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Tallon RE, Whitt B, Bladon BM. Antibiotic usage in 14 equine practices over a 10-year period (2012-2021). Equine Vet J 2024; 56:544-551. [PMID: 37587746 DOI: 10.1111/evj.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Monitoring antibiotic usage is an important part of tackling antimicrobial resistance. The use of computerised records for monitoring has been previously described in the equine sector but there is currently no consensus on metrics used to report usage. OBJECTIVES To document antibiotic use in equine practices in the United Kingdom over a 10-year period using commercially available practice management software. STUDY DESIGN Retrospective survey. METHODS A custom antibiotic usage report was created using Eclipse® practice management software. Participating practices were given instructions on how to generate the usage report. Annual reports were requested for a 10-year period (2012-2021 inclusive). Each report provided sales of each class of antibiotic in total mg and in mg/kg, based on the number of equids treated (for any transaction) and their average weight. The defined daily dose for animals (DDDvet) and the DDD/1000 (used in people) were also calculated to correct for variation in dosage rates between antibiotics. RESULTS Fourteen practices submitted data for an annual maximum of 107 977 horses. Overall, median annual antibiotic usage was 54.25 mg/kg (range 45.34-60.27 mg/kg), 1.52 defined daily doses/animal/year (range 1.39-1.70) and 4.17 defined daily dose/1000 animals (range 3.82-4.66). Overall median highest priority critically important antimicrobial usage was 0.67 mg/kg (range 0.56-1.71), 0.12 defined daily doses/animal/year (range 0.10-0.14) and 0.33 defined daily dose/1000 animals (range 0.29-0.39). MAIN LIMITATIONS The software relied on the accurate identification of antibiotic preparations. The calculation of DDDvet was complicated by the varying dose rates of antimicrobials used in equine practice. CONCLUSIONS A reliable technique to measure antibiotic usage is presented. Defined daily dosage calculations may be more helpful in equine practice due to the preponderance of potentiated sulphonamides usage. These data and methods may provide the basis for future clinical audits aiming to enhance antimicrobial stewardship.
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Ferrara F, Pasquinucci R, Capuozzo M, Polito G, Bagaglini G, Vaccaro M, Coluccia A, Langella R, Trama U, Nava E, Zovi A. Comparison and Analysis of Antibiotic Consumption in Two Italian Hospital Settings in Relation to the Fight of Antimicrobial Resistance. Pharmaceuticals (Basel) 2024; 17:183. [PMID: 38399398 PMCID: PMC10893110 DOI: 10.3390/ph17020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/17/2024] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: The emergence and spread of drug-resistant pathogens due to the improper use of antibiotics have become increasingly apparent in recent years. Objective: This retrospective comparative analysis aimed to assess and compare antibiotic prescription trends in Italy across two different regions based on geographic area and healthcare structure. One region represents a large hospital institution, while the other represents a populous local Italian health agency. The study also examined the impact of documented antibiotic stewardship programs and efforts to promote responsible antibiotic use at all levels, in alignment with international goals. Antibiotic consumption data were collected from the Umberto I Polyclinic Hospital and the ASL Napoli 3 South Local Health Agency. Methods: To compare consumption between regions, a standardized comparison using the Defined Daily Dose (DDD) was employed. The internal management system of each healthcare facility records all prescriptions and drug dispensations, and these data were extrapolated for this retrospective study. Results: A comparative assessment between the first half of 2022 and 2023 (January-June) highlighted a significant increase in beta-lactam antibiotic consumption, showing a twofold rise compared to the previous year's term. Regarding prescription averages, there was a noticeable increase of +29.00% in hospitalizations and +28.00% in hospital discharges within the ASL Napoli 3 South. Conversely, at Policlinico Umberto I, there was a marginal increase of +1.60% in hospitalizations and a decrease of -7.40% in hospital discharges. Conclusions: The study offers valuable insights into expenditure patterns and antibiotic consumption, underscoring the need for enhanced prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings stress the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.
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Affiliation(s)
- Francesco Ferrara
- Pharmacy Unit, ASL Napoli 3 Sud, 80035 Naples, Italy; (R.P.); (M.C.); (E.N.)
| | - Roberta Pasquinucci
- Pharmacy Unit, ASL Napoli 3 Sud, 80035 Naples, Italy; (R.P.); (M.C.); (E.N.)
| | - Maurizio Capuozzo
- Pharmacy Unit, ASL Napoli 3 Sud, 80035 Naples, Italy; (R.P.); (M.C.); (E.N.)
| | - Giacomo Polito
- Pharmacy Unit, Pharmacy Department, Policlinico Umberto I, 00161 Rome, Italy; (G.P.); (M.V.); (A.C.)
| | | | - Marcello Vaccaro
- Pharmacy Unit, Pharmacy Department, Policlinico Umberto I, 00161 Rome, Italy; (G.P.); (M.V.); (A.C.)
| | - Adriana Coluccia
- Pharmacy Unit, Pharmacy Department, Policlinico Umberto I, 00161 Rome, Italy; (G.P.); (M.V.); (A.C.)
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, 20159 Milan, Italy;
| | - Ugo Trama
- Health Protection and Coordination of the Campania Regional Health System, 80143 Naples, Italy;
| | - Eduardo Nava
- Pharmacy Unit, ASL Napoli 3 Sud, 80035 Naples, Italy; (R.P.); (M.C.); (E.N.)
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Vázquez-Prieto S, Vaamonde A, Paniagua E. An Analysis of the Use of Systemic Antifungals (Fluconazole, Itraconazole, and Terbinafine) in Galicia, Spain, between 2019 and 2022. Diseases 2024; 12:22. [PMID: 38248373 PMCID: PMC10814849 DOI: 10.3390/diseases12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
In the present work, we examined the consumption of systemic antifungals (fluconazole, itraconazole, and terbinafine) in outpatients in the four provinces of Galicia, Spain, between 2019 and 2022. We also described the variability in the use of these types of drugs between these provinces. In addition, we detected any deviation in consumption at a seasonal level and analyzed possible changes during the study period. A descriptive, cross-sectional, and retrospective study of the use of antifungals, expressed in terms of a defined daily dose per 1000 inhabitants per day, was carried out. The results obtained revealed statistically significant differences between provinces and by the active principle consumed in the four Galician provinces (p < 0.001), which can be explained by multiple factors. This study also revealed that there was stable consumption during the study period, with no significant seasonal differences observed. This study represents a contribution to the knowledge about the consumption of antifungals for systemic use in Galicia and serves as a basis for subsequent studies. This will allow us to understand the consumption patterns of these types of drugs and, ultimately, will help to establish stewardship strategies and prevent the development of resistance.
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Affiliation(s)
- Severo Vázquez-Prieto
- Laboratorio de Parasitología, Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain;
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán 3780000, Chile
| | - Antonio Vaamonde
- Departamento de Estadística e Investigación Operativa, Facultad de Ciencias Económicas y Empresariales, Universidad de Vigo, 36310 Vigo, Spain;
| | - Esperanza Paniagua
- Laboratorio de Parasitología, Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain;
- Instituto de Investigación en Análisis Químicos y Biológicos (IAQBUS), Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Rodríguez A, Gómez F, Sarvisé C, Gutiérrez C, Giralt MG, Guerrero-Torres MD, Pardo-Granell S, Picó-Plana E, Benavent-Bofill C, Trefler S, Berrueta J, Canadell L, Claverias L, Esteve Pitarch E, Olona M, García Pardo G, Teixidó X, Bordonado L, Sans MT, Bodí M. Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study. Biomedicines 2023; 11:3330. [PMID: 38137551 PMCID: PMC10741655 DOI: 10.3390/biomedicines11123330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. METHODS A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored. RESULTS A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed. CONCLUSION The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.
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Affiliation(s)
- Alejandro Rodríguez
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain;
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
| | - Frederic Gómez
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
- Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
| | - Carolina Sarvisé
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Cristina Gutiérrez
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Montserrat Galofre Giralt
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - María Dolores Guerrero-Torres
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Sergio Pardo-Granell
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Ester Picó-Plana
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Clara Benavent-Bofill
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
| | - Julen Berrueta
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Tarragona Health Data Research Working Group (THeDaR), Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Laura Canadell
- Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain;
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Laura Claverias
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
| | - Erika Esteve Pitarch
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Montserrat Olona
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
- Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Graciano García Pardo
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Xavier Teixidó
- ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
| | - Laura Bordonado
- ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
| | - María Teresa Sans
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - María Bodí
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
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Yossadania A, Hayati Z, Harapan H, Saputra I, Mudatsir, Diah M, Ramadhana IF. Quantity of antibiotic use and its association with clinical outcomes in COVID-19 patients: A snapshot from a provincial referral hospital in Indonesia. Narra J 2023; 3:e272. [PMID: 38450336 PMCID: PMC10914064 DOI: 10.52225/narra.v3i3.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/25/2023] [Indexed: 03/08/2024]
Abstract
Irrational antibiotic use in Indonesia is considered high, yet there are still lacks reliable information regarding the issue. The quantity of antibiotic use studies, in particular during coronavirus disease 2019 (COVID-19) pandemic, was not well reported. The aim of this study was to evaluate antibiotic use in COVID-19 patients at a province referral hospital in Aceh, Indonesia, Dr Zainoel Abidin Hospital, and to assess the association between antibiotic use and COVID-19 clinical outcomes. The defined daily dose (DDD) method was used and expressed in DDDs per 100 patient-days as in hospital setting. The data were obtained from inpatient confirmed COVID-19 patients between March 2020 and December 2021. A logistic regression was used to determine the association between patients' characteristics and antibiotic usage with clinical outcomes. A total of 361 treated COVID-19 patients were included using a random sampling technique and analyzed. Out of 361 patients, 89.2% of them were treated with antibiotic(s). All the antibiotics were given empirically except for cefazoline (5.5%) that was used as prophylaxis to obstetric patients who underwent the c-section. Azithromycin was the most prescribed antibiotic and levofloxacin had the highest DDD. Our data suggested that there was no association between antibiotic use and clinical outcomes of COVID-19 patients (p=0.128). Having sepsis and another pulmonary disease however were associated with mortality of COVID-19 patients with adjusted odds ratio (aOR) 14.14; 95%CI 2.94-67.90, p=0.001 and aOR 8.64; 95%CI 3.30-22.63, p<0.001, respectively. In addition, patients older than 60-year-old had a higher chance to an unfavorable outcome compared to those younger than 30-year-old, aOR: 7.61; 95%CI: 1.07-53.94. In conclusion, the use of antibiotics is prevalent among COVID-19 and it is not directly associated with clinical outcomes.
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Affiliation(s)
- Asyriva Yossadania
- Departement of Public Health, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Zinatul Hayati
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Prevention and Control Antimicrobial Resistance Committee, Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Harapan Harapan
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Center, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Indonesia
- Tsunami & Disaster Mitigation Research Centre (TDMRC), Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Irwan Saputra
- Departement of Public Health, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Mudatsir
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad Diah
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ika F. Ramadhana
- Prevention and Control Antimicrobial Resistance Committee, Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia
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Mittal N, Verma M, Siwach S, Bansal P, Singhal SK. Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study. Cureus 2023; 15:e50653. [PMID: 38229777 PMCID: PMC10790238 DOI: 10.7759/cureus.50653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Multiple drugs are commonly prescribed to intensive care unit (ICU) patients owing to the disease profile, multiple organ dysfunction, prophylaxis, management of stress ulcers, nosocomial infections, etc. This study aimed to evaluate the drug utilization patterns and factors influencing mortality and duration of stay in ICU patients. Methodology: A prospective observational study was conducted in the ICU of our tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak. Data was collected from treatment charts of patients using a structured pretested proforma. World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (WHO ATC/DDD) methodology and core prescribing indicators were used to assess drug utilization data. The effect of different variables on mortality and duration of stay in the ICU was evaluated using regression analysis. RESULTS An average of 8.78 drugs were prescribed per patient. Among the 922 prescriptions, anti-infectives, anti-inflammatory drugs, and drugs acting on the gastrointestinal tract were the most frequent medication classes prescribed. Polypharmacy and trade name prescribing were common. For most of the drugs, the prescribed daily dose corresponded to the WHO-DDD except ceftriaxone and levofloxacin. Age, presence of cardiac disorders, and Glasgow Coma Scale (GCS) score at admission directly correlated with mortality while the use of diuretics had a negative correlation with the duration of ICU stay. Conclusions: There is a need to rationalize drug therapy in the ICU with regard to limiting polypharmacy and emphasizing generic drug name prescribing and adherence to the essential drug list. Antibiotic prescription patterns, in particular, deserve a special focus keeping in mind the multitude of factors demanding aggressive antibiotic use in critically ill intensive care patients.
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Affiliation(s)
- Niti Mittal
- Pharmacology and Therapeutics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Monika Verma
- Pharmacology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Shaveta Siwach
- Pharmacology and Therapeutics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Priyanka Bansal
- Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Suresh Kumar Singhal
- Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Pan YJ, Yeh LL. Associations between mortality and exposure to psychotropic medication: A population-based cohort study for depressive disorders. Aust N Z J Psychiatry 2023; 57:1253-1262. [PMID: 36629047 DOI: 10.1177/00048674221145337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Use of antidepressants and antipsychotics to treat depressive disorders is becoming increasingly prevalent. METHODS This study investigated how the use and cumulative dosage of these medications affect the mortality risk in a Taiwan's national cohort of individuals ages 15 years and older who were diagnosed with depressive disorders in 2010 and followed up for 5 years. An age- and gender-matched control group was identified. The mean defined daily doses of antidepressants and antipsychotics were calculated, and survival analyses were conducted to examine the effects of exposure dosage on overall mortality and mortality due to cardiovascular diseases, in comparison with the control sample. RESULTS A total of 400,042 individuals (255,288 women; 63.8%) with depressive disorders were identified. A low-to-moderate dosage of antidepressants was associated with a decrease in cardiovascular disease-related mortality risks compared to no exposure for those with depressive disorders. By contrast, a dose-related increase was found when using antipsychotics, with a 1.6-, 2.4- and 2.9-fold risk in the low, moderate and high exposure groups, respectively, for overall mortality, and a 1.2-, 2.4- and 3.5-fold risk in the low, moderate and high exposure groups, respectively, for cardiovascular disease-related mortality, relative to the control sample. CONCLUSION For individuals with depression, use of low-to-moderate dosage antidepressants was associated with decreased mortality. However, use of antipsychotics was found to be associated with a dose-related increase in overall and cardiovascular disease-related mortality risks. Adverse health outcomes should be also considered when prescribing psychotropic medications to patients with depressive disorders.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City
- Department of Medical Humanities and Education, Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City
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Hersi H, Raitanen J, Saarinen JT, Peltola J. Prescribed antiseizure medication doses and their relation to defined daily doses for achieving seizure freedom in newly diagnosed patients with epilepsy. Epilepsia Open 2023; 8:811-819. [PMID: 37010264 PMCID: PMC10472398 DOI: 10.1002/epi4.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES To investigate the antiseizure medication (ASM) doses required to achieve seizure freedom and their correlation with the World Health Organization's defined daily doses (DDDs) in patients aged 16 years or older with newly diagnosed epilepsy. METHODS The study included 459 patients with a validated diagnosis of new-onset epilepsy. Patient records were retrospectively analyzed to determine the ASM doses in patients with or without seizure freedom during follow-up. The DDD of the relevant ASM was then retrieved. RESULTS The seizure-freedom rate with first and subsequent ASMs was 88% (404/459 patients) during the follow-up. The mean prescribed doses (PDDs) and PDD/DDD ratio of the most commonly used ASMs, ie, oxcarbazepine (OXC), carbamazepine (CBZ), and valproic acid (VPA), differed significantly between seizure-free and non-seizure-free status (992 mg and 0.99 vs 1132 mg and 1.13; 547 mg and 0.55 vs 659 mg and 0.66; and 953 mg and 0.64 vs 1260 mg and 0.84, respectively). The effect of the OXC dose as the first failed ASM on the possibility of achieving seizure freedom was significant (Fisher's exact test, p = 0.002). Thirty-four of 43 patients (79%) in which an OXC dose of ≤900 mg failed became seizure-free, as compared with 24 of 54 patients (44%) with a failed OXC dose >900 mg. SIGNIFICANCE The present study provides new insights into the doses of the commonly used ASMs such as OXC, CBZ, and VPA that can lead to seizure freedom as monotherapy or as combination therapy. The higher PDD/DDD ratio of OXC (0.99) than that of CBZ or VPA renders a generalized PDD/DDD comparison highly problematic.
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Affiliation(s)
- Hire Hersi
- Department of NeurologyVaasa Central HospitalVaasaFinland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences)Tampere University and the UKK Institute for Health Promotion ResearchTampereFinland
| | | | - Jukka Peltola
- Department of NeurologyTampere University and Tampere University HospitalTampereFinland
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9
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Oliva A, González de Chavez P, Dévora S, Abdala S. Opioid prescription patterns in the province of Las Palmas, Canary Islands, Spain (2016-2020): differences between urban and rural areas. Front Pharmacol 2023; 14:1184457. [PMID: 37533632 PMCID: PMC10390770 DOI: 10.3389/fphar.2023.1184457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction: The use of opioids has increased markedly in the past decades in European countries, especially for treatment of non-cancer pain including painful chronic musculoskeletal conditions. However, there are some notable differences in the relative levels of use between geographical areas and some distinct, context-specific patterns of weak and strong opioid use. The aim of this work is to describe real world trends in dosage forms and population exposure in the prescription opioid use on isolated geographically area: The Canary Islands of Gran Canaria, Lanzarote and Fuerteventura, Spain. For this, several factors such as living in a rural or urban area, population over 65 years of age, population density or socioeconomic status were analyzed. Methods: Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses (DDD) per 1,000 inhabitants per day. A model based on covariance analysis with two nested fixed factors and one co-variable was used for contrast analysis at different level. Results: The overall DDD per 1000 inhabitants per day and year variation rate in Spain was very similar to that obtained for Gran Canaria and Fuerteventura (0.967 vs. 1.006), although the levels of dispensation were different (14.75 versus 18.24 for Gran Canaria and 12.7 for Fuerteventura, respectively). Lanzarote is completely different in all issues, where the opioid consumption rate remained stable during the study period, but with a decreasing tendency. The dispensation level of strong opioids varied between islands, from 56.41% for Fuerteventura vs. 17.61% for Gran Canaria, although these values remained stable. Tramadol with acetaminophen and Tramadol in monotherapy were the most consumed forms of the weak opioids, whereas Buprenorphine was the most used strong opioid followed by Fentanyl, although demand for it varied between islands, the transdermal formulations were the most frequent pharmaceutical preparation. Conclusion: The differences in prescription opioid use are most likely explained by the opioid prescribing practices in each island, whereas factors such urbanicity level, population age, population density and status socioeconomic does not help to explain the differences in prescription opioid use across rural and urban areas.
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Affiliation(s)
- Alexis Oliva
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Patricia González de Chavez
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Sandra Dévora
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
| | - Susana Abdala
- Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain
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Rachina S, Belkova Y, Kozlov R, Mladov V, Mishchenko V, Andreeva A, Domanskaya O, Portnjagina U, Dushina A, Zainalabidova K. Assessment of Antimicrobial Consumption in Multi-Field Hospitals with Pediatric Inpatients: Conventional vs. Novel Pediatric-Adjusted Methodologies. Antibiotics (Basel) 2023; 12:1162. [PMID: 37508258 PMCID: PMC10376229 DOI: 10.3390/antibiotics12071162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/08/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND the objective of this study was to propose a methodology for the assessment of antimicrobial consumption (AMC) in pediatric inpatients and to estimate variances in consumption levels in multi-field hospitals with pediatric inpatients, calculated by means of the pediatric-adjusted methodology vs. the conventional methodology. METHODS the pediatric-adjusted methodology based on the conventional ATC/DDD method and children's DDDs (cDDD) for antimicrobials were proposed and validated in a series of probabilistic sensitivity analyses of real clinical data extracted from the receipt notes of three multi-field hospitals. Differences in AMC in multi-field hospitals with pediatric inpatients, calculated by means of the proposed methodology vs. the conventional methodology, were assessed for a virtual cohort of inpatients, with the pediatric share increasing by 1%. RESULTS in children ≤12 years old, assessment by the standard methodology resulted in a 59% underestimation of AMC from the levels based on prescribed doses, vs. a 25% underestimation for the proposed methodology. In a mixed-age virtual population of inpatients, the underestimation of consumption levels rose to 321% for the ATC/DDD methodology compared to the proposed one. CONCLUSIONS the proposed methodology demonstrated a higher accuracy of AMC estimates compared to the conventional one and can be considered for the quantification of antimicrobial utilization in pediatric institutions and multi-field hospitals with a substantial share of pediatric inpatients.
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Affiliation(s)
- Svetlana Rachina
- Hospital Therapy Department No. 2, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Yuliya Belkova
- Department of Clinical Pharmacology, Smolensk State Medical University, 214019 Smolensk, Russia
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, 214019 Smolensk, Russia
| | - Vladimir Mladov
- Faculty of Applied Mathematics and Control Processes, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Vladimir Mishchenko
- Federal Centre of Traumatology, Orthopedics and Endoprosthesis Replacement, 214019 Smolensk, Russia
| | - Alla Andreeva
- Smolensk Regional Clinical Hospital, 214018 Smolensk, Russia
| | - Olga Domanskaya
- Kuzbas Children's Clinical Hospital n.a. Professor Y.E. Malachovskiy, 654063 Novokuznetsk, Russia
| | - Ulyana Portnjagina
- Department of Internal Medicine and General Medical Practice (Family Medicine), North-Eastern Federal University, 677007 Yakutsk, Russia
| | - Anastasiia Dushina
- Institute of Engineering Physics for Biomedicine, National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), 115409 Moscow, Russia
| | - Khadizhat Zainalabidova
- Hospital Therapy Department No. 2, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
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Ma Y, Peng J, Yao X, Feng L, Shi X, Jiang M. Access to anticancer medicines in public hospitals of Northwestern China. Front Public Health 2023; 11:1182617. [PMID: 37275477 PMCID: PMC10235455 DOI: 10.3389/fpubh.2023.1182617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Objective We aimed to evaluate the accessibility of anticancer medicines in public hospitals of Shaanxi, a representative province of Northwestern China. Methods Thirty-one anticancer medicines were investigated in 146 designated public hospitals in 10 cities of Shaanxi Province. We used medicine procurement data from the Shaanxi Drug Centralized Purchasing Platform during 2019-2021. Primary outcomes included the availability, drug utilization, and affordability of anticancer medicines. Results The mean availability of 31 anticancer medicines increased significantly from 5.45% in 2019 to 14.72% in 2021. The mean availability of nationally negotiated medicines was significantly lower than that of Class B medicines (8.72% vs. 12.85%, p = 0.048), whilst the availability of injectable medicines was significantly greater than that of oral medicines (13.66% vs. 8.77%, p = 0.007). In 2019-2021, the annual mean amount purchased increased significantly from CNY 6.51 million to CNY 18.56 million (p = 0.007). The mean defined daily doses of 31 medicines significantly rose from 225.50 to 1019.50 (p = 0.008) whereas their defined daily drug cost significantly decreased from CNY 551.15 to CNY 404.50 (p < 0.001). The percentage of catastrophic health expenditure decreased from 71.0 to 51.65% and from 90.30 to 80.60% for urban and rural residents, respectively. The affordability of nationally negotiated medicines was significantly lower than that of Class B medicines (p = 0.032), and the affordability of injectable medicines had no significant difference compared to that of oral medicines (p = 0.124) for both urban and rural residents. Conclusion The accessibility of anticancer medicines improved dramatically in public hospitals of Northwestern China during the period 2019-2021.
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Affiliation(s)
- Yue Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Jin Peng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Xuelin Yao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Liuxin Feng
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xinke Shi
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
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Moreno V, Dévora S, Abdala-Kuri S, Oliva A. Trends in the Consumption of Antidepressant Drugs before and during the COVID-19 Pandemic in the Canary Islands, Spain: The Case of the Province of Las Palmas. Healthcare (Basel) 2023; 11:healthcare11101425. [PMID: 37239712 DOI: 10.3390/healthcare11101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The use of antidepressants (ADs) has increased significantly as a result of COVID-19 and its consequences. However, there are some notable differences in the relative levels of use between geographical areas and population groups. The aim of this work is to assess the impact of COVID-19 on the consumption of ADs in the Canary Islands, focusing on the islands of Gran Canaria, Fuerteventura and Lanzarote, by analyzing the trends in prescriptions of ADs during the pandemic period (2020) compared to the pre-pandemic period (2016-2020). Data were extracted from the community pharmacy wholesaler at a population level. Consumption patterns are expressed as the number of defined daily doses per 1000 inhabitant/day. The overall consumption of DIDs was higher in Gran Canaria, mainly in urban areas and the capital. It was similar in both Lanzarote and Fuerteventura, but particularly localized in the capital, which are considered semi-urban areas. Lanzarote and Fuerteventura present the same pattern of prescription ADs use, whereas Gran Canaria is notably different. This finding was also observed in the more consumed active pharmaceutical ingredients, although small inter-island variations in the ranking and percentages were observed. Sertraline and escitalopram are two of the most prescribed N06AB ADs, whereas the most recent N06AX ADs such as venlafaxine, mirtazapine and desvenlafaxine are more commonly prescribed. These differences in prescription ADs can be explained by demographical characteristics, population size, the fact of living in an urban area and general medical practice. In this context, the COVID-19 pandemic did not have an impact on the overall trend of the use of ADs between 2016 and 2020 in the islands under study.
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Affiliation(s)
- Vanessa Moreno
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Sandra Dévora
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Susana Abdala-Kuri
- Department of Physical Medicine and Pharmacology, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
| | - Alexis Oliva
- Department of Chemical Engineering and Pharmaceutical Technolgy, Faculty of Pharmacy, University of La Laguna, 38200 Tenerife, Spain
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Huang KH, Tsai YF, Lee CB, Gau SY, Tsai TH, Chung NJ, Lee CY. The Correlation between Metformin Use and Incident Dementia in Patients with New-Onset Diabetes Mellitus: A Population-Based Study. J Pers Med 2023; 13:jpm13050738. [PMID: 37240908 DOI: 10.3390/jpm13050738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The evidence of metformin's effect on dementia is conflicting. This study investigates the association between metformin use and the risk of dementia among patients with diabetes mellitus (DM). This study included patients with new-onset DM between 2002 and 2013. We divided the patients into patients who used metformin and patients who did not. Two models were used to assess metformin use: the cumulative defined daily dose (cDDD) of metformin use and the intensity of metformin use. This study with 3-year and 5-year follow-ups investigated the risk of dementia among patients with DM who used metformin. At the 3-year follow-up, patients who received cDDD < 300 had an odds ratio (OR) of developing dementia of 0.92 (95% confidence interval [CI] = 0.89-0.96); patients who used metformin at intensities <10 and 10-25 DDD/month had ORs of 0.92 (95% CI: 0.87-0.97) and 0.92 (95% CI: 0.85-1.00), respectively. Metformin use at cDDD 300-500 (OR = 0.80, 95% CI = 0.56-1.15) or >500 (OR = 1.48, 95% CI = 0.48-4.60) or at an intensity >25 DDD/month (OR = 0.84, 95% CI = 0.60-1.18) were not associated with an incident of dementia. There were similar results at the 5-year follow-up. Patients with a low intensity of metformin use had a lower risk of dementia. However, higher doses of metformin with higher intensity exhibited no protective role in dementia. Prospective clinical trials are warranted to evaluate the actual underlying mechanisms between metformin dosage and the risk of dementia.
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Affiliation(s)
- Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
| | - Ya-Fang Tsai
- Department of Health Policy and Management, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chiachi Bonnie Lee
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
| | - Ning-Jen Chung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Vázquez-Prieto S, Vaamonde A, Paniagua E. Study of the Use of Permethrin 5% Cream in Galicia (Spain) between 2018 and 2021. Infect Dis Rep 2023; 15:222-230. [PMID: 37102983 PMCID: PMC10138315 DOI: 10.3390/idr15020023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Drug utilization studies can provide direct insights into how a drug is used in real-world conditions and can give a rough estimate of the proportion of the study population treated with it. In the present work, we examined the consumption of permethrin 5% cream in the four provinces of Galicia (a Spanish autonomous community) and described the seasonal variability and the annual evolution of its consumption between 2018 and 2021. A descriptive, cross-sectional, and retrospective study of the consumption of this drug, expressed in defined daily dose per 1000 inhabitants per day (DID), was carried out. The results obtained revealed differences between the amounts consumed in the four Galician provinces (p < 0.001). No specific geographical pattern was observed; however, the results suggested a marked seasonality and a slightly increasing global trend in the consumption of permethrin 5% cream throughout the study period. Since the only authorized indication of this drug in the study area is the treatment of scabies, this work may give an idea of the epidemiological situation of the disease in Galicia and serve to establish public health strategies against this parasitosis.
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Affiliation(s)
- Severo Vázquez-Prieto
- Universidad de Los Lagos, Osorno, Chile
- Vicerrectoría de Investigación y Postgrado, Universidad Católica del Maule, Talca, Chile
| | - Antonio Vaamonde
- Departamento de Estadística e Investigación Operativa, Universidad de Vigo, 36310 Vigo, Spain
| | - Esperanza Paniagua
- Laboratorio de Parasitología, Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
- Instituto de Investigación en Análisis Químicos y Biológicos (IAQBUS), Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Dahlén E, Kindblom JM, Kimland EE. Defined daily doses in pediatric dosing- a theoretical example. Pharmacol Res Perspect 2023; 11:e01061. [PMID: 36808833 PMCID: PMC9939876 DOI: 10.1002/prp2.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
A defined daily dose for children (cDDD) taking body weight into account, was proposed as a better measure of drug utilization in children than the World Health Organization's DDD. There is no global definition of DDDs for children, and it is unclear which standard doses should be used for children when conducting drug utilization studies. We used doses according to the authorized medical product information and body weight according to national pediatric growth curves to calculate theoretical cDDD for three common medicines in children in a Swedish setting. These examples demonstrate that the concept of cDDD may not be optimal for drug utilization studies in children, especially not for younger children and when dosing is done according to weight is crucial. Validation of cDDD in real-world data is warranted. When conducting pediatric drug utilization studies, accessibility to individual-level data on body weight and age combined with dosing information is needed.
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Affiliation(s)
- Elin Dahlén
- Swedish Medical Products AgencyUppsalaSweden,Karolinska InstitutetDepartment of Clinical Science and EducationStockholmSweden
| | - Jenny Marianne Kindblom
- Pediatric Clinical Research Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital and Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
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Saukkosalmi P, Kankaanranta H, Vähätalo I, Sillanmäki L, Sumanen M. Defined daily dose definition in medication adherence assessment in asthma. Eur Clin Respir J 2023; 10:2207335. [PMID: 37139181 PMCID: PMC10150619 DOI: 10.1080/20018525.2023.2207335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC ≥ 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting β2-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.
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Affiliation(s)
- Päivi Saukkosalmi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Regional State Administrative Agency for Southern Finland, Hämeenlinna, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Iida Vähätalo
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- CONTACT Markku Sumanen Faculty of Medicine and Health Technology, Tampere University, TampereFIN-33014, Finland
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Yamaguchi K, Maeda M, Ohmagari N, Muraki Y. Association between Carbapenem Consumption and Clinical Outcomes in an In-Hospital Setting: Analysis of a Japanese Nationwide Administrative Database in 2020. Antibiotics (Basel) 2022; 11:antibiotics11121807. [PMID: 36551464 PMCID: PMC9774290 DOI: 10.3390/antibiotics11121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation into five facilities and calculated the median values, including facility characteristics, clinical outcomes, and carbapenem consumption. Next, a correlation analysis was performed between carbapenem consumption and clinical outcome, as well as a multiple regression analysis between carbapenem consumption as the dependent variable and clinical outcome, bed size, and proportion of patients by disease as independent variables. Additionally, three clinical outcomes available from the DPC payment system database were selected, including cure, readmission within 4 weeks, and the average length of stay. This study revealed no relationship between carbapenem consumption and clinical outcome in university hospitals and university hospital-equivalent community hospitals; however, a relationship was suggested in the community, DPC-prepared, and non-DPC hospitals. University hospitals and university hospital-equivalent community hospitals with a high consumption of carbapenems may need to reconsider the classification because of the limited number of facilities in this classification.
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Affiliation(s)
- Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
- Correspondence:
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto 607-8414, Japan
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Lin Y, Chen M, Chang Y, Chen L, Hsiung CA, Wu S. Prevalence of exposure to benzodiazepines among pregnant women in Taiwan: A nationwide longitudinal study. J Sleep Res 2022; 31:e13678. [PMID: 35775446 PMCID: PMC9788177 DOI: 10.1111/jsr.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/23/2022] [Accepted: 06/02/2022] [Indexed: 12/30/2022]
Abstract
Although more than one hundred studies have examined the prevalence of the use of benzodiazepines and benzodiazepine-like Z-hypnotics (BZDs) among pregnancy events, further analysis of the effects of dosage or type of BZDs is needed. The aim of this study was to examine the prevalence rate of BZDs use in pregnancy events, stratified by trimester over time, with characteristics of the dosage and type of BZDs. This is a retrospective population study based on linking three national databases. We examined the prevalence rates from 2004 to 2017, and contrasted the results based on >0 defined daily dose (DDD) and ≥0.5 DDD. We identified 2,630,944 pregnancy events with live births; 89,897 (3.4%) of the associated pregnancy events had used some form of BZD during pregnancy. The prevalence of BZDs use, as defined by >0 DDD, decreased from 4.1% in 2004 to 2.9% in 2017, indicating a decrease in sporadic use and an increase in stable use within therapeutic doses. Meanwhile, BZDs use defined by ≥0.5 DDD increased from 0.1% in 2004 to 0.4% in 2017. Zolpidem was the most frequently prescribed BZDs, as defined by >0 DDD or ≥0.5 DDD. This national cohort study demonstrates the importance of average dosage in the definition of BZDs use in pregnancy events, and it found opposite trends in the prevalence of use between different dosages.
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Affiliation(s)
- Yu‐Hsuan Lin
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan,Department of PsychiatryNational Taiwan University HospitalTaipeiTaiwan,Department of Psychiatry, College of MedicineNational Taiwan UniversityTaipeiTaiwan,Institute of Health Behaviors and Community Sciences, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Mei‐Huei Chen
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan,Department of PediatricsNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
| | - Ya‐Chen Chang
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan
| | - Likwang Chen
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan
| | - Chao A. Hsiung
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan
| | - Shiow‐Ing Wu
- Institute of Population Health SciencesNational Health Research InstitutesMiaoli CountyTaiwan
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Lau CL, Periyasamy P, Saud MN, Robert SA, Gan LY, Chin SY, Pau KB, Kong SH, Tajurudin FW, Yin MK, Ghan SL, Azman NJ, Chua XY, Lye PK, Tan SWY, Dort DV, Ramli R, Tan TL, Mohamad Yusof A, Cheah SK, Wan Mat WR, Naina-Mohamed I. Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital. Antibiotics (Basel) 2022; 11. [PMID: 36139951 DOI: 10.3390/antibiotics11091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/11/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016−2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5−8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue.
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Chu WM, Huang PSB, Wei JCC. Association between long-term opioid use and cancer risk in patients with chronic pain. Comment on Br J Anaesth 2022; 129: 84-91. Br J Anaesth 2022; 129:e104-e105. [PMID: 35965113 DOI: 10.1016/j.bja.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Paul S-B Huang
- Department of Medical Humanities, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James C-C Wei
- Department of Medical Humanities, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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Elsawah H, Samir A, Elrazzaz M, Ramadan A, Elnaggar A, Taema K. Carbapenems consumption and Klebsiella resistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program. J Infect Prev 2022; 23:142-148. [PMID: 37256159 PMCID: PMC10226057 DOI: 10.1177/17571774211060436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/08/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background The high prevalence of carbapenem-resistant Klebsiella imposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiella resistance. Method We retrospectively evaluated critically ill patients with isolated Klebsiella species from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiella clinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiella isolates were classified into sensitive, extended spectrum beta-lactamase (ESBL) producer, and carbapenem-resistant Klebsiella (CRK), respectively. Our primary outcome was the change in carbapenems consumption after implementing the program, while the secondary outcomes were the changes in the incidence of CRK. Results The study included 205 patients with isolated Klebsiella species during the study period. The antibiotic stewardship program started in March 2018. Out of the 205 patients, 61 patients (29.8%) represented the pre-intervention sample, and 144 patients (70.2%) represented the post-intervention sample. Applying the antibiotic stewardship program was associated with a significant decrease in the carbapenems consumption from 38.9 to 26.6 defined daily dose/1000 patient-days (p = 0.02). The incidence of CRK was decreased from 85.25% of total Klebsiella isolates to 48.6% (p < 0.001). Klebsiella species were more likely to be in a lower category of resistance after applying the program with an odds ratio of 6.3 (2.88-13.73) using ordinal logistic regression. Conclusion Applying the antibiotic stewardship program could reduce the unnecessary carbapenems use in the ICU with a subsequent decrease in the emergence of the Klebsiella-resistant strains.
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Affiliation(s)
- Hozaifa Elsawah
- Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt
| | | | | | | | | | - Khaled Taema
- Critical Care Department, Kasr Alainy Hospitals, Cairo University, Egypt
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22
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Ulla L A, Mervi R, Anna-Liisa J, Hannu K, Kaisu H P. The effect of educational intervention on use of psychotropics in defined daily doses and related costs - a randomized controlled trial. Scand J Prim Health Care 2022; 40:246-252. [PMID: 35546060 PMCID: PMC9397433 DOI: 10.1080/02813432.2022.2074055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents. DESIGN A secondary analysis of a randomized controlled intervention study with 12 months of follow-up. SETTING Assisted living facilities in Helsinki, Finland. SUBJECTS Older (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011. INTERVENTION The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group). MAIN OUTCOME MEASURES Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months. RESULTS A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished. CONCLUSIONS Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions. REGISTRATION NUMBER ACTRN 12611001078943 KEY POINTSWe explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.
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Affiliation(s)
- Aalto Ulla L
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- CONTACT Ulla L Aalto Dept of Social Services and Health Care, Home-care services, PO BOX 72654, City of Helsinki, 00099, Finland
| | - Rantsi Mervi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Juola Anna-Liisa
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Kautiainen Hannu
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Pitkälä Kaisu H
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
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Kim S, Jeong S, Park SJ, Chang J, Choi S, Cho Y, Ahn JC, Lee G, Son JS, Park SM. Association between Proton Pump Inhibitor Use and Risk of Hepatocellular Carcinoma: A Korean Nationally Representative Cohort Study. J Clin Med 2022; 11:jcm11102865. [PMID: 35628991 PMCID: PMC9146713 DOI: 10.3390/jcm11102865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The association between proton pump inhibitor (PPI) use and hepatocellular carcinoma (HCC) has been controversial, especially in the general population. We aimed to determine the impact of PPI on HCC risk in participants without liver cirrhosis or chronic hepatitis virus infection. (2) Methods: We assessed 406,057 participants from the Korean National Health Insurance Service database who underwent health screening from 2003 to 2006. We evaluated exposure to PPI before the index date using a standardized daily defined dose (DDD) system. The association of proton pump inhibitor use with the risk of HCC was evaluated using multivariable-adjusted Cox proportional hazards regression. (3) Results: Compared with non-users, PPI use was not associated with the HCC risk in low (<30 DDDs; aHR, 1.07; 95% CI, 0.91−1.27), intermediate (30 ≤ PPI < 60 DDDs; aHR, 0.96; 95% CI, 0.73−1.26), and high (≥60 DDDs; aHR, 0.86; 95% CI, 0.63−1.17) PPI groups in the final adjustment model. In addition, risks of cirrhosis-associated HCC and non-cirrhosis-associated HCC were not significantly associated with PPI use. The results remained consistent after excluding events that occurred within 1, 2, and 3 years to exclude pre-existing conditions that may be associated with the development of HCC. We also found no PPI-associated increase in HCC risk among the selected population, such as those with obesity, older age, and chronic liver diseases. (4) Conclusions: PPI use may not be associated with HCC risk regardless of the amount. We call for future studies conducted in other regions to generalize our findings.
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Affiliation(s)
- Soungmun Kim
- Graduate School of Data Science, Seoul National University, Seoul 08826, Korea;
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam 13488, Korea;
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
| | - Yoosun Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Joseph C. Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Gyeongsil Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
- Estherformula Medical Food R&D Center, Seoul 06019, Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; (S.J.P.); (J.C.); (S.C.); (G.L.)
- Estherformula Medical Food R&D Center, Seoul 06019, Korea
- Correspondence: ; Tel.: +82-2-2072-3331; Fax: +82-2-766-3276
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Birault F, Le Bonheur L, Langbour N, Clodion S, Jaafari N, Perault-Pochat MC, Thirioux B. Exposure to High Precariousness Prevalence Negatively Impacts Drug Prescriptions of General Practitioners to Precarious and Non-Precarious Populations: A Retrospective Pharmaco-Epidemiological Study. Int J Environ Res Public Health 2022; 19:ijerph19052962. [PMID: 35270655 PMCID: PMC8910740 DOI: 10.3390/ijerph19052962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Precarious patients are more difficult to care for due to low literacy rates and poor adherence to treatment and hospitalization. These difficulties have detrimental effects on general practitioners (GPs), deteriorating medical communication, advice, diagnoses, and drug prescriptions. To better understand how precariousness affects primary care, we tested whether, among GPs, exposure to high precariousness prevalence more severely impacts drug prescriptions to precarious and non-precarious populations compared to low precariousness prevalence. Materials and methods: This pharmaco-epidemiological study, using linear regression analyses, compared the defined daily dose of 20 drugs prescribed by GPs to precarious and non-precarious patients in four French regions with low and high precariousness prevalence in 2015. (2) Findings: Exposure to high precariousness prevalence significantly impacted the prescriptions of nine medications to precarious patients and two medications to non-precarious patients, and distributed into three interaction patterns. (3) Interpretation: The selective over-prescription of drugs with easy intake modalities to precarious patients probably reflects GPs’ attempts to compensate for poor patient compliance. In contrast, the under-prescription of drugs targeting fungal infections in precarious populations and diabetes and cardiovascular diseases in non-precarious populations was seemingly due to a breakdown of empathy and professional exhaustion, causing medical neglect.
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Affiliation(s)
- François Birault
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France;
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
- Correspondence: ; Tel.: +33-549-451-111; Fax: +33-549-455-041
| | - Lakshmipriva Le Bonheur
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France;
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
| | - Nicolas Langbour
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
| | - Sandivanie Clodion
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
| | - Nematollah Jaafari
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
- Département de Psychiatrie, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
| | - Marie-Christine Perault-Pochat
- Laboratoire de Neurosciences Expérimentales et Cliniques, Institut National de la Santé et de la Recherche Médicale (INSERM U 1084), Université de Poitiers, F-86000 Poitiers, France;
- Service de Pharmacologie Clinique et Vigilances, Centre Hospitalo-Universitaire de Poitiers, F-86021 Poitiers, France
- Centre Hospitalo-Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale (INSERM CIC1402), Université de Poitiers, F-86021 Poitiers, France
| | - Bérangère Thirioux
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
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Abe R, Fujimoto K, Endo Y, Sugiura K. Evaluation of antimicrobial use in dairy cattle, beef cattle and broilers in Japan using dosage-based indicators. J Vet Med Sci 2021; 83:1826-1837. [PMID: 34629334 PMCID: PMC8762408 DOI: 10.1292/jvms.21-0385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The sales amount of antimicrobials intended for use in dairy cattle, beef cattle and
broilers from 2008 to 2019 was evaluated for each antimicrobial class and administration
route using dosage-based indicators. Our results revealed that the antimicrobial sales
amount sold for use in dairy cattle in 2019 in terms of total weight of active ingredient,
the number of defined daily doses (DDDs) (theoretical amount of biomass subjected to
antimicrobial treatment in a year) and the number of treatment days (TDs) (theoretical
number of days of treatment that an animal is subjected to in a year) calculated using
Japanese DDD values (DDDjp values) was 36,751 kg, 8,261,848,000 kg·days and 15.5 days,
respectively. Likewise, the antimicrobial sales amount sold for use in beef cattle and
broilers in 2019 in terms of these metrics was 33,403 kg, 3,928,248,000 kg·days and 3.61
days, and 69,773 kg, 2,947,848,000 kg·days and 10.66 days, respectively. There was a
considerable difference between the number of DDDs calculated using DDDjp values and that
calculated using European DDD values (DDDvet values) for antimicrobial products sold for
use in dairy and beef cattle. Our results also revealed that the sales amount of some
antimicrobials, such as cephalosporins and quinolones represented larger proportions when
calculated using dosage-based indicators than when calculated using the weight of active
ingredient. Considering that Japanese veterinarians and farmers are more likely to conform
to the Japanese dosage recommendations rather than the European ones, these results
indicate the need for using dosage-based metrics, in particular metrics based on Japanese
dosages rather than European dosages.
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Affiliation(s)
- Reiko Abe
- Major in Veterinary Medical Science, Faculty of Agriculture, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kyoko Fujimoto
- Environmental Science for Sustainable Development, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Yuko Endo
- Environmental Science for Sustainable Development, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Katsuaki Sugiura
- Environmental Science for Sustainable Development, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.,Nippon Institute for Biological Sciences, 9-222-1 Shin-machi, Ome, Tokyo 198-0024, Japan
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Herawati F, Yulia R, Wiyono H, Massey FK, Muliani N, Kantono K, Soemantri D, Andrajati R. Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection. Pharmaceuticals (Basel) 2021; 14:1088. [PMID: 34832870 DOI: 10.3390/ph14111088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
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Marasine NR, Shrestha S, Sankhi S, Paudel N, Gautam A, Poudel A. Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal. SAGE Open Med 2021; 9:20503121211043710. [PMID: 34504707 PMCID: PMC8422810 DOI: 10.1177/20503121211043710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs. Objective: This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal. Methods: A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. Results: A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Conclusion: This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.
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Affiliation(s)
- Nirmal Raj Marasine
- Department of Pharmacy, Karnali College of Health Science, Kathmandu, Nepal.,School of Pharmacy, Chitwan Medical College, Bharatpur, Nepal
| | - Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Sabina Sankhi
- Department of Pharmacy, Modern Technical College, Lalitpur, Nepal
| | - Nabina Paudel
- School of Pharmacy, Kathmandu University, Dhulikhel, Nepal
| | - Ashish Gautam
- School of Pharmacy, Chitwan Medical College, Bharatpur, Nepal
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Steinbart D, Gaus V, Kowski AB, Holtkamp M. Valproic acid use in fertile women with genetic generalized epilepsies. Acta Neurol Scand 2021; 144:288-295. [PMID: 33977526 DOI: 10.1111/ane.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/02/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In genetic generalized epilepsies (GGE), valproic acid (VPA) is the most efficacious compound. However, due to teratogenicity and increased risk for impaired cognitive development after intrauterine exposure, its use in women of fertile age is strictly regulated but sometimes unavoidable. METHODS All patients with GGE treated at the outpatient clinic of a tertiary epilepsy center with at least one visit between January 2015 and April 2020 were included in this retrospective study. The rate of women aged 18 to 49 years taking VPA was compared to that of men of the same age group and to women > 49 years. Furthermore, in each group, clinical variables associated with VPA use were sought. RESULTS Twenty-eight out of 125 women of fertile age (22%) were treated with VPA, compared to 28 out of 56 men ≤ 49 years (50%; p = .002) and to 22 out of 40 female patients > 49 years (55%; p < .001). VPA dose was lower in fertile women compared to men, with no difference in seizure freedom rates. In women ≤ 49 years, multivariate analysis demonstrated age as the only variable independently associated with VPA use (OR 1.095; 95% CI 1.036-1.159). In the other two groups, no associated variables were identified. CONCLUSIONS Despite warnings with respect to teratogenicity and impaired cognitive development with VPA, from 2015 to 2020, almost every fourth women of fertile age with GGE received this compound. Inevitably lower VPA doses in these women seem sufficient for favorable seizure freedom rates.
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Affiliation(s)
- David Steinbart
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Verena Gaus
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Alexander B. Kowski
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Martin Holtkamp
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
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Barigelletti G, Tagliabue G, Fabiano S, Trama A, Bernasconi A, Tresoldi C, Perotti V, Tittarelli A, Ada Working Group. Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort. Healthcare (Basel) 2021; 9:1121. [PMID: 34574895 DOI: 10.3390/healthcare9091121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/28/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
Cancer patients are identified as fragile patients who are often immunodepressed and subject to secondary diseases. The Ada cohort comprises cancer survivors aged 15–39 years at diagnosis included in 34 Italian cancer registries. This study aimed to analyze the possible excess of non-cancer medicines use on the basis of the medicine database of the Ada cohort. Records of medicines present in the pharmaceutical flows collected by eight Lombardy cancer registries and used by patients with any type of cancer were extracted for the year 2012. Medicine consumption data were processed to assign a defined daily dose value and to evaluate the consumption of medicines belonging to different groups of the ATC (Anatomical Therapeutic Chemical) classification. The values were compared with values in the Lombardy population. Medicine consumption related to 8150 patients was analyzed, for a total of 632,675 records. ATC groups A and C for females and group N for both sexes showed significant increases. Group J for males and group M for females showed intermediate increases, and group H for both sexes showed smaller increases. This method allowed the identification of excess medicine use to reduce cancer therapy side effects and primary disease sequelae in this group of patients.
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Liu YX, Liang C, Yang Y, Le KJ, Zhang ZL, Gu ZC, Zhong H, Lin HW, Luo HJ. Reduction in antimicrobial use associated with a multifaceted antimicrobial stewardship programme in a tertiary teaching hospital in Shanghai: a segmented regression analysis. Ann Palliat Med 2021; 10:7360-7369. [PMID: 34353033 DOI: 10.21037/apm-21-700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/29/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rational use of antibiotics received great attention in China, therefore the multifaceted antimicrobial stewardship (MAMS) is urgently required in hospital management. We conducted this study to assess the impact of a MAMS programme on antimicrobial use in a tertiary teaching hospital in Shanghai. METHODS This retrospective observational study was conducted at a tertiary teaching hospital in Shanghai. The MAMS programme involved multifaceted interventions consisting of a quality premium with financial incentives, antibiotic restriction, audit and feedback, and education. Data were extracted from the electronic medical records of inpatients to analyse monthly and annual antibiotic consumption and the percentage of antibiotic prescriptions during 2017-2020. Segmented regression analysis of the interrupted time series was used to contrast antimicrobial use during 2019-2020, with non-MAMS data from the 2017-2018 period as the historical control. RESULTS With MAMS implementation, antibiotic consumption decreased from 63.3 (59.3, 67.2) defined daily doses (DDDs) per 100 patient-days (PD) to 43.3 (39.0, 49.8) DDDs/100 PD (P<0.001), and the percentage of antibiotic prescriptions decreased from 44.8% (44.1%, 45.4%) to 43.3% (42.2%, 44.3%) (P<0.001). Segmented regression models suggested a reduction in antibiotic consumption (coefficient = -12.537, P<0.001) and indicated a downward trend in the percentage of antibiotic prescriptions (coefficient =-0.165, P=0.049). Neither antibiotic consumption nor the percentage of antibiotic prescriptions was influenced by the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS This study suggests that MAMS plays an important role in reducing antibiotic use and is not affected by special circumstances such as the COVID-19 pandemic. This novel intervention, consisting of a quality premium and multidisciplinary cooperation, should be prioritized by policy and decision makers, where rational management of antimicrobial use is urgently needed.
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Affiliation(s)
- Yang-Xi Liu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Liang
- Department of Medical Administration, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ya Yang
- Department of Infection Control, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ke-Jia Le
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zai-Li Zhang
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Han Zhong
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hou-Wen Lin
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hua-Jie Luo
- Department of Medical Administration, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Geum MJ, Kim C, Kang JE, Choi JH, Kim JS, Son ES, Lim SM, Rhie SJ. Broad-Spectrum Antibiotic Regimen Affects Survival in Patients Receiving Nivolumab for Non-Small Cell Lung Cancer. Pharmaceuticals (Basel) 2021; 14:ph14050445. [PMID: 34066877 PMCID: PMC8151442 DOI: 10.3390/ph14050445] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 01/17/2023] Open
Abstract
Antibiotic-induced dysbiosis may affect the efficacy of immune checkpoint inhibitors. We investigated the impact of antibiotics on the clinical outcomes of nivolumab in patients with non-small cell lung cancer (NSCLC). Patients who received nivolumab for NSCLC between July 2015 and June 2018 and who were followed up until June 2020 were included in a retrospective cohort analysis. Of 140 eligible patients, 70 were on antibiotics. Overall survival (OS) was shorter in patients on antibiotics (ABX) compared to those not on antibiotics (NoABX) (p = 0.014). OS was negatively associated with piperacillin/tazobactam (PTZ) (HR = 3.31, 95% CI: 1.77–6.18), days of therapy (DOT) ≥ 2 weeks (HR = 2.56, 95% CI: 1.30–5.22) and DOT of PTZ. The defined daily dose (DDD) in PTZ (r = 0.27) and glycopeptides (r = 0.21) showed weak correlations with mortality. There was no difference in progression-free survival (PFS) between ABX and NoABX; however, PFS was negatively associated with the antibiotic class PTZ and DOT of PTZ. Therefore, the use of a broad-spectrum antibiotic, such as PTZ, the long-term use of antibiotics more than 2 weeks in total and the large amount of defined daily dose of specific antibiotics were associated with decreased survival in patients receiving nivolumab for NSCLC.
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Affiliation(s)
- Min Jung Geum
- The Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea; (J.S.K.); (E.S.S.)
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Korea;
| | - Ji Eun Kang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
- Department of Pharmacy, National Medical Center, Seoul 04564, Korea
| | - Jae Hee Choi
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Department of Pharmacy, Konkuk University Medical Center, Seoul 05030, Korea
| | - Jae Song Kim
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea; (J.S.K.); (E.S.S.)
| | - Eun Sun Son
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea; (J.S.K.); (E.S.S.)
| | - Sun Min Lim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul 03722, Korea;
| | - Sandy Jeong Rhie
- The Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Correspondence:
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Sun F, Zhou X, Li Q, Li Y, Zhang H, Yan Z, He H, Zhao Z, Ke Z, Gao Y, Li F, Tong W, Zhu Z. Achieving blood pressure targets and antihypertensive effects through metabolic surgery in type 2 diabetes patients with hypertension. Diabetes Metab Res Rev 2021; 37:e3422. [PMID: 33197293 DOI: 10.1002/dmrr.3422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 01/02/2023]
Abstract
AIMS The effect of metabolic surgery compared with that of conventional therapy on target blood pressure (BP)and defined daily dose (DDD) of antihypertensive drugs in type 2 diabetes (T2DM) patients with hypertension remains unclear. This study aimed to investigate the differences in target BP and DDD between metabolic surgery and conventional treatment in T2DM patients with hypertension. MATERIALS AND METHODS This was a prospective study of 535 diabetes patients who underwent metabolic surgery (n = 112) and medical treatment (n = 423). Changes in the target BP from baseline to every follow-up were analysed. RESULTS Metabolic surgery decreased both office systolic and diastolic BP (DBP) and also significantly reduced ambulatory systolic BP (SBP; 132 ± 2 vs. 119 ± 1 mmHg, p < 0.0001), but not DBP (78 ± 1 vs. 76 ± 1 mmHg, p = 0.177). Patients maintained their SBP at <120 mmHg after 2 years (50% vs. 1.9%, p < 0.0001). Moreover, the rate of achieving the target SBP of 130 and 140 mmHg was also significantly higher in the surgery group, and this started from the initial 6 months after commencing treatment to the end of follow-up. The dosage (DDD: 1.44 ± 0.65 vs. 0.32 ± 0.05, p < 0.001) of antihypertensive medication was significantly decreased after metabolic surgery. Furthermore, metabolic surgery, but not medical treatment, markedly improved the risks of atherosclerotic cardiovascular disease. CONCLUSIONS Metabolic surgery can effectively achieve the BP target and reduce the usage of antihypertensive medications as well as improve multiple metabolic dysfunction in T2DM patients with hypertension. This study provides an alternative approach to antagonize the metabolic related hypertension.
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Affiliation(s)
- Fang Sun
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Xunmei Zhou
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Qiang Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Yingsha Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Hexuan Zhang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Zhencheng Yan
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Hongbo He
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Zhigang Zhao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
| | - Zhigang Ke
- Department of General Surgery, Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Yu Gao
- Department of General Surgery, Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University of PLA, Chongqing, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University of PLA, Chongqing Institute of Hypertension, Chongqing, China
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Abstract
Drug utilization studies in developing countries is evolving. Rising medication cost for hypertensive patients is a major cause of noncompliance to therapy. The study was a cross-sectional drug utilization review involving outpatients in two purposively selected hospitals (secondary and tertiary) in Abeokuta, Southwestern Nigeria. Data and relevant information were obtained from the patients' medical records domiciled in the outpatients' hospital records department. Descriptive and inferential statistics were used at p < 0.05. Total medication cost to patients was USD$48,575; out of which antihypertensive medications accounted for 46% (USD$21,588) in two referral hospitals. Ramipril was the most prescribed in both hospitals. Generic drugs were cheaper than their branded alternatives. Study outcomes are beneficial for managing costs for hypertensive patients.
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Affiliation(s)
- Theophilus Ehidiamen Oamen
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ife, Osun State, Nigeria
| | - Kanayo Patrick Osemene
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ife, Osun State, Nigeria
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Melaku T, Gashaw M, Chelkeba L, Berhane M, Bekele S, Lemi G, Wakjira T, Tesfaw G, Mekonnen Z, Ali S, Kroidl A, Wieser A, Froeschl G, Gudina EK. Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics). Infect Drug Resist 2021; 14:1649-1658. [PMID: 33953576 PMCID: PMC8092616 DOI: 10.2147/idr.s293080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/30/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia. Methods A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization "AWaRe" classification scheme as "Access", "Watch" and "Reserve" group antibiotics and measured their consumption intensity. Results A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the "Watch" group had 2.10 DDD/100 outpatients per day. Conclusion There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the "Watch" group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.
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Affiliation(s)
| | - Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Sisay Bekele
- Department of Ophthalmology, Jimma University, Jimma, Ethiopia
| | - Gemechu Lemi
- Department of Surgery, Jimma University, Jimma, Ethiopia
| | - Tekle Wakjira
- Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Solomon Ali
- Department of Microbiology, Immunology and Parasitology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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Sheppard JP, Lown M, Burt J, Ford GA, Hobbs FDR, Little P, Mant J, Payne RA, McManus RJ. Blood Pressure Changes Following Antihypertensive Medication Reduction, by Drug Class and Dose Chosen for Withdrawal: Exploratory Analysis of Data From the OPTiMISE Trial. Front Pharmacol 2021; 12:619088. [PMID: 33959004 PMCID: PMC8093867 DOI: 10.3389/fphar.2021.619088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: Deprescribing of antihypertensive drugs is recommended for some older patients with polypharmacy, but there is little evidence to inform which drug (or dose) should be withdrawn. This study used data from the OPTiMISE trial to examine whether short-term outcomes of deprescribing vary by drug class and dose of medication withdrawn. Methods: The OPTiMISE trial included patients aged ≥80 years with controlled systolic blood pressure (SBP; <150 mmHg), receiving ≥2 antihypertensive medications. This study compared SBP control, mean change in SBP and frequency of adverse events after 12 weeks in participants stopping one medication vs. usual care, by drug class and equivalent dose of medication withdrawn. Equivalent dose was determined according to the defined daily dose (DDD) of each medication type. Drugs prescribed below the DDD were classed as low dose and those prescribed at ≥DDD were described as higher dose. Outcomes were examined by generalized linear mixed effects models. Results: A total of 569 participants were randomized, aged 85 ± 3 years with controlled blood pressure (mean 130/69 mmHg). Within patients prescribed calcium channel blockers, higher dose medications were more commonly selected for withdrawal (90 vs. 10%). In those prescribed beta-blockers, low dose medications were more commonly chosen (87 vs. 13%). Withdrawal of calcium channel blockers was associated with an increase in SBP (5 mmHg, 95%CI 0-10 mmHg) and reduced SBP control (adjusted RR 0.89, 95%CI 0.80-0.998) compared to usual care. In contrast, withdrawal of beta-blockers was associated with no change in SBP (-4 mmHg, 95%CI -10 to 2 mmHg) and no difference in SBP control (adjusted RR 1.15, 95%CI 0.96-1.37). Similarly, withdrawal of higher dose medications was associated with an increase in SBP but no change in BP control. Withdrawal of lower dose medications was not associated with a difference in SBP or SBP control. There was no association between withdrawal of specific drug classes and adverse events. Conclusion: These exploratory data suggest withdrawal of higher dose calcium channel blockers should be avoided if the goal is to maintain BP control. However, low dose beta-blockers may be removed with little impact on blood pressure over 12-weeks of follow-up. Larger studies are needed to confirm these associations.
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Affiliation(s)
- James P. Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Lown
- Primary Care Research Group, University of Southampton, Southampton, United Kingdom
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Gary A. Ford
- Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - F. D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, United Kingdom
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Rupert A. Payne
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Schrag NFD, Godden SM, Apley MD, Singer RS, Lubbers BV. Antimicrobial use quantification in adult dairy cows - Part 3 - Use measured by standardized regimens and grams on 29 dairies in the United States. Zoonoses Public Health 2021; 67 Suppl 1:82-93. [PMID: 33201606 DOI: 10.1111/zph.12773] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/21/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022]
Abstract
This study describes antimicrobial use in terms of standardized regimens per cow year (REG/CY) and grams per cow year (GMS/CY) for 29 dairies in the United States during the years 2016 and 2017. To explore potential priorities for antimicrobial stewardship programs, these measures were stratified by both disease syndrome and antimicrobial class. Potential confounders of use measurements are discussed and challenges for measure interpretation are identified. When measured as REG/CY, the results indicate that mastitis is the disease syndrome with the greatest contribution to overall antimicrobial use. However, when GMS/CY is measured, metritis, lameness and unknown disease syndromes are also significant contributors. When use is stratified by antimicrobial class, measures of REG/CY indicate the greatest magnitude of use is the cephalosporin class. However, when measures of GMS/CY are stratified by drug class, use within the penicillin class contributes more than any other single class. These differences highlight the need for a more complete understanding of the relationship between antimicrobial use measures and their relationship to antimicrobial resistance selection pressure.
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Affiliation(s)
- Nora F D Schrag
- College of Veterinary Medicine, Department of Clinical Sciences Kansas State University, Manhattan, KS, USA
| | - Sandra M Godden
- Department of Veterinary Population Medicine, University of Minnesota, Saint Paul, MN, USA
| | - Michael D Apley
- College of Veterinary Medicine, Department of Clinical Sciences Kansas State University, Manhattan, KS, USA
| | - Randall S Singer
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, USA.,Mindwalk Consulting Group, Falcon Heights, MN, USA
| | - Brian V Lubbers
- College of Veterinary Medicine, Department of Clinical Sciences Kansas State University, Manhattan, KS, USA
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Schrag NFD, Apley MD, Godden SM, Singer RS, Lubbers BV. Antimicrobial use quantification in adult dairy cows - Part 2 - Developing a foundation for pharmacoepidemiology by comparing measurement methods. Zoonoses Public Health 2021; 67 Suppl 1:69-81. [PMID: 33201608 DOI: 10.1111/zph.12772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/21/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 01/03/2023]
Abstract
As stewardship programmes seek to influence therapeutic choices and reduce resistance selection pressure, it is essential to understand the multiple factors which may influence any given antimicrobial use measure. This article compares 9 measures of antimicrobial use pertaining to adult cows in US dairy systems based on treatment records standardized to a single standardized regimen (SReg) format. There are 3 fundamental parameters underlying the nine measures: amount of active substance (AMOUNT), number of SRegs (ANIMALS) and treatment time (TIME). Additionally, three use categories were considered in the analysis: control of mastitis (Dry Cow), treatment of detected mastitis (Clinical Mastitis) and treatment of other diseases (Other Treatment). The assumptions necessary for calculation of each of the nine measures are identified. The influence of measure choice on farm rank was explored at the farm level both within and across fundamental parameters. Across all use categories, when measures of TIME and ANIMALS were compared, correlations between measures were greater than 0.91. However, when measures of AMOUNT were compared to either measures of TIME or ANIMALS, the correlation between measures was more variable across use categories (R = 0.31-0.91). These comparisons demonstrate that the selection of antimicrobial use metric can affect which dairies are considered the highest users of antimicrobials. Measurement selection also influences which use category has the greatest potential for use reduction. This indicates that measure selection can influence which use category is prioritized as a target for reduction of antimicrobial use. Utilization of this information may allow those developing dairy antimicrobial stewardship programmes to better understand the potential effects of measurement selection on driving changes in antimicrobial use.
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Affiliation(s)
- Nora F D Schrag
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Michael D Apley
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra M Godden
- Department of Veterinary Population Medicine, University of Minnesota, Saint Paul, MN, USA
| | - Randall S Singer
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, USA.,Mindwalk Consulting Group, MN, USA
| | - Brian V Lubbers
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
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Schrag NFD, Apley MD, Godden SM, Lubbers BV, Singer RS. Antimicrobial use quantification in adult dairy cows - Part 1 - Standardized regimens as a method for describing antimicrobial use. Zoonoses Public Health 2021; 67 Suppl 1:51-68. [PMID: 33201607 DOI: 10.1111/zph.12766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/21/2020] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 12/23/2022]
Abstract
This study describes a process to acquire and convert farm treatment records into a standardized regimen format. Multiple sources of on-farm data were utilized to convert the original treatment records to standardized regimens, enabling the generation of objective, granular descriptions of antimicrobial use. These standard regimen descriptions allow antimicrobial use data to be qualitatively stratified by active substance, disease syndrome treated, use category, and route of administration. Quantitative distributions are available for the grams of active substance per administration, the grams of active substance per regimen, the number of administrations, number of days of therapy and the time frame between the first and last administration. Granular quantification by this method informs future research, surveillance and policy.
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Affiliation(s)
- Nora F D Schrag
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Michael D Apley
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra M Godden
- Department of Veterinary Population Medicine, University of Minnesota, Saint Paul, MN, USA
| | - Brian V Lubbers
- College of Veterinary Medicine, Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Randall S Singer
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, USA.,Mindwalk Consulting Group, MN, USA
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Abrantes C, Tonin FS, Reis-Pardal J, Castel-Branco M, Furtado C, Figueiredo IV, Fernandez-Llimos F. Implications of a defined daily dose fixed database for drug utilization research studies: The case of statins in Portugal. Br J Clin Pharmacol 2021; 87:3542-3549. [PMID: 33576512 DOI: 10.1111/bcp.14770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/25/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS Given the discrepancies between PDDs (prescribed daily doses) and DDDs (defined daily doses), we aimed to assess the extent of error in the results of an 18-year population-level study on statin utilization in Portugal. METHODS The Portuguese regulatory agency provided data for the period 2000-2018 on statin dispensing (C10AA). The DDDs were gathered from the ATC/DDD database. DDDs were calculated by the DDD year-by-year approach (DDDYEAR ) and by the DDD last-year approach (DDDLAST ). PDDs were calculated according to the year-by-year approach (PDDYEAR ). Statin annual utilization rates per 1000 inhabitants per day were also calculated. Percent errors were calculated for PDDYEAR and DDDYEAR units. RESULTS The DDDYEAR approach revealed decreases in the consumption of atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin in 2009, when their DDD was modified. Conversely, the results from both DDDLAST and PDDYEAR approaches indicated gradual changes in the actual consumption of all statins in Portugal. Before 2009, atorvastatin, pravastatin and simvastatin utilization was greatly overestimated by DDDYEAR /1000 inhabitants/day. The average dose of lovastatin prescribed in the past 18 years (20 mg) was below the assigned DDDs during the study period, varying from 30 mg to 45 mg. Conversely, the PDD for fluvastatin was above the DDD values (ranging from 40 mg in 2000 to 70 mg in 2016). For atorvastatin, pravastatin and simvastatin, national PDDs were above the assigned DDD until the DDD modification in 2009. CONCLUSIONS A more dynamic system, based on national and annually updated DDDs, should be able to reduce discrepancies between DDDs and PDDs and the bias in utilization studies.
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Affiliation(s)
- Catarina Abrantes
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil
| | | | - Margarida Castel-Branco
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Claudia Furtado
- Health Technology Assessment Department, National Authority of Medicines and Health Products (INFARMED), Lisbon, Portugal
| | - Isabel V Figueiredo
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Nampoothiri V, Sudhir AS, Joseph MV, Mohamed Z, Menon V, Charani E, Singh S. Mapping the Implementation of a Clinical Pharmacist-Driven Antimicrobial Stewardship Programme at a Tertiary Care Centre in South India. Antibiotics (Basel) 2021; 10:220. [PMID: 33672095 DOI: 10.3390/antibiotics10020220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/30/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018-February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.
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Arulappen AL, Danial M, Haron N, Hau LC, Khan AH. The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime. Front Pharmacol 2021; 11:565818. [PMID: 33664664 PMCID: PMC7921835 DOI: 10.3389/fphar.2020.565818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p < 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p < 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p < 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.
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Affiliation(s)
- Ann L Arulappen
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Georgetown, Malaysia.,Pharmacy Department, Hospital Seberang Jaya, Georgetown, Malaysia
| | - Monica Danial
- Clinical Research Center, Hospital Seberang Jaya, Georgetown, Malaysia
| | - Norliza Haron
- Pharmacy Department, Hospital Seberang Jaya, Georgetown, Malaysia
| | - Lim Choo Hau
- Infection Control Unit, Hospital Seberang Jaya, Georgetown, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Georgetown, Malaysia
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Sahoo AK, Gupta D, Dhaneria S, Thangaraju P, Singh A. Retrospective Analysis of Drug Prescription Statistics in a Tertiary Care Center in India: Recommendations for Promoting Prudent Utilization of Drugs. J Res Pharm Pract 2021; 9:146-150. [PMID: 33489983 PMCID: PMC7808181 DOI: 10.4103/jrpp.jrpp_20_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/23/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Drug utilization studies provide information regarding the drug usage pattern in hospital settings, which can be used to promote cost-efficient uses of drugs. The present observational retrospective study was conducted to evaluate the drug utilization pattern in a tertiary care center in India and create a baseline consumption data for the drugs, simultaneously identifying targets for improving drug prescribing pattern. Methods The current retrospective cross-sectional study was conducted at All India Institute of Medical Sciences Raipur, wherein the 217 medical records of different departments for August 2019 were chosen randomly (using systematic random sampling) for evaluation. The information was extracted from medical records regarding the basic demographic details, drug strength, route, and total amount, and eventually, the World Health Organization (WHO) core indicators were estimated. Drug utilization data were assessed using the WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC-DDD) methodology. Potential drug-drug interactions were also analyzed. Findings Most of the records analyzed were of male patients (56.2%). Drugs prescribed by their generic name were 50%. Prescriptions containing injection and antimicrobials were 68.1% and 83.6%, respectively. 49.3% of the patients had received a fixed-dose combination, and 60.9% of drugs belonged to the National List of Essential Medicines 2015. A total of 15 potential drug interactions were found. Conclusion Calculated prescribed daily dose of most of the antimicrobials and other groups of drugs was close to the WHO-DDD. Trade name prescription and polypharmacy were very common. Antibiotics accounted for the majority of drug costs.
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Affiliation(s)
- Ajaya Kumar Sahoo
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Dhyuti Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Suryaprakash Dhaneria
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Alok Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Rahem LR, Franck B, Roy H, Lebel D, Ovetchkine P, Bussières JF. Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19. Can J Hosp Pharm 2021; 74:21-29. [PMID: 33487651 PMCID: PMC7801337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. OBJECTIVE To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. METHODS In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. RESULTS Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). CONCLUSIONS This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program.
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Affiliation(s)
- Lydia R Rahem
- is a candidate for the DPharm degree in the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec. She is also an intern with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Bénédicte Franck
- is a candidate for the DPharm degree, Université Paul Sabatier, Toulouse, France. She is also a Research Assistant with the Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Quebec
| | - Hélène Roy
- , BPharm, MSc, is a Pharmacist with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Denis Lebel
- , BPharm, MSc, FCSHP, is a Pharmacist and Assistant Director, Teaching and Research with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Philippe Ovetchkine
- , MD, is a Pediatrician with the Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec
| | - Jean-François Bussières
- , BPharm, MSc, MBA, FCSHP, is a Pharmacist and Director with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, and a Clinical Professor with the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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Kertes J, Stein Reisner O, Grunhaus L, Neumark Y. The Impact of Smoking Cessation on Hospitalization and Psychiatric Medication Utilization among People with Serious Mental Illness. Subst Use Misuse 2021; 56:1543-1550. [PMID: 34193007 DOI: 10.1080/10826084.2021.1942057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Despite the high prevalence of smoking amongst people with serious mental illness (SMI), referral rates to smoking cessation programs (SCPs) are low. Mental health workers reticence to refer to SCPs has been attributed, in part, to their belief that quitting will have a deleterious effect on their patients' mental health status. Objectives: This study's objective was to determine if participating in a smoking cessation program had an adverse effect on mental health status among people with SMI, measured here by a change in hospitalization occurrence or psychiatric medication utilization. People with SMI who had participated in at least one SCP session in a large health maintenance organization (n = 403) were compared to an age-gender-diagnosis matched sample of SMI smokers (1,209) who had never participated. Results: No change in psychiatric hospitalization occurrence pre- versus post-SCP participation was found among participants (Pre:7.2% vs. Post:5.2, p = 0.2) or nonparticipants (Pre:7.0% vs. Post:6.0%, p = 0.2). Mean defined daily dose (DDD) for anti-psychotic, mood stabilizer, anti-depressant and anxiolytic medications also did not change over time for participants and nonparticipants. However, participants who did not complete the SCP and didn't quit had a 0.35 higher mean DDD for anti-psychotic medications compared with participants who had completed the SCP or quit, and with nonparticipants (p = 0.006), and were the only group to exhibit an increase in mean antipsychotic DDD over time (Pre:1.42, Post:1.63). SCP participation was not associated with hospitalization occurrence or psychiatric medication utilization. Conclusions/Importance: Smoking cessation should be encouraged, with close monitoring during the quit process.
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Affiliation(s)
- Jennifer Kertes
- Department of Health Evaluation & Research, Maccabi HealthCare, Jerusalem, Israel
| | | | - Leon Grunhaus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Neumark
- Braun Hebrew University-Hadassah School of Public Health & Community Medicine, Jerusalem, Israel
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Różańska A, Pac A, Jachowicz E, Jaślan D, Siewierska M, Wójkowska-Mach J. Outpatient Antibiotic Prescriptions in Pregnant Women in Małopolska Province. Antibiotics (Basel) 2020; 10:14. [PMID: 33375236 DOI: 10.3390/antibiotics10010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background: excessive and incorrect use of antibiotics is a common event that contributes to increased bacterial resistance to antibiotics. Based on the European Centre for Disease Control and Prevention (ECDC) European Surveillance of Antimicrobial Consumption (ESAC)-Net reports, outpatient antibiotics prescribing in Poland, is higher than the European average rate. However, ECDC reports do not provide data on consumption in specific patient groups. Additional studies focused on selected patient groups are needed for a more detailed analysis. The use of antibiotics during pregnancy is inevitable due to the proven risk of complications in this period, perinatal infections, and infections in newborns, in the situation of frequent infections of the genital tract, urinary tract, and asymptomatic bacteriuria in pregnant women. The aim of this study was to analyze the use of antibiotics/the implementation of antibiotic prescriptions ordered by gynecologists during pregnancy in pregnant women in Małopolska Voivodeship, with particular emphasis on demographic data and drug groups. Material and methods: the analysis used data on the reimbursement of antibiotics from the Małopolska Health Fund for 2013–2014. The database contained information of a demographic nature: age, place of residence, date of birth, as well as information on the type of drug, and the number of packages purchased by the patients. Results: the study included 67,917 women. During pregnancy, 23.6% filled their prescriptions for antibiotics. In the first trimester, the percentage of women filling their prescriptions for antibiotics was the lowest and amounted to 7.8%, in the second and third trimesters, these were 9.0% and 11.2%, respectively. The inhabitants of rural areas bought antibiotics more often (23.5%). Most frequently, antibiotics were purchased by women under 18 years of age (32.1%), but the use of antibiotics in women aged 18–34 and over 35 was similar, amounting to 23.8% and 22.7%, respectively. Most often (94.78% of cases) monotherapy was used, including beta-lactams and beta-lactams with an inhibitor (67.3%), then second-generation cephalosporins (13.5%), macrolides (14.73%), and others. Prescription of two different preparations was found in 5.06% of cases, three (0.19%), and four or more (0.03%). Conclusions: due to the fact that studies on antibiotic therapy in pregnant women in Poland are rare, it is impossible to assess the situation thoroughly. Additionally, in Poland, the prevalence of gestational infections is unknown, and their diagnostics is important, especially in relation to microbiological diagnostics and targeted treatment. However, the present results indicate the need to implement broad health promotion programs, accessible to all women, also those living outside large cities, particularly promoting the prevention of urinary tract infections and reproductive health in general.
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Toya R, Sasaki Y, Uemura R, Sueyoshi M. Indications and patterns of antimicrobial use in pig farms in the southern Kyushu, Japan: large amounts of tetracyclines used to treat respiratory disease in post-weaning and fattening pigs. J Vet Med Sci 2020; 83:322-328. [PMID: 33342965 PMCID: PMC7972880 DOI: 10.1292/jvms.20-0436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Japan, reducing the use of antimicrobials in pig production is a significant issue.
However, there are no published reports concerning porcine disease treatment, as related
to the age of the pigs and the indications (e.g., organ system) in Japan. In this study,
we analyzed the prescription records of 17 farrow-to-finish farms from 2014 to 2018 in
southern Kyushu, Japan. The farms’ antimicrobial usage was calculated as the active
ingredient per population correction unit (PCU) or the number of treated pigs per PCU
using the defined daily dose. All data were analyzed according to the indications and
production stages (sows, suckling pigs, post-weaning pigs, and fattening pigs). In terms
of active ingredients/PCU, tetracyclines were the most commonly used (43.2–59.3%), and the
largest amounts of antimicrobials administered through feeds were for treating the
respiratory organs of fattening pigs. In terms of the number of treated pigs/PCU,
tetracyclines were most frequently used (16.3–31.1%), and a high frequency of
antimicrobials administered through feeds was used for the treatment of respiratory organs
in post-weaning pigs. In this study, it was confirmed that tetracyclines were used
frequently as a herd treatment for respiratory diseases in post-weaning and fattening pigs
in southern Kyushu, Japan. The findings suggest that it is necessary to improve the
treatment and prevention of respiratory diseases in post-weaning and fattening pigs in
order to reduce the frequencies of antimicrobial treatments.
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Affiliation(s)
- Ryohei Toya
- Production Medicine Center, Agricultural Mutual Aid Association in Miyazaki Prefecture, 18802-3 Nyuta, Koyugun-Shintomicho, Miyazaki 889-1406, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 5200 Kiyotakecho-Kihara, Miyazaki 889-1692, Japan
| | - Yosuke Sasaki
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen-Kibanadai-Nishi, Miyazaki 889-2192, Japan
| | - Ryoko Uemura
- Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen-Kibanadai-Nishi, Miyazaki 889-2192, Japan
| | - Masuo Sueyoshi
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 5200 Kiyotakecho-Kihara, Miyazaki 889-1692, Japan.,Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen-Kibanadai-Nishi, Miyazaki 889-2192, Japan
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Echtermann T, Muentener C, Sidler X, Kuemmerlen D. Antimicrobial Usage Among Different Age Categories and Herd Sizes in Swiss Farrow-to-Finish Farms. Front Vet Sci 2020; 7:566529. [PMID: 33385014 PMCID: PMC7769871 DOI: 10.3389/fvets.2020.566529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
In the Swiss pig sector, the usage of antimicrobials has been recorded, evaluated and systematically reduced on a voluntary basis since 2015. This monitoring has been carried out using various methods thereby enabling continuous national scrutiny as well as international comparisons. To gain a better understanding of the dynamics of the antimicrobial usage on Swiss farms, consumption data of farrow-to-finish farms were analyzed for (i) the within-herd relationships among different age categories and (ii) the influence of the herd size. The data were collected on 71 farms for the year 2017, encompassing the amount of active ingredients and number of defined daily doses Switzerland (nDDDch) in total, and stratified for the different age categories of piglets, weaners, fattening pigs, and sows. The differences in nDDDch per animal among the age categories were determined by a Wilcoxon test and subsequent post-hoc analysis according to Bonferroni. The within-herd relationship among the individual age categories as well as the influence of the herd size on nDDDch per animal measured as kept sows were analyzed by simple linear regression. The evaluation of the treatment days showed that 50% of the nDDDch were used in piglets, 44% for weaners, and 3% each for fattening pigs and sows. Compared to the other age categories, the examination of the number of nDDDch per animal showed a significantly higher number for sows, whereas for fattening pigs the number was significantly lower (P < 0.01). The farm-based analysis using linear regression showed a relationship between antimicrobial usage in sows and piglets (P < 0.001; adj. R2 = 0.19). Similarly, a significant relationship between larger herd size and increased antimicrobial usage was observed (P = 0.02; adj. R2 = 0.06). The present study provides an insight into the antimicrobial treatment dynamics of farrow-to-finish farms. In particular, the age categories piglets and sows—with their higher number of treatment days in total or per animal—are of interest regarding the potential reduction in antimicrobial usage. Likewise, larger farms with higher management requirements were found to be of particular importance for the reduction of antimicrobial usage. Monitoring programs should therefore evaluate different age categories separately to identify problems for individual farms.
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Affiliation(s)
- Thomas Echtermann
- Division of Swine Medicine, Department for Farm Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Cedric Muentener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Xaver Sidler
- Division of Swine Medicine, Department for Farm Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Dolf Kuemmerlen
- Division of Swine Medicine, Department for Farm Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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O'Neill L, Rodrigues da Costa M, Leonard F, Gibbons J, Calderón Díaz JA, McCutcheon G, Manzanilla EG. Does the Use of Different Indicators to Benchmark Antimicrobial Use Affect Farm Ranking? Front Vet Sci 2020; 7:558793. [PMID: 33195531 PMCID: PMC7590364 DOI: 10.3389/fvets.2020.558793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022] Open
Abstract
The need to reduce antimicrobial use (AMU) in livestock production has led to the establishment of national AMU data collection systems in several countries. However, there is currently no consensus on which AMU indicator should be used and many of the systems have defined their own indicators. This study sought to explore the effect of using different internationally recognized indicators on AMU data collected from Irish pig farms and to determine if they influenced the ranking of farms in a benchmarking system. AMU data for 2016 was collected from 67 pig farms (c. 35% of Irish pig production). Benchmarks were defined using seven AMU indicators: two based on weight of active ingredient; four based on the defined daily doses (DDD) used by the European Medicines Agency and the national monitoring systems of Denmark and the Netherlands; and one based on the treatment incidence (TI200) used in several published studies. An arbitrary “action zone,” characterized by farms above an acceptable level of AMU, was set to the upper quartile (i.e., the top 25% of users, n = 17). Each pair of indicators was compared by calculating the Spearman rank correlation and assessing if farms above the threshold for one indicator were also above it for the comparison indicator. The action zone was broadly conserved across all indicators; even when using weight-based indicators. The lowest correlation between indicators was 0.94. Fifteen farms were above the action threshold for at least 6 of the 7 indicators while 10 farms were above the threshold for all indicators. However, there were important differences noted for individual farms between most pairs of indicators. The biggest discrepancies were seen when comparing the TI200 to the weight-based indicators and the TI200 to the DDDANED (as used by Dutch AMU monitoring system). Indicators using the same numerator were the most similar. All indicators used in this study identified the majority of high users. However, the discrepancies noted highlight the fact that different methods of measuring AMU can affect a benchmarking system. Therefore, careful consideration should be given to the limitations of any indicator chosen for use in an AMU monitoring system.
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Affiliation(s)
- Lorcan O'Neill
- Pig Development Department, Teagasc, The Irish Food and Agriculture Authority, Moorepark, Fermoy, Ireland.,School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Maria Rodrigues da Costa
- Pig Development Department, Teagasc, The Irish Food and Agriculture Authority, Moorepark, Fermoy, Ireland.,School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Finola Leonard
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | | | | | - Gerard McCutcheon
- Pig Development Department, Teagasc, The Irish Food and Agriculture Authority, Moorepark, Fermoy, Ireland.,Pig Development Department, Teagasc, The Irish Food and Agriculture Authority, Oakpark, Carlow, Ireland
| | - Edgar García Manzanilla
- Pig Development Department, Teagasc, The Irish Food and Agriculture Authority, Moorepark, Fermoy, Ireland.,School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Fondevilla E, Grau S, Echeverría-Esnal D, Gudiol F. Antibiotic consumption trends among acute care hospitals in Catalonia (2008-2016): impact of different adjustments on the results. Expert Rev Anti Infect Ther 2020; 19:245-251. [PMID: 32825806 DOI: 10.1080/14787210.2020.1814142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Hospital antibiotic consumption is measured using defined-daily-doses (DDD) divided by bed days. However,other denominators as discharges could provide a more accurate interpretation of consumption. The main objective was to analyze trends of antibiotic consumption among hospitals in Catalonia during the period 2008-2016, using both DDD/100 bed days and DDD/100 discharges. METHODS Retrospective, descriptive, and longitudinal study performed among acute care hospitals affiliated to VINCat Program. Antibiotic consumption was expressed using the Anatomical Therapeutic Chemical/DDD classification and trends with a mixed linear model. Trends after using both DDD/100 bed days and DDD/100 discharges were determined and compared. RESULTS Overall antibiotic consumption from 2008 to 2016 increased by 10.24% (P < 0.001) DDD/100 bed days, but remained stable (-0.87%, P = 0.051) in DDD/100 discharges. Although DDD and discharges remained unchanged, a significant reduction in bed days (-9.63%) and length of stay (-8.19%) was observed. A worrisome increase in the consumption of carbapenems and anti-MRSA drugs was noticed. CONCLUSION Whereas a significant upward trend in antibiotic consumption in DDD/100 bed days was noticed, DDD/100 discharges remained stable. The description of both indicators seems therefore essential for a correct interpretation of data.
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Affiliation(s)
- Esther Fondevilla
- Department of Health, VINCat Coordinating Centre (2006-2018) , Catalonia, Spain
| | - Santiago Grau
- Department of Health, Member of VINCat Committee , Catalonia, Spain.,Pharmacy Department, Hospital Del Mar , Barcelona, Spain.,Pharmacy Department, Universitat Autònoma De Barcelona , Barcelona, Spain
| | | | - Francesc Gudiol
- Department of Health, Director of VINCat Program (2006-2018) , Catalonia, Spain.,Emeritus Professor of Medicine, University of Barcelona , Barcelona, Spain
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Mahmoudi L, Sepasian A, Firouzabadi D, Akbari A. The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention. Risk Manag Healthc Policy 2020; 13:1701-1709. [PMID: 33061704 PMCID: PMC7520156 DOI: 10.2147/rmhp.s265407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result. Materials and Methods Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective cross-sectional study between two time periods introduced as pre- and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated. Results A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (P-value=0.001). Implementing ASP also increased AM susceptibility of Pseudomonas aeruginosa, while the susceptibility of methicillin-resistant Staphylococcus aureus did not change significantly. Conclusion The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists' role was critical to the success of this ASP and was uniquely empowered at our center.
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Affiliation(s)
- Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Sepasian
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dena Firouzabadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbari
- Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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