos numéricos , Guatemala , Humanos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/economía , Pequeña Empresa/estadística & datos numéricos
5.
Rev Chilena Infectol ; 37(1): 9-18, 2020 Feb.
Artículo en Español | MEDLINE | ID: mdl-32730394

RESUMEN

BACKGROUND: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. AIMS: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. METHODS: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. RESULTS: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. CONCLUSION: The ASP showed a decrease in consumption and costs of some antimicrobials.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Infecciones Bacterianas , Servicios Preventivos de Salud , Antibacterianos/economía , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/economía , Programas de Optimización del Uso de los Antimicrobianos/normas , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/prevención & control , Niño , Hospitales Pediátricos/economía , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Pruebas de Sensibilidad Microbiana , Panamá , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/normas , Servicios Preventivos de Salud/estadística & datos numéricos , Estudios Prospectivos , Estudios Retrospectivos
6.
Int J Infect Dis ; 96: 621-629, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32505875

RESUMEN

Antimicrobial resistance is a global public health crisis. Antimicrobial Stewardship involves adopting systematic measures to optimize antimicrobial use, decrease unnecessary antimicrobial exposure and to decrease the emergence and spread of resistance. Low- and middle-income countries (LMICs) face a disproportionate burden of antimicrobial resistance and also face challenges related to resource availability. Although challenges exist, the World Health Organization has created a practical toolkit for developing Antimicrobial Stewardship Programs (ASPs) that will be summarized in this article.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/economía , Infecciones Bacterianas/tratamiento farmacológico , Antibacterianos/economía , Infecciones Bacterianas/economía , Infecciones Bacterianas/microbiología , Países en Desarrollo/economía , Humanos , Pobreza , Organización Mundial de la Salud
7.
Ars pharm ; 61(2): 121-126, abr.-jun. 2020. graf
Artículo en Español | IBECS | ID: ibc-191332

RESUMEN

INTRODUCCIÓN: El objetivo de este artículo fue analizar los costos financieros de la terapia con antibióticos contra la resistencia bacteriana en un hospital público de alta complejidad en Agreste Pernambucano. MÉTODOS: Se realizó un estudio descriptivo, retrospectivo y transversal a partir de los datos recopilados de los registros de la Comisión de Control de Infecciones Hospitalarias (CCIH), la Farmacia y el Centro de Suministros Farmacéuticos (CAF) del hospital investigado. Esto se obtuvo a través de un instrumento de recolección estructurado, con datos correspondientes al período de enero a diciembre de 2016. RESULTADOS: Las principales muestras clínicas con presencia de resistencia a múltiples fármacos bacterianos fueron sangre, orina y secreción traqueal, con mayor prevalencia de las siguientes bacterias: Staphylococcus aureus, Staphylococcus coagulasa negativo, Citrobacter sp, Enterobacter sp. y Pseudomonas sp. En vista de la resistencia a múltiples fármacos presentada, los antibióticos más utilizados para el tratamiento fueron: vancomicina, piperacilina con tazobactam, ampicilina con sulbactam, cefepima y meropenem. La presencia de bacterias resistentes fue la causa del aumento de los costos en el tratamiento de los pacientes. Los valores en este estudio con terapia con antibióticos generaron un costo de R$ 83,298.83 en 2016, con el 49% de las muertes hospitalarias. CONCLUSIÓN: La prevención, a través de políticas relacionadas con el control racional y el uso de antimicrobianos, es fundamental en la lucha contra las infecciones nosocomiales por bacterias multirresistentes


INTRODUCTION: The objective of this article was to analyze the financial costs of antibiotic therapy against bacterial resistance in a public hospital of high complexity located in the Agreste region of Pernambuco. METHOD: It was performed a descriptive, retrospective and cross-sectional study based on data collected from Hospital Infection Control Commission (CCIH) and the Pharmaceutical Supply Center (CAF) of the investigated hospital. It was obtained by a structured instrument of data collection and the period analysed was from January to December 2016. RESULTS: The main clinical samples with presence of bacterial multiresistance were blood, urine and tracheal secretion, with a higher prevalence of the following bacteria: Staphylococcus aureus (23,08%), Coagulase-negative Staphylococcus (26,15%), Citrobacter sp. (19,23%), Enterobacter sp. (10,77%) and Pseudomonas sp (7,69%). Faced to the multiresistance presented, the most common antibiotics used in the treatment were: vancomycin (21,7%), piperacillin-tazobactam (24,55%), ampicillin-sulbactam (10,4%), cefepime (18,43%) and meropenem (58,5%). The presence of resistant bacteria was a cause of increased costs in the treatment of PATIENTS: According to this study, the antibiotic therapy listed above generated a cost of R$ 83.298,83 and 49% of hospital death in 2016


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Tratamiento de Urgencia/economía , Farmacorresistencia Bacteriana Múltiple , Antibacterianos/economía , Estudios Retrospectivos , Estudios Transversales , Brasil
8.
Nature ; 581(7806): 94-99, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32376956

RESUMEN

Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics1-4. However, the effects of vaccination on antibiotic consumption remain poorly understood-especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest5. Here we show that vaccines that have recently been implemented in the World Health Organization's Expanded Programme on Immunization reduce antibiotic consumption substantially among children under five years of age in LMICs. By analysing data from large-scale studies of households, we estimate that pneumococcal conjugate vaccines and live attenuated rotavirus vaccines confer 19.7% (95% confidence interval, 3.4-43.4%) and 11.4% (4.0-18.6%) protection against antibiotic-treated episodes of acute respiratory infection and diarrhoea, respectively, in age groups that experience the greatest disease burden attributable to the vaccine-targeted pathogens6,7. Under current coverage levels, pneumococcal and rotavirus vaccines prevent 23.8 million and 13.6 million episodes of antibiotic-treated illness, respectively, among children under five years of age in LMICs each year. Direct protection resulting from the achievement of universal coverage targets for these vaccines could prevent an additional 40.0 million episodes of antibiotic-treated illness. This evidence supports the prioritization of vaccines within the global strategy to combat antimicrobial resistance8.


Asunto(s)
Antibacterianos , Países en Desarrollo/economía , Utilización de Medicamentos/estadística & datos numéricos , Vacunas , Antibacterianos/administración & dosificación , Antibacterianos/economía , Preescolar , Diarrea/tratamiento farmacológico , Diarrea/prevención & control , Diarrea/virología , Farmacorresistencia Microbiana , Utilización de Medicamentos/economía , Humanos , Incidencia , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/inmunología , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Vacunas contra Rotavirus/inmunología , Vacunas/administración & dosificación , Vacunas/economía , Vacunas/inmunología , Organización Mundial de la Salud/organización & administración
9.
Medicine (Baltimore) ; 99(20): e20022, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443305

RESUMEN

PURPOSE: Febrile neutropenia has a significant clinical and economic impact on cancer patients. This study evaluates the cost-effectiveness of different current empiric antibiotic treatments. METHODS: A decision analytic model was constructed to compare the use of cefepime, meropenem, imipenem/cilastatin, and piperacillin/tazobactam for treatment of high-risk patients. The analysis was performed from the perspective of U.S.-based hospitals. The time horizon was defined to be a single febrile neutropenia episode. Cost-effectiveness was determined by calculating costs and deaths averted. Cost-effectiveness acceptability curves for various willingness-to-pay thresholds (WTP), were used to address the uncertainty in cost-effectiveness. RESULTS: The base-case analysis results showed that treatments were equally effective but differed mainly in their cost. In increasing order: treatment with imipenem/cilastatin cost $52,647, cefepime $57,270, piperacillin/tazobactam $57,277, and meropenem $63,778. In the probabilistic analysis, mean costs were $52,554 (CI: $52,242-$52,866) for imipenem/cilastatin, $57,272 (CI: $56,951-$57,593) for cefepime, $57,294 (CI: $56,978-$57,611) for piperacillin/tazobactam, and $63,690 (CI: $63,370-$64,009) for meropenem. Furthermore, with a WTP set at $0 to $50,000, imipenem/cilastatin was cost-effective in 66.2% to 66.3% of simulations compared to all other high-risk options. DISCUSSION: Imipenem/cilastatin is a cost-effective strategy and results in considerable health care cost-savings at various WTP thresholds. Cost-effectiveness analyses can be used to differentiate the treatments of febrile neutropenia in high-risk patients.


Asunto(s)
Antibacterianos/economía , Antibacterianos/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/economía , Neutropenia/tratamiento farmacológico , Neutropenia/economía , Cefepima/economía , Cefepima/uso terapéutico , Combinación Cilastatina e Imipenem/economía , Combinación Cilastatina e Imipenem/uso terapéutico , Simulación por Computador , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Fiebre/mortalidad , Costos de la Atención en Salud , Humanos , Meropenem/economía , Meropenem/uso terapéutico , Neutropenia/mortalidad , Combinación Piperacilina y Tazobactam/economía , Combinación Piperacilina y Tazobactam/uso terapéutico , Resultado del Tratamiento
10.
N Z Med J ; 133(1512): 22-30, 2020 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242175

RESUMEN

AIMS: To assess a persuasive multimodel approach to decreasing unnecessary intravenous (IV) clarithromycin use for community-acquired pneumonia (CAP) in Canterbury District Health Board (CDHB) hospitals. METHODS: In December 2013, CDHB guidelines for empiric treatment of CAP changed to prioritise oral azithromycin over IV clarithromycin. The multimodel approach we used to implement this change included obtaining stakeholder agreement, improved guidelines access, education and pharmacist support. The impact of the intervention was evaluated by comparing macrolide usage and expenditure for the four years pre- and post-intervention. RESULTS: Mean annual clarithromycin IV use decreased by 72% from 6.4 to 1.8 defined daily doses (DDDs) per 1,000 occupied bed days (OBDs) post-intervention, while oral azithromycin increased by 833% (4.2 to 39.2 DDDs per 1,000 OBDs). Concurrently, oral clarithromycin use decreased by 91% (32.9 to 2.9 DDDs per 1,000 OBDs), and roxithromycin by 71% (17.0 to 5.0 DDDs per 1,000 OBDs). Mean annual total macrolide use decreased by 21% (68.2 to 53.9 DDDs per 1,000 OBDs), while expenditure decreased by 69% mainly through avoided IV administration. CONCLUSIONS: A persuasive multimodel approach to support adoption of CAP guidelines produced a sustained decrease in IV clarithromycin use, which may have clinical benefits such as reduced occurrence of catheter-related complications.


Asunto(s)
Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/normas , Azitromicina/administración & dosificación , Claritromicina/administración & dosificación , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía/tratamiento farmacológico , Administración Intravenosa , Administración Oral , Antibacterianos/economía , Programas de Optimización del Uso de los Antimicrobianos/economía , Azitromicina/economía , Claritromicina/economía , Formas de Dosificación , Adhesión a Directriz , Hospitales , Humanos , Nueva Zelanda
11.
Biol Pharm Bull ; 43(4): 693-696, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32238711

RESUMEN

In Japan, there is no national surveillance study of Clostridioides (Clostridium) difficile infection (CDI), and details about the epidemiology and treatment status of CDI are unknown. Additionally, clinical practice guidelines (CPGs) for CDI are published by four different institutions. All CPGs recommend that the antimicrobials, vancomycin (VCM) and metronidazole (MNZ), should be selected according to disease severity. However, the trends for VCM and MNZ use in Japan remain unclear. Therefore, this study was aimed at clarifying the secular trends for VCM and MNZ use based on sales data from 2006 to 2015 and discussing its impact on CDI status and drug costs. This is the first study to clarify the antibiotic use trends for CDI treatment. We found that the total use increased over time (r = 0.0013, Pfor trend < 0.0001). While VCM use significantly decreased (r = -0.0003, Pfor trend = 0.0002), MNZ use increased (r = 0.0017, Pfor trend < 0.0001). These results show that although treatment for CDI was in line with CPGs, CDI incidence might be on an increasing trend. Additionally, despite the increased total use, the total drug costs decreased by 55% ($ 25 million) from 2006 to 2015. It was also surmised that CDI treatment in compliance with CPGs would lead to a reduction in drug costs. Hence, to understand the epidemiology of CDI, it is important to continuously investigate the use of drugs used for CDI therapy.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Metronidazol/uso terapéutico , Vancomicina/uso terapéutico , Antibacterianos/economía , Infecciones por Clostridium/economía , Costos de los Medicamentos , Utilización de Medicamentos/economía , Utilización de Medicamentos/tendencias , Humanos , Japón , Metronidazol/economía , Vancomicina/economía
12.
Circ Arrhythm Electrophysiol ; 13(5): e008280, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32281393

RESUMEN

BACKGROUND: Current understanding of the impact of cardiac implantable electronic device (CIED) infection is based on retrospective analyses from medical records or administrative claims data. The WRAP-IT (Worldwide Randomized Antibiotic Envelope Infection Prevention Trial) offers an opportunity to evaluate the clinical and economic impacts of CIED infection from the hospital, payer, and patient perspectives in the US healthcare system. METHODS: This was a prespecified, as-treated analysis evaluating outcomes related to major CIED infections: mortality, quality of life, disruption of CIED therapy, healthcare utilization, and costs. Payer costs were assigned using medicare fee for service national payments, while medicare advantage, hospital, and patient costs were derived from similar hospital admissions in administrative datasets. RESULTS: Major CIED infection was associated with increased all-cause mortality (12-month risk-adjusted hazard ratio, 3.41 [95% CI, 1.81-6.41]; P<0.001), an effect that sustained beyond 12 months (hazard ratio through all follow-up, 2.30 [95% CI, 1.29-4.07]; P=0.004). Quality of life was reduced (P=0.004) and did not normalize for 6 months. Disruptions in CIED therapy were experienced in 36% of infections for a median duration of 184 days. Mean costs were $55 547±$45 802 for the hospital, $26 867±$14 893, for medicare fee for service and $57 978±$29 431 for Medicare Advantage (mean hospital margin of -$30 828±$39 757 for medicare fee for service and -$6055±$45 033 for medicare advantage). Mean out-of-pocket costs for patients were $2156±$1999 for medicare fee for service, and $1658±$1250 for medicare advantage. CONCLUSIONS: This large, prospective analysis corroborates and extends understanding of the impact of CIED infections as seen in real-world datasets. CIED infections severely impact mortality, quality of life, healthcare utilization, and cost in the US healthcare system. Registration: URL: https://www.clinicaltrials.gov Unique Identifier: NCT02277990.


Asunto(s)
Antibacterianos/economía , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/economía , Desfibriladores Implantables/economía , Costos de la Atención en Salud , Recursos en Salud/economía , Marcapaso Artificial/economía , Infecciones Relacionadas con Prótesis/economía , Infecciones Relacionadas con Prótesis/prevención & control , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Profilaxis Antibiótica/efectos adversos , Causas de Muerte , Desfibriladores Implantables/efectos adversos , Remoción de Dispositivos/economía , Costos de los Medicamentos , Planes de Aranceles por Servicios/economía , Femenino , Gastos en Salud , Costos de Hospital , Humanos , Tiempo de Internación/economía , Masculino , Medicare/economía , Persona de Mediana Edad , Marcapaso Artificial/efectos adversos , Readmisión del Paciente/economía , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Calidad de Vida , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
13.
Am J Obstet Gynecol ; 223(3): 417.e1-417.e8, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32135143

RESUMEN

BACKGROUND: The rising incidence rates of sexually transmitted infections in the United States highlight the need for concurrent treatment of patients and their sexual partners. Expedited partner therapy allows healthcare providers to offer antibiotic prescriptions or medications to an index patient for distribution to their sexual partner(s) without evaluating the partner. We hypothesized that there was a gap between expedited partner therapy policy at the state level and its downstream implementation by community pharmacists. OBJECTIVE: The objectives of our study were to evaluate pharmacists' expedited partner therapy knowledge and practices in 41 expedited partner therapy-permissible US states, to determine whether there were differences in practice based on the length of time expedited partner therapy was permissible in the state and chlamydia incidence rates, and to measure the cost of expedited partner therapy treatment. STUDY DESIGN: A randomized cohort of pharmacists (n=335) was invited to complete a telephone interview from November 2017 through January 2018. Descriptive statistics were calculated and stratified by early, mid, and late expedited partner therapy-adopter status based on the year of the state's expedited partner therapy enactment and the state's chlamydia incidence rate. Fisher's exact test and 1-way analyses of variance were used to compare measures across strata. RESULTS: We had 143 pharmacists (42.7%) agree to complete the survey. Among our respondents, 40.6% (n=58/143) indicated that they were aware of expedited partner therapy; 14.7% (n=21/143) reported that they had ever received an expedited partner therapy prescription, and 97% (n=139/143) reported that they would dispense an expedited partner therapy prescription if they received 1 in the future. These findings were stable across the 6 strata defined by early, mid, or late expedited partner therapy-adopter and high or low incidence rates of chlamydia status. Mean cost of azithromycin 1000 mg and cefixime 400 mg for treatment of chlamydia and gonorrhea was $22.17 (95% confidence interval, 20.29-24.05) and $30.46 (95% confidence interval, 28.65-32.26), respectively. CONCLUSION: Fewer than one-half of the pharmacists were aware of expedited partner therapy. A small minority of pharmacists reported ever having received an expedited partner therapy prescription, regardless of the length of time expedited partner therapy had been legal in their states and the incidence of chlamydia. However, almost all pharmacists reported that they would dispense an expedited partner therapy prescription if they received 1. Additionally, costs were high for expedited partner therapy for self-pay patients. These data suggest that there are opportunities to increase expedited partner therapy utilization by healthcare providers, patients, and pharmacists.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Personal de Salud , Farmacéuticos , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Antibacterianos/economía , Antibacterianos/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Estudios de Cohortes , Femenino , Humanos , Entrevistas como Asunto , Masculino , Distribución Aleatoria , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos/epidemiología , Adulto Joven
14.
BMC Health Serv Res ; 20(1): 153, 2020 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-32111202

RESUMEN

BACKGROUND: Antibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan. METHODS: We conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from JMDC Claims Database, which contains data from 5·1 million corporate employees and family members under the age of 65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data. RESULTS: The annual additional cost of inappropriate antibiotic prescription for URI was estimated at 423·6 (95% CI: 416·8-430·5) million USD in 2013, 340·9 (95% CI: 335·7-346·2) million USD in 2014, 349·9 (95% CI: 344·5-355·3) million USD in 2015, and 297·1 (95% CI: 292·4-301·9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for > 90% of the total additional cost. CONCLUSIONS: Although a decreasing trend was observed, annual additional costs of inappropriate antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.


Asunto(s)
Antibacterianos/economía , Antibacterianos/uso terapéutico , Prescripción Inadecuada/economía , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adolescente , Adulto , Atención Ambulatoria/economía , Niño , Preescolar , Costos y Análisis de Costo , Investigación sobre Servicios de Salud , Humanos , Lactante , Recién Nacido , Revisión de Utilización de Seguros , Japón , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
15.
Transl Res ; 220: 182-190, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32165059

RESUMEN

While antibiotics are a key infrastructure underpinning modern medicine, evolution will continue to undermine their effectiveness, requiring continuous investment to sustain antibiotic effectiveness. The antibiotic R&D ecosystem is in peril, moving towards collapse. Key stakeholders have identified pull incentives such as Market Entry Rewards or subscription models as the key long-term solution. If substantial Market Entry Rewards or other pull incentives become possible, there is every reason to expect that for-profit companies will return to the antibiotic field. However, the political and financial will to develop such Market Entry Rewards or other similar incentives may be difficult to muster in the timeframes needed to prevent further diminishment of antibiotic research and development, especially if large drug companies are seen as substantial beneficiaries of these taxpayer-funded pull incentives. Bridging solutions are required from private actors in the interim. This article explores potential solutions led by private actors, including (1) traditional for-profit companies; (2) non-profit enterprises; and (3) public benefit corporations with lower profit expectations, akin to a public utility. All face similar commercial struggles, but nonprofits and public benefit corporations can accept lower profit expectations and might be more politically attractive recipients of pull incentives.


Asunto(s)
Antibacterianos/economía , Desarrollo de Medicamentos/economía , Industria Farmacéutica/economía , Comercio
16.
BMC Med ; 18(1): 38, 2020 03 06.
Artículo en Inglés | MEDLINE | ID: mdl-32138748

RESUMEN

BACKGROUND: Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR. METHODS: A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review. RESULTS: The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor. CONCLUSIONS: Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.


Asunto(s)
Antibacterianos/economía , Farmacorresistencia Microbiana , Antibacterianos/uso terapéutico , Estudios de Cohortes , Humanos
17.
Yakugaku Zasshi ; 140(2): 319-328, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32009051

RESUMEN

In this study, antimicrobial stewardship team (AST) intervention was evaluated by comparing patient outcomes and consumption of broad-spectrum antibiotics [carbapenem antibiotics and tazobactam/piperacillin (TAZ/PIPC)] before and after the intervention. There was no fluctuation in the consumption rate of carbapenem, TAZ/PIPC and other antibiotics, but there was a decreased annual consumption of antibiotics after AST intervention compared to before intervention. For the carbapenems, antimicrobial use density (AUD) of meropenem (MEPM) was highest in both periods, at 20.1 and 20.4 before and after AST intervention, respectively, with no significant change after AST intervention. However, the days of therapy (DOT) for MEPM were 27.4 and 24.8 d, respectively, with a decreasing trend after AST intervention. AUD and DOT for TAZ/PIPC after AST intervention were 6.5 and 8.1 d, respectively, which were lower than the pre-intervention values. Rapid identification of the causative strain enables early de-escalation and may improve the economics of antibiotic use, but there was no difference from before to after AST intervention. Compared with before and after strain identification, the carbapenem administration rate after AST intervention was significantly lower than the pre-intervention rate (p<0.01). There was no difference in 28-day mortality and treatment period before and after AST intervention, and there were no differences in outcomes such as resolution of bacteremia, mortality, exacerbation and no change from before to after AST intervention. Based on these results, we suggest that AST intervention can reduce consumption of antibiotics without altering patient outcomes.


Asunto(s)
Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia/tratamiento farmacológico , Grupo de Atención al Paciente , Anciano , Anciano de 80 o más Años , Antibacterianos/economía , Antibacterianos/farmacología , Bacteriemia/microbiología , Bacteriemia/mortalidad , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Pseudomonas aeruginosa/efectos de los fármacos , Factores de Tiempo , Resultado del Tratamiento
20.
Arch Dis Child ; 105(8): 713-719, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32079569

RESUMEN

BACKGROUND AND OBJECTIVES: Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. METHODS: A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year. RESULTS: Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. CONCLUSION: Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.


Asunto(s)
Antibacterianos/uso terapéutico , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Neumonía/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Administración Intravenosa , Administración Oral , Antibacterianos/economía , Preescolar , Femenino , Hospitalización/economía , Humanos , Prescripción Inadecuada/economía , Lactante , Masculino , Uso Excesivo de los Servicios de Salud/economía , Neumonía/diagnóstico , Neumonía/economía , Pautas de la Práctica en Medicina/economía , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Vietnam
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA