Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.
Background or Introduction: Amoxicillin alone and with clavulanic acid are among the most prescribing antibacterial agents in Italy. These drugs are generally well tolerated and usually prescribed by paediatrics, although published studies indicate that they are frequently associated with adverse drug reactions (ADRs), in particular cutaneous and gastrointestinal ones. We analyzed the Italian database of spontaneous reporting of suspected ADRs in order to compare the safety profile of amoxicillin and amoxicillin/clavulanic acid (amoxiclav) in pediatrics. Material and Methods: Reports of suspected ADRs due to amoxicillin and amoxi-clav in pediatric patients, until 1 September 2014, were extracted. ADRs were coded using MedDRA terminology. To evaluate the correlation between drug use and occurrence of ADRs a disproportionality analysis through Reporting Odds Ratio (ROR) was performed. Results: We collected 3.345 reports associated with amoxicillin and amoxicillin/clavulanic acid, 1.188 (35.5%) related to amoxicillin and 2.157 (64.5%) to amoxicillin with clavulanic acid. The percentages of serious ADRs were 12% for amoxicillin and 16% for amoxi-clav. The percentage of skin reactions was higher for amoxicillin (75%) than for amoxicillin/clavulanic acid (67%) and for gastrointestinal reactions was higher for amoxicillin/clavulanic acid (16%) than for amoxicillin (10%). For amoxicillin, significant disproportionality was observed only for cutaneous ADR like dermatitis (ROR, 2.31; 95% CI, 1.26-4.25), rash (1.30; 1.08-1.57), erythematous rash (1.70; 1.18-2.45). For amoxicillin/clavulanic acid was observed only for gastrointestinal ADR: diarrhoea (1.56; 1.15-2.12), abdominal pain (2.11; 1.14-3.93) and sickness (1.69; 1.20-2.38). Conclusions: Our analysis shows a different safety profile for amoxicillin and amoxi-clav in paediatrics: the first is associated with an higher risk of skin reactions while the amoxi-clav with gastrointestinal ones. Nevertheless, data did not reveal an increased risk of liver damage from clavulanic acid than amoxicillin alone, as widely reported in literature.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.