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1.
J Dairy Sci ; 102(8): 7345-7358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31178192

RESUMO

Metritis is a prevalent disease with effects on production, reproduction, and survival, thereby affecting dairy farm profitability. A component of the cost of metritis is antimicrobial therapy. Some antimicrobials result in milk withhold that adds to the cost of disease. The objectives were (1) to determine cost of metritis for 2 antimicrobial treatments using a herd budget that includes costs associated with incidence of concurrent diseases, milk production and reproduction losses, and removal from the herd and (2) to apply sensitivity analysis to determine the cost of different scenarios. Cows with metritis from a previous study assigned randomly to receive ampicillin (AMP, n = 259), an antimicrobial that requires milk withhold, or ceftiofur (CEFT, n = 269), an antimicrobial with no milk withhold, were used for the economic analysis. A group of cows with no metritis (NOMET, n = 268), matched by parity and calving day, served as the baseline for comparison. The incidence of other diseases in the first 60 d postpartum, culling and death, reproductive performance, discarded milk, milk yield, total milk sold per cow, and residual cow value were used as responses. The economic analysis considered the costs associated with therapy, reproductive management, discarded milk, estimated DM consumed, income from saleable milk, and the residual cow value at 300 d postpartum or earlier if the cow was removed from the herd. Sensitivity analyses were performed considering 3 scenarios for milk and feed prices. The incidence of diseases other than metritis (NOMET, 30.4%; AMP, 45.4%; CEFT, 34.0%) and days in the hospital (NOMET, 2.7 d; AMP, 8.6 d; CEFT, 3.5 d) were greater for cows treated with AMP than CEFT. Treatment did not affect the risk of leaving the herd (NOMET, 15.5%; AMP, 15.0%; CEFT, 19.1%). The 21-d pregnancy rate was lower for cows with metritis but did not differ between AMP and CEFT (NOMET, 24.9%; AMP, 18.9%; CEFT, 17.0%). Milk yield was greater for cows without metritis than those with metritis and greater for AMP than CEFT (NOMET, 33.7 kg/d; AMP, 32.5 kg/d; CEFT, 31.2 kg/d). Cost of metritis did not differ with choice of therapy, but it increased as milk price increased. When both milk and feed prices were the average values considered ($0.44/kg and $0.26/kg, respectively), the costs of a case of metritis for AMP and CEFT were, respectively, $344 and $410 when milk was discarded and $267 and $406 when milk was fed to calves. Cost of therapy for AMP and CEFT represented 16.6 and 24.6% of the total cost of metritis when milk was discarded and 21.5 and 24.8% of the total cost of metritis when milk was fed to calves. The largest component of cost of metritis for both therapies was the reduced income from milk minus feed cost, ranging from 40.0 to 56.7%. Collectively, metritis is an expensive disease, and choice of antimicrobial therapy did not influence survival, reproduction, or cost of the disease.


Assuntos
Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Doenças dos Bovinos/tratamento farmacológico , Indústria de Laticínios/economia , Indústria de Laticínios/métodos , Endometrite/veterinária , Ampicilina/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Bovinos , Doenças dos Bovinos/economia , Cefalosporinas/uso terapêutico , Endometrite/tratamento farmacológico , Endometrite/economia , Feminino , Lactação/fisiologia , Leite/economia , Paridade , Doença Inflamatória Pélvica , Período Pós-Parto , Gravidez , Reprodução/fisiologia
2.
Farm Hosp ; 43(3): 94-100, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31072287

RESUMO

OBJECTIVE: To identify indicators of hospital use of antimicrobials from the  benchmark analysis of consumption data between hospitals at the same level  through the collective judgement of a group of experts. METHOD: A committee formed by members of the Spanish Societies of Hospital Pharmacy and Infectious Diseases and Clinical Microbiology prepared a proposal of indicators which was submitted to  consensus by a panel of 21 experts on infectious diseases, microbiology and  antimicrobial therapy, through a modified Delphi method. The panel  underwent two rounds of scores by e-mail. Participants assigned a score  from 1 (completely disagree) to 9 (completely agree) to the relevance of  each indicator in four dimensions: scientific evidence, efficacy and safety,  ecological impact and cost. Scores were processed according to the RAND- UCLA method. An indicator was considered to be relevant if at least one  dimension other than cost obtained a median score equal to or higher than 7 without disagreement among the panel. RESULTS: The committee submitted an initial proposal of 14 indicators. After the first round of panel scores, one indicator was ruled out and two  were  modified for moving on to the second round. Finally, 13 indicators  were considered relevant. CONCLUSIONS: Determining indicators of the hospital use of antimicrobial agents based on consumption can allow the antimicrobial  stewardship programs to detect any potential problems with the use of  antimicrobial agents, and to help guide their efforts in order to implement actions of improvement, as well as to assess the impact of the  measures implemented.


Assuntos
Anti-Infecciosos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/economia , Gestão de Antimicrobianos , Consenso , Técnica Delfos , Custos de Medicamentos , Medicina Baseada em Evidências , Humanos , Espanha , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(22): e15914, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145355

RESUMO

The objective of this study was to examine whether patient income has an impact on likelihood of being prescribed an antimicrobial agent at the county level. A better understanding of factors that influence antimicrobial prescription is needed to efficiently mitigate rates of antimicrobial agents prescribed.This cross-sectional study used data from two publicly available datasets. The 2015 Medicare Part D PUF data quantifies the antimicrobial prescription rate at the county level and data from US Census Bureau provides information on socioeconomic status at the county level.At the county level, we explained 48% of the variation in antimicrobial prescriptions by socioeconomic status, age, gender, and race. More specifically, socioeconomic status accounted for 26% of the variation in antimicrobial rate and as income increased, correlation with antimicrobial prescription rate trended down.We determined patient income and other sociodemographics to influence the prescription of antimicrobial agents. Interventions should consider these factors to effectively evaluate antimicrobial prescription methods. Findings from this study can help guide intervention efforts which aim to minimize the number of inappropriate antimicrobials prescribed, such as antimicrobial stewardship programs. Effective interventions have the capability of decreasing levels of inappropriate antimicrobials prescribed and prevent future cases of resistance.


Assuntos
Anti-Infecciosos/economia , Prescrições de Medicamentos/economia , Renda/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Geografia , Humanos , Masculino , Classe Social , Estados Unidos
4.
PLoS Negl Trop Dis ; 13(4): e0007190, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973876

RESUMO

A subset of anti-infective drugs are increasingly unavailable for patients in the United States due to pricing or withdrawal from the market. Timely market solutions are needed. We assert that solutions to ensure access to some essential anti-infective agents lie outside capital markets and that public-private partnerships may be the most viable solution.


Assuntos
Anti-Infecciosos/provisão & distribução , Doenças Transmissíveis/tratamento farmacológico , Indústria Farmacêutica/economia , Anti-Infecciosos/economia , Indústria Farmacêutica/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução , Setor Público , Estados Unidos , United States Food and Drug Administration
5.
Crit Care Med ; 47(2): 159-166, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30407951

RESUMO

OBJECTIVES: Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary antimicrobial consumption. Evidence has been limited to short, single-center studies. We evaluated whether antimicrobial stewardship in ICUs could reduce antimicrobial consumption and costs. DESIGN: We conducted a phased, multisite cohort study of a quality improvement initiative. SETTING: Antimicrobial stewardship was implemented in four academic ICUs in Toronto, Canada beginning in February 2009 and ending in July 2012. PATIENTS: All patients admitted to each ICU from January 1, 2007, to December 31, 2015, were included. INTERVENTIONS: Antimicrobial stewardship was delivered using in-person coaching by pharmacists and physicians three to five times weekly, and supplemented with unit-based performance reports. Total monthly antimicrobial consumption (measured by defined daily doses/100 patient-days) and costs (Canadian dollars/100 patient-days) before and after antimicrobial stewardship implementation were measured. MEASUREMENTS AND MAIN RESULTS: A total of 239,123 patient-days (57,195 patients) were analyzed, with 148,832 patient-days following introduction of antimicrobial stewardship. Antibacterial use decreased from 120.90 to 110.50 defined daily dose/100 patient-days following introduction of antimicrobial stewardship (adjusted intervention effect -12.12 defined daily dose/100 patient-days; 95% CI, -16.75 to -7.49; p < 0.001) and total antifungal use decreased from 30.53 to 27.37 defined daily doses/100 patient-days (adjusted intervention effect -3.16 defined daily dose/100 patient-days; 95% CI, -8.33 to 0.04; p = 0.05). Monthly antimicrobial costs decreased from $3195.56 to $1998.59 (adjusted intervention effect -$642.35; 95% CI, -$905.85 to -$378.84; p < 0.001) and total antifungal costs were unchanged from $1771.86 to $2027.54 (adjusted intervention effect -$355.27; 95% CI, -$837.88 to $127.33; p = 0.15). Mortality remained unchanged, with no consistent effects on antimicrobial resistance and candidemia. CONCLUSIONS: Antimicrobial stewardship in ICUs with coaching plus audit and feedback is associated with sustained improvements in antimicrobial consumption and cost. ICUs with high antimicrobial consumption or expenditure should consider implementing antimicrobial stewardship programs.


Assuntos
Centros Médicos Acadêmicos , Gestão de Antimicrobianos/métodos , Unidades de Terapia Intensiva , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/organização & administração , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Melhoria de Qualidade
6.
Expert Rev Pharmacoecon Outcomes Res ; 19(4): 483-489, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30418035

RESUMO

Background: The research evaluated the impact of intravenous antimicrobial restriction strategy (IARS) on different types of hospitals in China for evidence-based management, for outpatients implemented in 2016. Methods: Based on panel data on antimicrobial use in 121 tertiary hospitals in Zhejiang, China, segmented regression analysis was used to evaluate the impact of IARS in children's hospitals (CHs), obstetrics and gynecology hospitals (OGHs), women's and children's hospitals (WCHs), traditional Chinese medicine hospitals (TCMHs) and general hospitals (GHs). Antimicrobial use was measured using the percentage of total encounters with prescribing and the percentage of total drug expenditure relating to antimicrobials (APP and AEP). Results: There was a downward baseline slope of APP in all types of hospitals and AEP in WCHs, TCMHs and GHs (P < 0.01). After IARS, a level reduction in AEP in CHs (-3.14%, 95% CI = -6.21 to 0.06), WCHs (-1.33%, 95% CI = -2.44 to 0.22) and TCMHs (-0.85%, 95%CI = -1.51 to 0.18). After IARS, the slope of AEP changed significantly in OGHs (-0.42%, 95%CI = -0.81 to 0.03) and WCHs (0.29%, 95% CI = 0.08 to 0.49), and the slope of APP changed significantly in CHs (2.35%, 95%CI = 1.20 to 3.49). Conclusions: IARS had the mixed effects including positive effect in AEP and no significant change in APP, and an unexpected rise in APP in CHs needs further study.


Assuntos
Anti-Infecciosos/administração & dosagem , Gestão de Antimicrobianos/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Administração Intravenosa , Anti-Infecciosos/economia , Gestão de Antimicrobianos/economia , China , Medicina Baseada em Evidências , Gastos em Saúde/estatística & dados numéricos , Humanos , Ambulatório Hospitalar/economia , Ambulatório Hospitalar/estatística & dados numéricos , Padrões de Prática Médica/normas , Análise de Regressão , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/estatística & dados numéricos
7.
Expert Rev Pharmacoecon Outcomes Res ; 19(3): 341-352, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30362845

RESUMO

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS: Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS: Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION: Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.


Assuntos
Assistência Ambulatorial/métodos , Anti-Infecciosos/administração & dosagem , Árvores de Decisões , Programas Nacionais de Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Anti-Infecciosos/economia , Brasil , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Hospitais Universitários/economia , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
8.
J Pharm Pract ; 32(1): 36-40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29092659

RESUMO

BACKGROUND:: Cerebrospinal fluid (CSF) Gram stain and culture along with CSF viral polymerase chain reaction (PCR) are the current standard of care (SOC) to diagnose meningitis. Unfortunately, these tests take up to 72 hours to provide results and are not always sensitive to detect a pathogen. BioFire FilmArray (FA) meningitis/encephalitis (ME) panel uses PCR to provide quick, accurate identification of the causative organism. For community hospitals, the cost of this technology may be prohibitive. OBJECTIVE:: To compare the institution cost of current SOC versus the anticipated cost of the FA ME panel to diagnose and treat suspected meningitis. METHODS:: A retrospective cohort study was conducted evaluating adult patients with a lumbar puncture performed and empiric antimicrobials administered for a diagnosis of meningitis. The time to receive CSF culture results and cost associated with empiric antimicrobials were assessed and compared to the theoretical time to results and cost of treatment using the FA ME panel. RESULTS:: Thirty-three patients were included in the analysis. The cost of antimicrobials using SOC was $63.43 versus $24.70 per treatment course if using the FA ME panel ( P < .001). When the cost of diagnostic testing supplies per patient was included, the median cost of SOC was $239.63 versus $239.14 per treatment course when using the FA ME panel ( P = .15). CONCLUSION:: There is potential for significant cost savings in direct antibiotic utilization if FA ME is used versus SOC to diagnose meningitis in a community hospital. Antimicrobial cost savings were able to offset the increased cost of testing.


Assuntos
Anti-Infecciosos/administração & dosagem , Encefalite/diagnóstico , Meningite/diagnóstico , Reação em Cadeia da Polimerase/métodos , Adulto , Idoso , Anti-Infecciosos/economia , Estudos de Coortes , Custos e Análise de Custo , Custos de Medicamentos , Encefalite/economia , Feminino , Violeta Genciana , Hospitais Comunitários , Humanos , Masculino , Meningite/economia , Pessoa de Meia-Idade , Fenazinas , Reação em Cadeia da Polimerase/economia , Estudos Retrospectivos , Punção Espinal/métodos , Padrão de Cuidado/economia , Fatores de Tempo
9.
BMC Infect Dis ; 18(1): 684, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572843

RESUMO

BACKGROUND: Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited. Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis. METHODS: A prospective study was conducted over three months in a teaching hospital in Ethiopia with limited laboratory resources. Cerebrospinal fluid (CSF) samples from patients with suspected meningitis were analysed using a multiplex PCR-based system (FilmArray, BioFire), in addition to basic routine testing with microscopy and culture. Clinical data, as well as information on treatment and outcome were collected. RESULTS: Two hundred and eighteen patients were included; 117 (54%) neonates (0-29 days), 63 (29%) paediatrics (1 month-15 years) and 38 (17%) adults (≥16 years). Of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in paediatrics and 18% in adults. Virus was detected in 57% of the PCR positive samples, bacteria in 33% and fungi in 10%. All CSF samples that were PCR positive for a bacterial agent had a white cell count ≥75 cells/mm3 and/or turbid appearance. The majority (90%) of patients received more than one antibiotic for treatment of the meningitis episode. There was no difference in the mean number of different antibiotics received or in the cumulative number of days with antibiotic treatment between patients with a microorganism detected in CSF and those without. CONCLUSIONS: A rapid molecular diagnostic system was successfully implemented in an Ethiopian setting without previous experience of molecular diagnostics. Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia, and viral agents were the most commonly detected microorganisms in CSF. This study illustrates the potential of rapid diagnostic tests for reducing antibiotic usage in suspected meningitis cases. However, the cost of consumables for the molecular diagnostic system used in this study limits its use in low-income countries.


Assuntos
Anti-Infecciosos/classificação , Anti-Infecciosos/uso terapêutico , Meningite/diagnóstico , Meningite/tratamento farmacológico , Técnicas de Diagnóstico Molecular , Reação em Cadeia da Polimerase Multiplex , Padrões de Prática Médica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/economia , Criança , Pré-Escolar , Diagnóstico Diferencial , Etiópia , Feminino , Recursos em Saúde , Hospitais de Ensino/economia , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/líquido cefalorraquidiano , Meningite/genética , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/diagnóstico , Meningite Viral/tratamento farmacológico , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/economia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/tendências , Reação em Cadeia da Polimerase Multiplex/economia , Padrões de Prática Médica/economia , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Melhoria de Qualidade , Adulto Jovem
10.
Prev Vet Med ; 160: 63-67, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30388999

RESUMO

Antimicrobial resistance is a public threat for humans, generated by the use of antimicrobials in human medicine as well as animal agriculture. Consequently, governments set public policies aim at curbing antimicrobial use (AMU). In dairy production, the occurrence of diseases triggers AMU to limit the costs associated with these afflictions. Therefore, any policies targeting AMU are likely to generate additional costs for farmer, and impact the dairy market. The objective of our research was to assess at the market level the costs associated with potential regulations (a prohibition scenario and tax scenarios) surrounding antimicrobial use in the U.S. dairy sector, comparing to a business as usual scenario. We conducted a two-step analysis, first at the farm and then the market level, to estimate the costs to both farmers and consumers. We found that potential policies restricting AMU would have a minor effect at the market level. In the case of prohibition of AMU, the average milk price would rise from $0.423 to $0.425 per liter. In the short run, the total annual losses would be $152 million. Implementing taxes on AMU would also slightly increase milk price, up to $0.426 in the case of a tax multiplying by five the initial antimicrobial price. Under the prohibition scenario, the quantity of milk produced would decrease by 356 million kilograms, representing 0.4% of the average U.S. milk production over the period 2012-2016. Implementing such policies would lead to a slight increase in costs of production, borne by both consumers and farmers through higher milk prices and lower milk production. As AMU in animal agriculture also fulfills animal welfare and public health objectives, the impacts of restricting AMU should be weighed with these other objectives in policy decisions. Further research is necessary to assess the distributional benefits and costs of AMU policies across farmers, retailers, animal and human health workers, and the public, incorporating multiple dimensions, such as animal welfare and food safety.


Assuntos
Anti-Infecciosos/uso terapêutico , Custos e Análise de Custo/estatística & dados numéricos , Indústria de Laticínios/economia , Animais , Anti-Infecciosos/economia , Bovinos , Indústria de Laticínios/legislação & jurisprudência , Leite/economia , Modelos Econômicos , Estados Unidos
12.
BMC Infect Dis ; 18(1): 492, 2018 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268106

RESUMO

BACKGROUND: To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan. METHODS: A cross-sectional study was designed according to the World Health Organization (WHO) methodology for AM usage from January, 2017 to June, 2017. Standard data collection forms designed by the WHO were used to collect the data from 32 PHCCs (16 rural healthcare centers (RHCs) and 16 basic health units (BHUs)) in Punjab province of Pakistan. PHCCs were randomly selected from 8 main cities. The study sample consisted of prescription records of 6400 outpatients (200 prescriptions records from each PHCC) and 800 inpatients (25 inpatient records from each PHCC). Data of the year 2016 were collected retrospectively by using systematic random sampling technique and analyzed through SPSS. RESULTS: Among the hospital indicators, standard treatment guidelines (STGs) regarding the infectious diseases were not available in PHCCs. Number of days during which key AMs were out of stock was 12.1 days per month (range = 3.1-19.2). Out of total PHCC medicines costs, expenditures on AMs were 26.2% (range = 17.1-39.0). In case of prescribing indicators, the average number of AMs per prescription was 1.4 (range = 1.1-1.7), percentage of prescriptions prescribed with AMs was 81.5% (range = 68.9-89.1) and duration of AM treatment on average was 5.1 days per patient (range = 3.3-6.4). Average cost of prescribed AMs per patient was 1.3 USD (range = 0.6-4.3). The PHCCs prescribed a median of 5 (range = 3-9) types of AMs, including 10 (range = 5-15) individual agents. Out of 79.3% prescriptions of outpatients prescribed with AMs, only 16.4% were properly prescribed. Out of 100% prescriptions of inpatients prescribed with AMs, 12.1% were properly prescribed. Out of all the AM prescriptions 23.6% contained penicillins, 20.1% contained cephalosporins and 19.4% contained fluoroquinolones Metronidazole (18.0%), ciprofloxacin (16.5%) and co-amoxiclav (14.3%) were most commonly prescribed AMs. CONCLUSIONS: In PHCCs, AMs were prescribed more frequently. However large proportions of these prescriptions were inappropriate. Continuous education and training of medical staff and cost effective policies could play an important role in promotion of rational use of AMs.


Assuntos
Anti-Infecciosos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Anti-Infecciosos/economia , Doenças Transmissíveis/patologia , Estudos Transversais , Resistência Microbiana a Medicamentos , Feminino , Humanos , Pacientes Ambulatoriais , Paquistão , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Organização Mundial da Saúde
13.
Int J Infect Dis ; 77: 34-39, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30292892

RESUMO

OBJECTIVE: The objective of this study was to evaluate the effects of earlier intervention by an antimicrobial stewardship team (AST) on antimicrobial use, antimicrobial resistance rates, and the clinical outcomes, without changing the weekly intervention schedule. METHODS: A retrospective study was conducted at Fukuoka University Hospital between April 2013 and March 2016. The effects were compared among three study periods (SP): SP1 (patients receiving anti-methicillin-resistant Staphylococcus aureus agents and carbapenems for ≥14 days), SP2 (patients receiving specific antimicrobials for ≥14 days), and SP3 (patients receiving specific antimicrobials regardless of the duration of treatment). RESULTS: The timing of AST intervention was shortened from an average of 15.5days after administration in SP1 to 4.2 days in SP3. The antimicrobial use density (AUD) of carbapenems and piperacillin-tazobactam decreased significantly (SP2 vs. SP3, p<0.05), and the costs of specific antimicrobials decreased (SP1, US$ 1080000; SP2, US$ 944000; SP3, US$ 763000). The rates of carbapenem resistance among Pseudomonas aeruginosa isolates showed a significant reduction from 16.2% in SP2 to 8.7% in SP3 (p<0.05). The mortality rate and length of stay did not change during the study period. CONCLUSIONS: Earlier intervention by an AST could contribute to the proper use of antimicrobials without adversely affecting patient outcomes.


Assuntos
Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , Anti-Infecciosos/economia , Carbapenêmicos/economia , Carbapenêmicos/uso terapêutico , Daptomicina/uso terapêutico , Resistência Microbiana a Medicamentos , Fluoroquinolonas/uso terapêutico , Humanos , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Combinação Piperacilina e Tazobactam/economia , Combinação Piperacilina e Tazobactam/uso terapêutico , Pseudomonas aeruginosa/efeitos dos fármacos , Estudos Retrospectivos , Teicoplanina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Vancomicina/uso terapêutico
15.
Nutr Hosp ; 35(4): 761-766, 2018 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-30070861

RESUMO

INTRODUCTION: catheter-related bloodstream infections (CRBSI) are one of the most serious concerns in patients on home parenteral nutrition (HPN) which involve high morbidity and cost for the healthcare system. In the last years, taurolidine lock has proven to be beneficial in the prevention of CRBSI; however, the evidence of its efficiency is limited. OBJECTIVE: to determine if taurolidine lock is a cost-effective intervention in patients on HPN. MATERIALS AND METHODS: retrospective study in patients on HPN with taurolidine lock. We compared the CRBSI rate and cost of its complications before and during taurolidine lock. RESULTS: thirteen patients, six (46%) males and seven (54%) females, with a mean age of 61.08 (SD = 14.18) years received taurolidine lock. The total days of catheterization pre and per-taurolidine were 12,186 and 5,293, respectively. The underlying disease was benign in five patients (38.5%) and malignant in eight (61.5%). The CRBSI rate pre vs per-taurolidine was 3.12 vs 0.76 episodes per 1,000 catheter days (p = 0.0058). When the indication was a high CRBSI rate, this was 9.72 vs 0.39 (p < 0.001) in pre and per-taurolidine period respectively. No differences have been observed in the occlusion rates. None of the patients reported any adverse effects. The total cost of CRBSI in the pre-taurolidine period was 151,264.14 euros vs 24,331.19 euros in the per-taurolidine period. CONCLUSIONS: our study shows that taurolidine lock is a cost-effective intervention in patients on HPN with high risk of CRBSI.


Assuntos
Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/economia , Infecções Relacionadas a Cateter/prevenção & controle , Nutrição Parenteral no Domicílio/economia , Nutrição Parenteral no Domicílio/métodos , Taurina/análogos & derivados , Tiadiazinas/economia , Tiadiazinas/uso terapêutico , Adulto , Idoso , Anti-Infecciosos/efeitos adversos , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taurina/efeitos adversos , Taurina/economia , Taurina/uso terapêutico , Tiadiazinas/efeitos adversos
16.
Med Clin North Am ; 102(5): 937-946, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30126582

RESUMO

Optimal antimicrobial therapy must take into account the key factors in antibiotic selection, that is, spectrum, tissue penetration, resistance potential, safety profile, and relative cost-effectiveness. The least expensive drug is usually accompanied by other concerns, such as high resistance potential, poor side effect profile, pharmacokinetic properties that limit penetration into target tissue (site of infection), and/or suboptimal activity against the presumed/known pathogen. It is false economy to preferentially select the least expensive antibiotics solely because of its acquisition cost. Therapeutic failure and hidden costs may make an apparently less expensive antibiotic most costly in the end.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Farmacorresistência Bacteriana/efeitos dos fármacos , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos/economia , Custos e Análise de Custo , Vias de Administração de Medicamentos , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Humanos
17.
Nutr. hosp ; 35(4): 761-766, jul.-ago. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-179865

RESUMO

Introduction: catheter-related bloodstream infections (CRBSI) are one of the most serious concerns in patients on home parenteral nutrition (HPN) which involve high morbidity and cost for the healthcare system. In the last years, taurolidine lock has proven to be beneficial in the prevention of CRBSI; however, the evidence of its efficiency is limited. Objective: to determine if taurolidine lock is a cost-effective intervention in patients on HPN. Materials and methods: retrospective study in patients on HPN with taurolidine lock. We compared the CRBSI rate and cost of its complications before and during taurolidine lock. Results: thirteen patients, six (46%) males and seven (54%) females, with a mean age of 61.08 (SD = 14.18) years received taurolidine lock. The total days of catheterization pre and per-taurolidine were 12,186 and 5,293, respectively. The underlying disease was benign in five patients (38.5%) and malignant in eight (61.5%). The CRBSI rate pre vs per-taurolidine was 3.12 vs 0.76 episodes per 1,000 catheter days (p = 0.0058). When the indication was a high CRBSI rate, this was 9.72 vs 0.39 (p < 0.001) in pre and per-taurolidine period respectively. No differences have been observed in the occlusion rates. None of the patients reported any adverse effects. The total cost of CRBSI in the pre-taurolidine period was 151,264.14 euros vs 24,331.19 euros in the per-taurolidine period. Conclusions: our study shows that taurolidine lock is a cost-effective intervention in patients on HPN with high risk of CRBSI


Introducción: las infecciones asociadas al catéter (IAC) son una de las complicaciones más serias en pacientes con nutrición parenteral domiciliara (NPD), generando una alta morbilidad y costes sanitarios. En los últimos años, el sellado con taurolidina ha demostrado ser eficaz en su prevención, si bien la evidencia en cuanto a su eficiencia es escasa. Objetivo: determinar si el sellado del catéter con taurolidina es una intervención coste-efectiva en pacientes con NPD. Materiales y métodos: estudio retrospectivo de pacientes con NPD que recibieron sellados con taurolidina. Comparamos la incidencia de IAC antes y durante el tratamiento y los costes asociados. Resultados: el estudio incluyó trece pacientes, seis (46%) varones y siete (54%) mujeres, con edad media de 61,08 (± 14,18) años y un seguimiento de 12.186 y 5.293 días antes y durante el uso de taurolidina. La enfermedad de base era benigna en cinco pacientes (38,5%) y maligna en ocho (61,5%). La tasa de IAC antes y durante el sellado con taurolidina fue de 3,12 vs. 0,76 episodios por 1.000/días de catéter (p = 0,0058). Cuando la indicación fue por alta tasa de IAC, esta fue de 9,72 vs. 0,39 (p < 0,001) episodios por 1.000/días de catéter antes y durante el tratamiento. No hubo diferencias en la tasa de oclusión del catéter en ambos periodos. No se reportaron efectos adversos. El coste total de las IAC antes y durante el uso de taurolidina fue de 151.264,14 euros vs. 24.331,19 euros


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/economia , Infecções Relacionadas a Cateter/prevenção & controle , Nutrição Parenteral no Domicílio/economia , Nutrição Parenteral no Domicílio/métodos , Taurina/análogos & derivados , Tiadiazinas/economia , Tiadiazinas/uso terapêutico , Anti-Infecciosos/efeitos adversos , Custos e Análise de Custo , Estudos Retrospectivos , Taurina/efeitos adversos , Taurina/economia , Taurina/uso terapêutico , Tiadiazinas/efeitos adversos
18.
Microbiol Spectr ; 6(4)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30003871

RESUMO

Monitoring antimicrobial drug usage in animals at the national and international levels is important for identification and tracking if and how often quantities are used. This information can be used for many purposes, including raising awareness, comparing use patterns across countries, identifying trends over time, integrating with antimicrobial resistance data, conducting risk assessment, and evaluating the effectiveness of measures to manage antimicrobial usage. The goal of this article is to describe how monitoring systems for antimicrobial drug usage in animals are set up and conducted, using examples from specific countries as well as international efforts. Several key figures and variables are used to describe and evaluate antimicrobial consumption in animals, including the amount in kilograms of active ingredient, standardized units (e.g., number of defined daily dose animals, DDDAs) and number of treatments (e.g., number of used daily doses, UDDA). Data can be collected from a variety of sources including pharmaceutical sales, pharmacy dispensing, veterinary prescriptions, and farm records. In many countries, data analysis and reporting at the national level provide statistics on overall quantities used in animals, in some cases by animal species. Antimicrobial consumption data should be contrasted to the respective animal population, for example, the weight of different categories of livestock and slaughtered animals. Several countries have established antimicrobial usage monitoring systems. Most report overall sales data, but some provide usage data to the levels of animal species and production type. At the international level, several organizations (e.g., European Union, World Organization for Animal Health, World Health Organization) have initiatives to support the development of antimicrobial consumption data collection and reporting. However, these initiatives are ongoing and so far lack harmonization, which will be the biggest challenge for the future.


Assuntos
Anti-Infecciosos/normas , Anti-Infecciosos/uso terapêutico , Uso de Medicamentos , Criação de Animais Domésticos/métodos , Criação de Animais Domésticos/normas , Animais , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/economia , Comércio , União Europeia , Humanos , Gado , Organização Mundial da Saúde
19.
Viruses ; 10(7)2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29954053

RESUMO

The antimicrobial resistance (AMR) crisis and HIV/AIDS epidemic exhibit many parallels. In both, infectious diseases have caused millions of deaths worldwide, with AMR expected to kill even more people each year than HIV/AIDS did at its peak. In addition, both have required or will require new classes of drugs for control. For HIV/AIDS, development of vital antiretroviral drugs (ARVs) was accomplished in several stages: expanding public awareness about the disease, gathering commitment from the international community to tackle the problem, and eventually establishing policies and global funds to deliver new therapeutics. For AMR, the pursuit of new antimicrobials appears to be following a similar trajectory. This paper examines how lessons and processes leading to ARVs might be applied to developing AMR drugs, in particular bacteriophages (phages). These possess many essential characteristics: inexpensive manufacture, rapid drug development, and a ready means to prevent phage-resistant microbes from emerging. However, the broad application of phage-based products has yet to be fully demonstrated, and will require both international coordination and modified regulatory policies.


Assuntos
Anti-Infecciosos/uso terapêutico , Países em Desenvolvimento , Resistência Microbiana a Medicamentos , Epidemias/prevenção & controle , Terapia por Fagos , África/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Anti-Infecciosos/economia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Descoberta de Drogas , Saúde Global , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos
20.
Am J Health Syst Pharm ; 75(14): 1023-1038, 2018 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-29748254

RESUMO

PURPOSE: Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2018 in nonfederal hospitals, clinics, and overall (all sectors). METHODS: Drug expenditure data through calendar year 2017 were obtained from the IQVIA (formerly QuintilesIMS) National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2018 were also reviewed. Expenditure projections for 2018 for nonfederal hospitals, clinics, and overall (all sectors) were made based on a combination of quantitative analyses and expert opinion. RESULTS: Total U.S. prescription sales in the 2017 calendar year were $455.9 billion, a 1.7% increase compared with 2016. The top drug based on expenditures was adalimumab ($17.1 billion), followed by insulin glargine and etanercept. Prescription expenditures in nonfederal hospitals totaled $34.2 billion, a 0.7% decrease in 2017 compared with 2016. Expenditures in clinics increased 10.9%, to a total of $70.8 billion. The decrease in spending in nonfederal hospitals was driven by lower utilization. The top 25 drugs by expenditures in nonfederal hospitals and clinics were dominated by specialty drugs. CONCLUSION: We project a 3.0-5.0% increase in total drug expenditures across all settings, a 11.0-13.0% increase in clinics, and a 0.0-2.0% increase in hospital drug spending in 2018. Health-system pharmacy leaders should carefully examine their own local drug utilization patterns to determine their own organization's anticipated spending in 2018.


Assuntos
Medicamentos sob Prescrição/economia , Instituições de Assistência Ambulatorial/economia , Anti-Infecciosos/economia , Antineoplásicos/economia , Medicamentos Biossimilares/economia , Aprovação de Drogas , Uso de Medicamentos , Medicamentos Genéricos/economia , Custos Hospitalares/estatística & dados numéricos , Humanos , Patentes como Assunto , Assistência Farmacêutica/economia , Assistência Farmacêutica/estatística & dados numéricos , Estados Unidos
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