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1.
Rev. colomb. anestesiol ; 49(4): e200, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341236

ABSTRACT

Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.


Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.


Subject(s)
Humans , Male , Middle Aged , Aged , Shock , Vasoconstrictor Agents , Vasopressins , Intensive Care Units , Phenylephrine , Pharmaceutical Preparations , Dopamine , Epinephrine , Norepinephrine , Dobutamine , Drug Utilization , Dosage , Prescriptions
2.
Arch. pediatr. Urug ; 92(2): e305, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278305

ABSTRACT

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.


Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.


As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Acidosis, Lactic , Bronchodilator Agents/adverse effects , Albuterol/adverse effects , Hyperglycemia/chemically induced , Hypokalemia/chemically induced , Psychomotor Agitation/etiology , Recurrence , Asthma/drug therapy , Tachycardia/chemically induced , Tremor/chemically induced , Hallucinations/chemically induced
3.
Question and answer in Portuguese | SOF - Formative Second Opinion | ID: sof-44413

ABSTRACT

Um dos principais fatores que fazem com que as mulheres interrompam a amamentação precocemente, é o uso de medicamentos seja pelo receio de causar algum dano à criança, pelo acesso a informações muitas vezes inadequadas, ou mesmo por orientações incorretas de profissionais de saúde. O Ministério da Saúde publicou em 2010, a segunda edição do manual “Amamentação e uso de medicamentos e outras substâncias”, disponível para download gratuito no site do Ministério da Saúde(1). Este manual utiliza as categorias de risco das drogas e seus respectivos marcadores Verde, Amarelo e Vermelho:

Verde = Uso compatível com a amamentação: Desta categoria fazem parte os fármacos cujo uso é potencialmente seguro durante a lactação, haja vista não haver relatos de efeitos farmacológicos significativos para o lactente.

Amarelo = Uso criterioso durante a amamentação: Nesta categoria estão os medicamentos cujo uso no período da lactação depende da avaliação do risco/benefício. Quando utilizados, exigem monitorização clínica e/ou laboratorial do lactente, devendo ser utilizados durante o menor tempo e na menor dose possível. Novos medicamentos cuja segurança durante a amamentação ainda não foi devidamente documentada encontram-se nesta categoria.

Vermelho = Uso contraindicado durante a amamentação: Esta categoria compreende as drogas que exigem a interrupção da amamentação, pelas evidências ou risco significativo de efeitos colaterais importantes no lactente.

Segundo o documento cientifico da Sociedade Brasileira de Pediatria(2), o princípio fundamental da prescrição de medicamentos para nutrizes baseia-se, sobretudo, na avaliação do risco versus benefício. Os aspectos a serem avaliados incluem os benefícios da amamentação, o alívio dos sintomas e da doença sobre a saúde materna e os riscos da terapêutica para o lactente e para a produção láctea.


Subject(s)
Breast Feeding , Drug Utilization , Lactation
4.
Euro Surveill ; 26(46)2021 11.
Article in English | MEDLINE | ID: mdl-34794534

ABSTRACT

We present a European Union/European Economic Area-wide overview of the changes in consumption of antibacterials for systemic use (ATC J01) in the community between 2019 and 2020 as reported to the European Surveillance of Antimicrobial Consumption Network. Overall antibiotic consumption decreased by 18.3% between 2019 and 2020, the largest annual decrease in the network's two-decade history. We observed a strong association between the level of community antibiotic consumption in 2019 and the size of the decrease between 2019 and 2020.


Subject(s)
Anti-Bacterial Agents , COVID-19 , Anti-Bacterial Agents/therapeutic use , Drug Utilization , Europe/epidemiology , European Union , Humans , Pandemics/prevention & control , SARS-CoV-2
5.
Jt Dis Relat Surg ; 32(3): 759-766, 2021.
Article in English | MEDLINE | ID: mdl-34842110

ABSTRACT

OBJECTIVES: The aim of the present study was to assess the prescriptions of patients who were admitted to the orthopedics and traumatology outpatient clinic of a tertiary care hospital according to the WHO prescribing indicators. PATIENTS AND METHODS: Between January 2020 and March 2020, a total of 1,024 patients (273 males, 751 females; mean age: 51.9±13.9 years; range, 19 to 103 years) were included in the study. Only patients who were prescribed drugs and 18 years of age or older were included in the study. The WHO core prescribing indicators were utilized for the assessment of rational drug use. The WHO prescribing indicators percentages between the age categories were analyzed. The average number of drugs between the age categories was also examined. RESULTS: The average number of drugs per encounter was 2.9. The percentage of encounters with an antibiotic prescribed was 2.6% and with an injection prescribed was 10.7%. The percentage of drugs prescribed from essential drugs list was 33.8%. There were no prescriptions consisting generic name of drugs (0%). Polypharmacy was significantly higher in the ≥65 age group compared to the 18-44 age group (p=0.001). CONCLUSION: The percentage of encounters with an antibiotic and injection prescribed were optimal according to WHO standards, while the average number of drugs per encounter was higher than the WHO ideal ranges. Unfortunately, the parameters such as the percentage of prescribing with generic name and from essential drug list was far more behind the optimal range.


Subject(s)
Drugs, Essential , Orthopedics , Traumatology , Adolescent , Adult , Aged , Ambulatory Care Facilities , Cross-Sectional Studies , Drug Prescriptions , Drug Utilization , Female , Humans , Male , Middle Aged , Practice Patterns, Physicians'
6.
Lancet Psychiatry ; 8(12): 1071-1082, 2021 12.
Article in English | MEDLINE | ID: mdl-34801129

ABSTRACT

BACKGROUND: The WHO Comprehensive Mental Health Action Plan 2013-2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region. METHODS: In this longitudinal trends study, we used pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS). We analysed monthly sales data of psychotropic medicines between Jan 1, 2008, and Dec 31, 2019. Total psychotropic medicine consumption included sales of antidepressants, antipsychotics, tranquilisers, sedatives or hypnotics, and mood stabilisers. Population estimates of each country or region (eight lower-middle-income countries, 19 upper-middle-income countries, and 38 high-income countries) were based on the UN World Population Prospects 2019 report. Average annual sales trends of psychotropic medicines, expressed as defined daily dose (DDD) per 1000 inhabitants per day, were estimated using a random-effects model adjusted for income level and region. Relative changes in the annual consumption of psychotropic medicines by income, expressed as DDD per 1000 inhabitants per day, were assessed as percentage change for each medicine class. FINDINGS: Psychotropic medicine sales increased from 28·54 DDD per 1000 inhabitants per day in 2008 to 34·77 DDD per 1000 inhabitants per day in 2019, corresponding to a 4·08% (95% CI 2·96-5·21) relative average increase annually. The absolute annual increase was greater in high-income countries (3·31 DDD per 1000 inhabitants per day, 95% CI 3·01-3·61) compared with upper-middle-income countries (1·94 DDD per 1000 inhabitants per day, 1·45-2·44) and low-middle-income countries (0·88 DDD per 1000 inhabitants per day, 0·62-1·13; p<0·0001). The relative average annual increase in psychotropic medicine sales from 2008 to 2019 was greater in upper-middle-income countries (7·88%, 95% CI 6·99-8·77) than in lower-middle-income countries (2·90%, 2·40-3·39) and high-income countries (1·02%, 0·80-1·24). In 2019, the regional consumption of psychotropic medicines varied greatly, with the highest sales of all psychotropic medicine classes reported in northern America (167·54 DDD per 1000 inhabitants per day) and lowest sales reported in Asia (5·59 DDD per 1000 inhabitants per day). 17 countries had very low consumption of psychotropic medicines in 2019, including high-income countries and countries with a high prevalence of mental disorders. INTERPRETATION: The consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. FUNDING: None.


Subject(s)
Drug Utilization , Psychotropic Drugs , Health Services Accessibility , Humans , Longitudinal Studies , Mental Disorders/drug therapy , Psychotropic Drugs/economics , Psychotropic Drugs/therapeutic use
7.
Open Heart ; 8(2)2021 11.
Article in English | MEDLINE | ID: mdl-34785588

ABSTRACT

BACKGROUND: Early in the COVID-19 pandemic, the National Health Service (NHS) recommended that appropriate patients anticoagulated with warfarin should be switched to direct-acting oral anticoagulants (DOACs), requiring less frequent blood testing. Subsequently, a national safety alert was issued regarding patients being inappropriately coprescribed two anticoagulants following a medication change and associated monitoring. OBJECTIVE: To describe which people were switched from warfarin to DOACs; identify potentially unsafe coprescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic. METHODS: With the approval of NHS England, we conducted a cohort study using routine clinical data from 24 million NHS patients in England. RESULTS: 20 000 of 164 000 warfarin patients (12.2%) switched to DOACs between March and May 2020, most commonly to edoxaban and apixaban. Factors associated with switching included: older age, recent renal function test, higher number of recent INR tests recorded, atrial fibrillation diagnosis and care home residency. There was a sharp rise in coprescribing of warfarin and DOACs from typically 50-100 per month to 246 in April 2020, 0.06% of all people receiving a DOAC or warfarin. International normalised ratio (INR) testing fell by 14% to 506.8 patients tested per 1000 warfarin patients each month. We observed a very small increase in elevated INRs (n=470) during April compared with January (n=420). CONCLUSIONS: Increased switching of anticoagulants from warfarin to DOACs was observed at the outset of the COVID-19 pandemic in England following national guidance. There was a small but substantial number of people coprescribed warfarin and DOACs during this period. Despite a national safety alert on the issue, a widespread rise in elevated INR test results was not found. Primary care has responded rapidly to changes in patient care during the COVID-19 pandemic.


Subject(s)
Anticoagulants/administration & dosage , Blood Coagulation/drug effects , COVID-19 , Drug Substitution/standards , Factor Xa Inhibitors/administration & dosage , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/standards , State Medicine/standards , Warfarin/administration & dosage , Aged , Anticoagulants/adverse effects , Blood Coagulation Tests , Drug Monitoring , Drug Prescriptions , Drug Substitution/adverse effects , Drug Utilization/standards , England , Factor Xa Inhibitors/adverse effects , Female , Humans , Male , Middle Aged , Patient Safety , Primary Health Care/standards , Retrospective Studies , Risk Assessment , Risk Factors , Warfarin/adverse effects
8.
Salud Colect ; 17: e3583, 2021 Sep 27.
Article in Spanish | MEDLINE | ID: mdl-34752020

ABSTRACT

Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.


Subject(s)
Benzodiazepines , Pharmaceutical Preparations , Adolescent , Adult , Argentina , Benzodiazepines/adverse effects , Female , Humans , Income , Middle Aged , Social Security
9.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 10(4): 84-98, out.-dez.2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1344343

ABSTRACT

Introducción: el derecho al acceso a la información administrativa es un derecho fundamental consagrado en la Constitución Política de Costa Rica. La información que presentan las empresas respecto a seguridad, calidad y eficacia para que se otorgue la aprobación para comercializar un medicamento en el país por parte del Estado es necesaria para un usoracional de los medicamentos. Objetivo: determinar si la población costarricense tiene acceso a la información pública del registro sanitario de un medicamento. Metodología: consistió en la revisión detallada de la normativa nacional relacionada con acceso a la información pública y su aplicaciónpara los expedientes de registros sanitarios en el país. Resultados: según la legislación nacional esta información es de acceso público, excepto algunos datos de sustancias nuevas. Sin embargo, el Ministerio de Salud de Costa Rica no permite que la ciudadanía conozca esta información, al no disponer de una base de datos pública, de acceso en tiempo real, a partir de una plataforma digital. Conclusión: existe una violación del derecho fundamental a acceder a la información administrativa por parte del Ministerio de Salud de Costa Rica.


Introduction: the right of access to administrative information is a fundamental right enshrined in the Political Constitution of Costa Rica. The information that companies present regarding safety, quality,and efficacy forthe State to grant approval to market a drug in the country is necessary for a rational use ofdrugs. Objective: To determine if the Costa Rican population has access to the public information of the sanitary registry of a medicine. Methods: a detailed review of the national regulations related to access to public information was made and its application to the records of health records in the country. Results: According to national legislation, this information is publicly accessible, except for data on new substances. However, the Costa Rican Ministry of Health does not allow citizens to know this information, as it does not have a public database, accessible in real time, from a digital platform. Conclusion: there is a violation of the fundamental right to access administrative information by the Ministry of Health of Costa Rica.


Introdução: o direito de acesso à informação administrativa é um direito fundamental consagrado na Constituição Política da Costa Rica. As informações que as empresas apresentam sobre segurança, qualidade e eficácia para que o Estado conceda a aprovação para comercialização de um medicamento no país são necessárias para o uso racional dos medicamentos. Objetivo: determinar se a população costarriquenha tem acesso às informações públicas do registro sanitário de um medicamento. Metodologia: consistiu em uma revisão detalhada das regulamentações nacionais relacionadas ao acesso à informação pública e sua aplicação aos registros dos prontuários de saúde do país. Resultados: de acordo com a legislação nacional, essa informação está acessível ao público, exceto para alguns dados sobre novas substâncias. No entanto, o Ministério da Saúde da Costa Rica não permite que os cidadãos conheçam essas informações, pois não possui um banco de dados público, acessível em tempo real, a partir de uma plataforma digital. Conclusão: há uma violação do direito fundamental de acesso à informação administrativa por parte do Ministério da Saúde da Costa Rica.

10.
Question and answer in Portuguese | SOF - Formative Second Opinion | ID: sof-44384

ABSTRACT

Buscopan® está classificado na categoria B de risco na gravidez. Já o Buscopan composto, pertence a categoria D de risco na gravidez.


Subject(s)
Butylscopolammonium Bromide/classification , Pregnant Women , Drug Utilization
11.
Washington, D.C.; OPS; 2021-10-14.
Non-conventional in Spanish | PAHO-IRIS | ID: phr-54992

ABSTRACT

La adquisición de antimicrobianos sin prescripción es una preocupación a nivel mundial. Esta práctica está prosperando en países que carecen de la legislación adecuada o en los que no se aplican las reglamentaciones correctamente. La Organización Panamericana de la Salud (OPS) y los Estados Miembros de la Región de las Américas aprobaron el Plan de acción sobre resistencia a los antimicrobianos, que reconoce la resistencia a los antimicrobianos como una amenaza para la salud pública mundial que requiere una respuesta multisectorial. Para combatir la resistencia a los antimicrobianos, es necesario un cambio de comportamiento a nivel mundial sobre la forma en que se utilizan y se adquieren. Para abordar el uso indiscriminado de antimicrobianos y su prescripción excesiva, y aplicar la reglamentación sobre prescripción y prácticas de adquisición, se requieren enfoques nacionales. En este contexto, el objetivo del presente manual de comunicación es apoyar a los profesionales de la comunicación y oficiales a cargo de programas de salud a elaborar estrategias para concientizar y promover la importancia del uso adecuado de antimicrobianos entre las diferentes partes interesadas; concientizar al público sobre la importancia de la adquisición de antimicrobianos con prescripción para lograr la colaboración multisectorial para el cumplimiento de las disposiciones legales y las reglamentaciones sobre este tema, y promover un cambio de comportamiento sobre el uso y la adquisición adecuados de antimicrobianos de todas las partes involucradas.


Subject(s)
Anti-Infective Agents , Drug Resistance, Microbial , Pharmacology, Clinical , Nonprescription Drugs , Drug Prescriptions , Health Systems , Public Health Systems , Public Health
12.
Medisan ; 25(5)2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1346551

ABSTRACT

La relevancia y el alcance del uso racional de medicamentos y su contribución al mejoramiento de la salud poblacional constituyen suficientes argumentos para que el médico general integral en Cuba lo adopte como modalidad de superación que cualifica su desempeño profesional. Al respecto, se han desarrollado varios estudios históricos sobre la superación de este especialista; sin embargo, se requiere profundizar en determinados temas que pueden aportarle un sentido renovador como prescriptor de medicamentos. A tal efecto, en este artículo se exponen los antecedentes del proceso de educación de posgrado de este galeno, con énfasis en la actualización sobre el uso racional de medicamentos. Pudo concluirse que existen vacíos importantes en el diseño de superación profesional en cuanto al uso racional de medicamentos en la atención primaria de salud; no obstante, se reconoce la trascendencia social de esa problemática por parte de los niveles directivos correspondientes.


The relevance and reach of the rational use of medications and their contribution to the improvement of the populational health constitute enough arguments so that the comprehensive general doctor in Cuba adopts it as training modality that qualifies his professional performance. In this respect, several historical studies have been developed on the training of these specialists; however, it is required to deepen in certain topics that can contribute a renovating sense to them as drugs prescribers. To such an effect, the history of the postdegree educational process of this doctor is exposed in this work, with emphasis in upgrading on the rational use of medications. It could be concluded that there are important gaps in the training design as for the rational use of medications in the primary health care; nevertheless, the social transcendency of that problem is recognized on the part of the corresponding directive levels.


Subject(s)
Primary Health Care , Drug Utilization , Professional Training , Community Health Services , Cuba
14.
Medicine (Baltimore) ; 100(40): e27488, 2021 Oct 08.
Article in English | MEDLINE | ID: mdl-34622881

ABSTRACT

ABSTRACT: Pneumonia is a common disease-causing hospitalization. When a healthcare-associated infection is suspected, antibiotics that provide coverage for multi-drug resistant (MDR) or extended-spectrum beta-lactamase (ESBL) bacteria are frequently prescribed. Limited data is available for guidance on using meropenem as a first-line empiric antimicrobial in hospitalized patients with risk factors for MDR/ESBL bacterial infections.This was a single-center, retrospective study designed and conducted to identify factors associated with positive cultures for MDR/ESBL pathogens in hospitalized patients with suspected healthcare-associated pneumonia.Of the 246 patients, 103 patients (41%) received meropenem. Among patients prescribed meropenem, MDR/ESBL pathogens were detected in only 20 patients (13%). Patients admitted from a skilled nursing facility/long-term acute care (SNF/LTAC) or with a history of a positive culture for MDR/ESBL pathogens were significantly associated with positive cultures of MDR/ESBL pathogens during the hospitalization (odds ratio [95% confidence intervals], 31.40 [5.20-189.6] in SNF/LTAC and 18.50 [2.98-115.1] in history of culture-positive MDR/ESBL pathogen). There was no significant difference in mortality between the 3 antibiotic groups.Admission from a SNF/LTAC or having a history of cultures positive for MDR/ESBL pathogens were significantly associated with a positive culture for MDR/ESBL pathogens during the subsequent admission. We did not detect significant association between meropenem use as a first-line drug and morbidity and mortality for patients admitted to the hospital with suspected healthcare-associated pneumonia, and further prospective studies with larger sample size are needed to confirm our findings.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Healthcare-Associated Pneumonia/drug therapy , Hospitalization/statistics & numerical data , Meropenem/therapeutic use , Aged , Anti-Bacterial Agents/administration & dosage , Drug Utilization/statistics & numerical data , Female , Humans , Male , Meropenem/administration & dosage , Microbial Sensitivity Tests , Middle Aged , Practice Patterns, Physicians'/statistics & numerical data , Residential Facilities/statistics & numerical data , Retrospective Studies
15.
BMC Health Serv Res ; 21(1): 1091, 2021 Oct 13.
Article in English | MEDLINE | ID: mdl-34645451

ABSTRACT

BACKGROUND: The lack of medication standards is a serious problem in paediatrics mainly because of age-related differences in organ development and physiological functions in children. Consequently, dosage measurement becomes inaccurate. For this reason, methods for evaluating and monitoring rational paediatric medications should be developed. Drug use indicators, such as those similar to the drug utilisation index (DUI) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) and widely used for the assessment of appropriate dosage in adults, should be explored in terms of their applicability to children. METHODS: A total of 5,538 prescriptions of antibiotics selected from a general teaching hospital were included. Drug, dose, frequency and treatment duration were obtained from each prescription. The prescription daily dose (PDD) of each antibiotic drug was calculated as the average of the daily doses. Underdose and overdose were determined in terms of the PDD/DDD ratio for each prescription. Children's DUI (cDUI) was explored in terms of the appropriate dosage for children as follows: the meaning of children's DDD (cDDD) and the evaluation of paediatric drug dosage. RESULTS: The top five antibiotics and their utilisation rates were as follows: cefmetazole sodium injection (18.47 %), erythromycin lactobionate injection (15.07 %), amoxicillin/clavulanate potassium injection (10.72 %), ceftriaxone sodium injection (9.50 %) and azithromycin dry suspension (8.02 %). The ratio of cDUI and PDD/cDDD was mostly not close to 1. CONCLUSIONS: The establishment of a cDUI system is an effective means of paediatric dosage evaluation. In addition to DDDs, cDUI and PDD/cDDD should be used to analyse the utilisation of antibiotics in children.


Subject(s)
Anti-Bacterial Agents , Pediatrics , Adult , Anti-Bacterial Agents/therapeutic use , Child , Cross-Sectional Studies , Drug Prescriptions , Drug Utilization , Hospitals, Teaching , Humans
17.
BMC Health Serv Res ; 21(1): 1118, 2021 Oct 19.
Article in English | MEDLINE | ID: mdl-34663315

ABSTRACT

BACKGROUND: Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. METHODS: We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler's sales databases. Using 2016-2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. RESULTS: DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. CONCLUSION: The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.


Subject(s)
Anti-Infective Agents , Cefazolin , Drug Utilization , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/economics , Anti-Infective Agents/therapeutic use , Cefazolin/supply & distribution , Humans
18.
Rev Sci Tech ; 40(2): 511-521, 2021 Aug.
Article in English | MEDLINE | ID: mdl-34542097

ABSTRACT

The emergence of antimicrobial resistance (AMR) is a major global public health issue, but it also jeopardises the effectiveness of antimicrobials as a means of curing infections in animals that threaten their health, welfare and productivity. Several reports show that infections in humans caused by antimicrobial-resistant pathogens may be linked to antimicrobial use (AMU) and AMR in food-producing animals; however, to what extent this happens is unknown. Use of antimicrobials drives the emergence of AMR, therefore, their extensive over-use and misuse in livestock is of concern. Robust AMU and AMR data are important to monitor the progress of interventions aiming to reduce AMR in the livestock sector. However, not all countries have complete data on antibiotic sales or use, so our current knowledge of global AMU is primarily based on modelling estimates. Antimicrobial resistance prevalence data are limited, particularly in low- and middle-income countries, but in some high-income regions fairly robust data are available. It should also be noted that monitoring guidelines and protocols are available to provide globally harmonised AMR data. Using antimicrobials rationally and not using them for disease prevention purposes is key to reducing AMU. To ensure that these drugs are used appropriately we must ensure that: a) veterinary services are accessible and affordable for farmers; b) antibiotics are only sold on prescription; c) veterinarians earn no revenue linked to the sale or prescription of antibiotics; d) veterinarians have substantial skills in preventive medicine (good animal husbandry, efficient biosecurity and vaccinology); and e) the benefits of preventive measures must appeal to farmers so that they are willing to pay for them.


Subject(s)
Anti-Infective Agents , Livestock , Animals , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Farmers , Humans
19.
Sci Rep ; 11(1): 17787, 2021 09 07.
Article in English | MEDLINE | ID: mdl-34493774

ABSTRACT

Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/therapy , Health Care Costs/statistics & numerical data , Health Care Rationing/economics , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/economics , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/economics , Alanine/therapeutic use , COVID-19/diagnosis , COVID-19/economics , COVID-19/mortality , COVID-19/virology , Clinical Decision-Making/methods , Computer Simulation , Cost-Benefit Analysis , Dexamethasone/economics , Dexamethasone/therapeutic use , Health Care Rationing/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/statistics & numerical data , Middle Aged , Oxygen/administration & dosage , Oxygen/economics , Quality-Adjusted Life Years , Respiration, Artificial/economics , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , United States/epidemiology
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