Efficacious Cefazolin Prophylactic Dose for Morbidly Obese Women Undergoing Bariatric Surgery Based on Evidence from Subcutaneous Microdialysis and Populational Pharmacokinetic Modeling.

PURPOSE: To determine the efficacious cefazolin prophylactic dose for bariatric surgery using free subcutaneous concentrations accessed by microdialysis after 2 g or 3 g i.v. bolus dosing to morbidly obese women and POPPK modeling. METHODS: A POPPK model with variable plasma and subcutaneous tissue protein binding was developed to simultaneously describe plasma and tissue data sets. The outcomes was predicted for common surgical site infection (SSI) bacteria over 3, 4, 5 and 6 h periods postdose, as probability of target attainment (PTA) using Monte Carlo simulation. RESULTS: CFZ 2 g warrant up to 5 h SSI prophylaxis for bacteria with MICs ≤1 mg/L such as Escherichia coli and Staphylococcus aureus. For species such as Klebsiella pneumoniae, which present MIC distribution frequency of 2 mg/L, the maintenance of PTA ≥ 90% occurs with a 3 g dose for surgeries lasting up to 5 h, and 2 g dose provide an adequate response up to 4 h (PTA of 89%). CONCLUSIONS: Effectiveness of CFZ 2 g is similar to 3 g against bacteria with a MIC up to 2 mg/L, especially if the surgery does not last for more than 4 h.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial.

INTRODUCTION: Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. OBJECTIVE: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. MATERIAL AND METHODS: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. RESULTS: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. CONCLUSION: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review.

PURPOSE: To review the use of cefazolin in prophylaxis of surgical wound infection (SSI) in bariatric surgery (BS). METHODS: A systematic review was performed from October to November, 2013 using the following databases: The Cochrane Library, Medline, LILACS, and EMBASE. The inclusion criteria were randomized clinical trials and observational studies that were evaluated by two independent reviewers. RESULTS: Nine hundred and sixty one titles were recovered after preliminary analysis (title and abstract), seven studies remained for final analysis. There were three clinical trials (one with SSI, and two with antibiotic levels as the outcome), and four were observational studies (three cohorts and one case-control, all had SSI as the outcome). After administration of 1g or 2 g, levels of cefazolin in serum and tissue were suboptimal according to two studies. Results from observational studies indicated that different antibiotics were used for prophylaxis of SSI in BS and that use of other drugs may be associated with higher rates of SSI. CONCLUSION: The use of cefazolin for surgical wound infection prophylaxis in bariatric surgery is recommended, however further studies are needed in order to refine parameters as initial dose, redose, moment of administration and lasting of prophylaxis.

Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review

To review the use of cefazolin in prophylaxis of surgical wound infection (SSI) in bariatric surgery (BS). METHODS: A systematic review was performed from October to November, 2013 using the following databases: The Cochrane Library, Medline, LILACS, and EMBASE. The inclusion criteria were randomized clinical trials and observational studies that were evaluated by two independent reviewers. RESULTS: Nine hundred and sixty one titles were recovered after preliminary analysis (title and abstract), seven studies remained for final analysis. There were three clinical trials (one with SSI, and two with antibiotic levels as the outcome), and four were observational studies (three cohorts and one case-control, all had SSI as the outcome). After administration of 1g or 2 g, levels of cefazolin in serum and tissue were suboptimal according to two studies. Results from observational studies indicated that different antibiotics were used for prophylaxis of SSI in BS and that use of other drugs may be associated with higher rates of SSI. CONCLUSION: The use of cefazolin for surgical wound infection prophylaxis in bariatric surgery is recommended, however further studies are needed in order to refine parameters as initial dose, redose, moment of administration and lasting of prophylaxis.

Factors associated with healthcare services utilization and pharmacological treatment in individuals with diabetes diagnosis: lessons from a nationwide program for diabetes mellitus detection in Brazil.

The Brazilian Nationwide Population Screening Program for Diabetes, conducted in 2001, diagnosed 346,168 new cases. Although unexpected, approximately 65,000 previously diabetic individuals participated. We describe their characteristics compared to new cases, based on data obtained by a follow-up study of a subsample of 4991 positively screened from a representative sample of 90,106 individuals. Two groups were analyzed regarding factors associated with adherence to treatment, healthcare services utilization, and compliance to pharmacological treatment: 497 with newly diagnosed diabetes and 257 individuals with previous diabetes diagnosis who were not under treatment at the screening program. For this group, healthcare service utilization was lower when compared with the new cases (OR = 0.06; 95% CI: 0.03-0.12). Diabetes status (OR = 0.23; 95% CI: 0.14-0.37), a healthy behavior score (OR = 0.53, 95% CI: 0.34-0.83), and glucose levels at screening (altered, OR = 5.01; 95% CI: 2.38-10.6 and likely and very likely DM OR = 11.2; 95% CI: 6.85-18.4) were independently associated with pharmacological treatment.

Diagnosis of the availability and use of drug information sources in drugstores and pharmacies in southern Brazil / Diagnóstico da disponibilidade e da utilização de fontes de informação sobre medicamentos em drogarias e farmácias no sul do Brasil

This research has aimed to estimate the use of drug information sources by pharmacists in drugstores and pharmacies in southern Brazil. It consisted of sending a questionnaire through regular mail, contacting the pharmacist via phone and visiting the drugstores. Four hundred and eight (68.6 percent) of the 595 enrolled establishments answered the questionnaire. The information at pharmacies and drugstores is searched mainly to orient the patient. At drugstores the professionals have an average of 2.3 books, whereas at pharmacies they rely on 6.1. In a pharmacy, the chance to find more than five books is 27 times higher than in a drugstore. The more often available books are pharmaceutical specialties compendiums. There is access to Internet in 87.5 percent of pharmacies and 59 percent of drugstores. The National Agency of Health Surveillance webpage is the most accessed website, and the call centers of Pharmaceutical Companies are the most searched information service. Lack of time is the main alleged difficulty for searching information. The pharmacists working in the studied establishments miss appropriate drug information sources. Taking into consideration how important information is in the pharmaceutical practice, there is a need to emphasize this subject through an educative process, during undergraduate studies and continued education.

A pesquisa teve como objetivo descrever a utilização de fontes de informação em drogarias e farmácias no sul do Brasil. A mesma consistiu do envio do questionário pelo correio, contato com farmacêuticos por telefone e visita aos estabelecimentos. A resposta foi obtida em 408 (68,6 por cento) dos 595 estabelecimentos amostrados. A informação nas farmácias e drogarias é buscada, principalmente, para orientar o paciente. O profissional tem, em média, 2,3 livros nas drogarias e 6,1 nas farmácias. Em uma farmácia, a chance de se encontrar mais de cinco livros corresponde a 27 vezes aquela em uma drogaria. Os bulários são os livros mais frequentemente disponíveis. Há acesso à Internet em 87,5 por cento das farmácias e em 59 por cento das drogarias, sendo a chance de uma farmácia ter este recurso, cinco vezes maior que aquela em uma drogaria. A página da Agência Nacional de Vigilância Sanitária é a mais acessada e o Serviço de Atendimento ao Consumidor das Companhias Farmacêuticas, o serviço de informação mais consultado. A falta de tempo é a principal limitação da busca de informação. O farmacêutico nos estabelecimentos pesquisados é carente de fontes adequadas de informação. Considerando a importância da informação na prática farmacêutica, é necessário enfatizar o tema utilizando um processo educativo no período de formação e em atividades de atualização.

Dipyrone use during pregnancy and adverse perinatal events.

OBJECTIVE: To evaluate the risk of adverse perinatal events among newborns exposed to dipyrone during gestation. DESIGN AND SETTING: The present study is a secondary analysis of Brazilian study of gestational diabetes (EBDG), a cohort of women attended at healthcare units of the Brazilian national health system (SUS) located in six Brazilian state capitals, between February 1991 and June 1995. SAMPLE: A total number of 5,564 women aged 20 years and over who were between their 21st and 28th week of pregnancy were followed up. METHODS: A structured questionnaire was used to obtain data on the pregnant women, their pregnancies, and their use of medications. Other data and the outcomes congenital abnormalities, intrauterine death, preterm birth, or low birth weight were obtained from the medical records. To estimate the odds ratios after adjustment for the potential confounding factors, logistic regression modeling was developed. MAIN OUTCOME MEASURES: Congenital abnormalities, intrauterine death, preterm birth, and low birth weight. RESULTS: Dipyrone use was reported by 555 pregnant women (11.5%). Their exposure to this medication did not present any association with the outcomes of congenital abnormalities (OR 1.11; 95% CI, 0.58-2.10), intrauterine death (OR 0.69; 95% CI, 0.33-1.43), preterm birth (OR 0.94; 95% CI, 0.73-1.20), or low birth weight (OR 0.88; 95% CI, 0.64-1.22), in the crude analysis. This absence of associations was maintained after performing logistic regression analysis. CONCLUSIONS: The data suggest that the exposure to dipyrone during pregnancy does not increase the risk of congenital abnormalities and other adverse events as outcomes from pregnancy.