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Samura M, Hirose N, Kurata T, Ishii J, Nagumo F, Takada K, Koshioka S, Uchida M, Yamamoto S, Inoue J, Enoki Y, Taguchi K, Ishida A, Sekine H, Kunika N, Kunishima H, Matsumoto K. Support for fungal infection treatment mediated by pharmacist-led antifungal stewardship activities. J Infect Chemother 2019; 26:272-279. [PMID: 31732440 DOI: 10.1016/j.jiac.2019.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/20/2019] [Accepted: 09/29/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE At the Yokohama General Hospital, pharmacist-led antimicrobial stewardship programs (ASP) including antifungal stewardship programs (AFP) were started in 2012. To investigate the efficacy of the programs, we compared several parameters that are recommended for the measurement of ASP in Japan based on pre- and post-AFP activities. PATIENTS AND METHODS The subjects were inpatients who developed candidemia between April 2008 and March 2016. They were divided into two groups: pre-AFP (April 2008 until March 2012) and post-AFP (April 2012 until March 2016). The results were compared between the two groups. RESULTS The cumulative optimal antifungal drug usage rate, as a process parameter, significantly increased in the post-AFP group (p = 0.025). Furthermore, the days of therapy of antifungal drugs in the pre- and post-AFP groups was median 6.0 (interquartile range [IQR] 0.3-15.7) and median 3.4 (IQR 1.9-3.4) per 1,000 patient-days, respectively; there was a significant decrease in the post-AFP group (p < 0.001). Expenditure on antifungal drugs, as an outcome parameter, in the pre- and post-AFP groups was 9390.5 ± 5687.1 and 5930.8 ± 4687.0 US dollars, respectively; there was a significant decrease in the post-AFP group (p = 0.002). CONCLUSIONS These results suggest that pharmacist-led antifungal stewardship activities improve both outcome and process parameters.
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Affiliation(s)
- Masaru Samura
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan; Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
| | - Naoki Hirose
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Takenori Kurata
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Junichi Ishii
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Fumio Nagumo
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Keisuke Takada
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Sakura Koshioka
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Masaki Uchida
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Syunya Yamamoto
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Junki Inoue
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
| | - Akira Ishida
- Internal Medicine, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Hisakazu Sekine
- Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Norifumi Kunika
- Internal Medicine, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan.
| | - Hiroyuki Kunishima
- Department of Infectious Disease, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
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Kawai A, Yonemori K, Takahashi S, Araki N, Ueda T. Systemic Therapy for Soft Tissue Sarcoma: Proposals for the Optimal Use of Pazopanib, Trabectedin, and Eribulin. Adv Ther 2017; 34:1556-71. [PMID: 28547734 DOI: 10.1007/s12325-017-0561-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Indexed: 12/21/2022]
Abstract
Soft tissue sarcoma (STS) is a rare tumor with more than 50 histologic subtypes. Although treatment outcomes for patients with STS have improved greatly over the past few decades owing to the adoption of a multidisciplinary approach, patients with advanced disease have a poor prognosis. The development of anticancer drugs has been directed toward improving overall survival (OS). Doxorubicin monotherapy is currently the only standard option for the first-line treatment of STS. However, there is no standard therapy for second-line and later treatment at present. Since 2012, three anticancer drugs—pazopanib, trabectedin, and eribulin—have been approved in Japan for the second-line or later treatment of patients with advanced STS of any histologic subtype. However, the chemosensitivity of STS to each of these drugs varies by histologic subtype and their safety profiles differ; thus, histologic subtype and patient characteristics must be considered when determining optimal treatment. In this article, we review data from clinical studies related to the efficacy of all three drugs, including their effect on OS, and propose optimal treatment strategies for advanced STS by histologic subtype. In addition, with regard to the safety profiles, we highlight the key issues to be considered when selecting patients for treatment with pazopanib, trabectedin, or eribulin and ensuring their appropriate use, based on our combined clinical experience as specialists in the treatment of patients with STS. The proposed treatment strategies as well as treatment precautions based on clinical experience would benefit patients by maximizing the therapeutic effects and enhancing the proper use of these drugs. Funding: Eisai Co., Ltd.
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