Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods

OBJECTIVE

The last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a  university hospital emergency department at two different periods of time  to analyze potential differences in terms of patient characteristics,  prescription profile, and treatment.

METHOD

This is a retrospective observational study of opioid  verdoserelated visits in two periods of time: 2009-2014 and 2018-2020.

RESULTS

The study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year).  A comparison between the two period showed a decrease in the patients' age (81.1 vs 74.0; p = 0.044) and an increase in the number of  acute trauma-derived pain treatments at the expense of chronic pain  treatments (p = 0.002). No differences were observed in the opioids  involved. As regards symptoms, there was a decrease in the incidence of  confusional syndromes (p = 0.026) and an increase in deaths.

CONCLUSIONS

Emergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A  change has also been observed in the profile of affected patients, with a  higher number of cases where pain is derived from acute trauma.

Tacrolimus, Sirolimus and Everolimus Doses in HIV-Infected Solid-Organ Recipients, Requiring a Cobicistat-Based Antiretroviral Regimen: Report of Three Cases and Review

People living with HIV should be considered candidates for solid-organ transplantation (SOT). However, managing HIV-infected patients undergoing SOT represents a major challenge due to the potential drug-drug interactions between antiretroviral drugs and immunosuppressive agents, particularly when resorting to antiretroviral drugs that require pharmacokinetic enhancers. We report three cases of cobicistat-tacrolimus co-administration, two of which also include the co-administration of mTOR inhibitors, in HIV-positive patients undergoing SOT (2 kidney and 1 liver recipient). We review previously reported cases and provide recommendations for initial management following transplantation.

[Influence of ethnicity on the pharmacokinetics of amikacin]

OBJECTIVE

Despite the increasing ethnic diversity, there are few studies of its influence on the pharmacokinetics of amikacin. The objective of this study was to compare the pharmacokinetics of amikacin in different populations: Asian, Hispanic, North Africans and Caucasian.

METHODS

A retrospective observational study was performed in a tertiary teaching hospital during eight years. It was included all patients with intravenous amikacin treatment in extended interval dosing regimen with therapeutic drug monitoring of amikacin. Pharmacokinetic parameters were analysed. A bivariate and multiple linear regression statistical analysis were carried out.

RESULTS

164 patients were included: 7 asians, 135 Caucasians, 11 Hispanics and 11 from North Africa. It was shown a lower plasma concentrations of amikacin in North Africa population due to its greater clearance.

CONCLUSIONS

Amikacin plasma concentrations monitoring is advisable in patients from North Africa in order to avoid subtherapeutic concentrations.

Monitorización de concentraciones plasmáticas de antibióticos en hospitales españoles

BACKGROUND

Monitoring of plasma aminoglycoside and vancomycin concentrations is a measure of good clinical practice in critically ill patients. However, the frequency and application of this practice in Spanish hospitals is unknown.

METHODS

Observational, multicenter study based on a survey designed by the Study Group for Infection in the Critically Ill Patient of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society of Infectious Diseases and Clinical Microbiology). The survey was sent to the 221 general hospitals with a more than 150-bed capacity included in the hospital directory. Questions regarding the antibiotics monitored, hospital services involved, systems used to report the results, and levels of intervention were included.

RESULTS

Information was recorded from 56 (25.3%) hospitals with a total of 36,886 beds, among which 933 (2.5%) corresponded to critically ill patients. In 47 (83.9%) hospitals, plasma concentrations of one or two antibiotics were determined: vancomycin in 47 (83.9% of the total), amikacin in 41 (73.2%), and gentamicin in 40 (71.2%). Analyses were performed by the following services: Biochemistry in 34%, Pharmacy in 25.5% and Pharmacology in 8.5%. Only 57.4% of services recommended dose adjustments according to the results obtained, using eight different dose adjustment models.

CONCLUSIONS

In 16% of the hospitals surveyed, monitoring of antibiotic concentrations was not performed in daily practice. There was considerable variation in all phases of the process, especially with regard to adjustment of plasma antibiotic concentrations. Consensus recommendations established by all the Services implicated are required to standardize monitoring of plasma antibiotic concentrations.

Pharmacoeconomic Evaluation of Linezolid Versus Teicoplanin in Bacteremia by Gram-Positive Microorganisms*

OBJECTIVE

The objective of this study was to compare the efficiency of linezolid versus teicoplanin in the treatment of bacteremia produced by Gram-positive microorganisms through a pharmacoeconomic analysis based on clinical results obtained from a previous clinical trial.

METHODS

We applied an analysis of cost-effectiveness elaborated through a pharmacoeconomic model. We defined each unit of effectiveness as 'each successfully cured of infections with bacteremia.' We used the program Pharma-Decision (version Hospital 1.1) that allows to build interactive pharmacoeconomic models. Effectiveness data of both antibiotics were obtained from a published clinical trial, while resources consumed were obtained from the same source and from a consensus provided by a local expert panel. Only direct costs were included in the analysis without taking into consideration indirect costs. The perspective chosen was hospital assistance and the time horizon was set to 28 days. All costs are expressed in Euros.

RESULTS

Linezolid demonstrated a better clinical outcome with less associated costs compared to teicoplanin (88.5 versus 56.7% of cured patients and 5,557.04 versus 6,327.43 <euro> per treated patient, respectively), thus resulting in a lower cost-effectiveness ratio for linezolid versus teicoplanin (6,279.1 versus 11,159.5 <euro> per cured patient with a 95% CI of 5,960.2-6,510.4 and 10,865.2-12,647.3, respectively) which results in a the dominant position for linezolid. The sensitivity analysis showed that linezolid was always the most efficient option even when modifying the value of variables with higher uncertainty.

CONCLUSIONS

Linezolid is a more efficient option than teicoplanin because it presents higher rate of effectiveness with lower consumption of resources, thus being a dominant alternative in the treatment of Gram-positive infection with bacteremia.

Linezolid-associated serotonin syndrome: what we can learn from cases reported so far

OBJECTIVES

To study the characteristics of the linezolid-associated serotonin syndrome cases.

METHODS

Database search for linezolid-associated serotonin syndrome.

RESULTS

Twelve cases were found. The mean age of patients was 52.8 years. All patients received linezolid concomitantly with selective serotonin re-uptake inhibitor drugs (SSRID). The onset of syndrome was 9.5 days after linezolid introduction and was directly correlated to patients' age (P = 0.024). The symptoms resolved in 2.9 days. Citalopram was associated with a delayed resolution (P = 0.018). A trend was observed towards longer resolution time the longer the half-life of the interacting drug (P = 0.096).

CONCLUSIONS

Patients are at risk when receiving SSRID concomitant with linezolid. The syndrome onset could be delayed in older patients. The resolution could be delayed when citalopram is involved in the syndrome.

Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva

OBJECTIVE

Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain.

MATERIAL AND METHODS

A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatment of therapeutic failures). The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial.

RESULTS

Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericin B was of 56,296 and 56,382 Euros respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 Euros. The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 Euros per patient.

CONCLUSIONS

Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus) resulting in healthcare resources saving due to better clinical results with lower associated costs.