Background Prompt treatment with effective antimalarials is important in the treatment of malaria. Purpose To assess the suitability of the first-line antimalarials in our hospital according to a proposed treatment protocol following the World Health Organisation (WHO) guidelines and to analyse the admissions for suspected uncomplicated malaria. Materials and methods We collected data from the clinical history (2008–2012): patient’s country of origin, prior prophylaxis and the time of initiation of antimalarial treatment. Antimalarial treatment received during hospitalisation was collected from the prescription program, and identification of Plasmodium species from patients analytics. Results There were 32 patients, 5 of them children. 33 cases diagnosed suspected malaria (one was a relapse): 32 came from Africa and one from Asia. 22 cases were immigrants returned from their country of origin after visiting friends and relatives, 2 were passengers, 4 recently arrived immigrants and 4 were no data. Of the 33 cases, 22 had not taken prophylaxis, 3 had taken prophylaxis completely, 5 had taken prophylactics incompletely and 3 were no data. Plasmodium species were confirmed in all cases except one: 25 were P. falciparum, 4 P. vivax, 1 P. ovale and 2 were not identified. The treatment received during hospitalisation was: 25 cases (76%) quinine-doxycycline, 2 quinine-clindamycin, 2 (1 was a child) atovaquone-proguanil, 2 chloroquine-primaquine and in 2 data was not available. As current guidelines recommended, in 13 suspected malaria cases (40%) treatment started in the Emergency Department, 8 did not begin any treatment despite suspected malaria, 2 cases of malaria was not suspected and in 10 there were no data. Conclusions In the last five years the treatment for suspected uncomplicated malaria has been quinine-doxycycline. Due to lack of a malaria protocol and reviewing the WHO guidelines for malaria treatment (2010), a protocol was proposed. This led to updating the first-line antimalarial treatment, introducing atovaquone-proguanil for uncomplicated malaria. No conflict of interest.
Background In order to get a decrease in incidents with impact on safety and improve the effectiveness of the prescriptions, the authors implemented ISOFAR software for electronic prescription. Purpose To describe the impact of the implementation of electronic prescription in the nature of pharmaceutical interventions recorded in the ISOFAR software. Materials and methods From November 2009 to February 2010 the authors implemented the electronic prescription with the e-osabide application in the 488 hospital beds. The authors have evaluated pharmaceutical interventions recorded in the ISOFAR software in the period 1 November 2008–31 October 2009 (preimplantation) and in the period 1 November 2009–31 October 2010 (postimplantation). The impact of each pharmaceutical intervention has been assessed and classified according to their impact on safety or efficacy, based on the software. Results The number of registered pharmaceutical interventions has decreased from 1129 in 2009 to 766 in 2010. This decrease is due, to some extent, to the great effort that this implantation has caused, which made it difficult for us to devote to other activities. There was also a decrease from 94.2% to 74.1% in interventions with impact on safety and an increase from 5.8% to 22.6% in interventions with impact on the effectiveness of treatment. Conclusions It can be considered that the implementation of electronic prescription has improved security, because of the decrease in incidents with impact on safety and therefore the possibility of potential adverse events, and interventions with impact on effectiveness have increased
BackgroundTo analyse the cost of biological drugs in clinical practice is a useful tool in choosing a drug, especially when direct comparison studies are limited and systematic reviews report similar effectiveness for these medicines.PurposeTo describe the dispensing pattern and calculate, according to clinical practice, the annual median cost and percentage of dispensing median dose of tocilizumab, etanercept, adalimumab or infliximab in rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA). Moreover, to compare these results with recommended doses and theoretical costs (annual cost of each drug according to Spanish official unitary price and official dispensing frequency).Material and methodsObservational retrospective study. From 1 January 2009 to 31 December 2013, all adults with RA, AS or PsA treated with tocilizumab, etanercept, adalimumab and/or infliximab for at least 1 year were included. They were attending the rheumatology and pharmacy services. The information was collected from the electronic medical history programme and pharmaceutical care database. Data were analysed with SPSS statistical.Results251 episodes of treatment were included: 106 of adalimumab, 89 of etanercept, 38 of infliximab and 18 of tocilizumab. These episodes corresponded to 236 patients. Adalimumab was the most usually dispensed drug in all pathologies (42.2%). 59.4% of drugs were dispensed to treat RA, 23.5% for AS and 17.1% for PsA. Change in dispensing frequency was the most common posology adjustment.For all indications, statistical differences in real cost between two subcutaneous therapies were described: etanercept was 4.0% cheaper than adalimumab in RA (p = 0.012), 12.2% cheaper in AS (p = 0.002) and 18.2% more economical than adalimumab in PsA (p = 0.001). Otherwise, the real annual median cost was lower than the theoretical annual cost (statistically significant differences) for all therapies with indications, except for infliximab. Only in RA was the real annual median cost of infliximab higher than the theoretical annual cost (p = 0.140). In AS, statistically significant differences were described in the percentage of dispensed median real dose of tocilizumab (86.7%), infliximab (114.2%), etanercept (93.1%) and adalimumab (89.3%) compared with recommended doses.ConclusionReal dosage of etanercept, adalimumab and tocilizumab is lower than the recommended dosage. Therefore, the real annual cost should be taken into account to choose one biological therapy.No conflict of interest.
A196Eur J Hosp Pharm 2013;20(Suppl 1):A1-A238Results A total of 52 patients (84% women) were prescribed aprepitant during the study period. The average age was 49 years (age range: 19-69 years). The following data were collected: diagnosis and stage of disease, chemotherapy scheme, anti-emesis change cycle number, combination with radiotherapy and alcohol intake. 65% of patients had breast cancer followed by non-small lung cancer (5%). 27% and 25% of cancers were in stages IA and IIA respectively. The most common chemotherapy scheme (55%) for which the change of antiemetic therapy was seen, was FEC 500-100-500. 26% of patients started ondansetron 4 or 8 mg before aprepitant was prescribed. The rest (74%) received aprepitant directly after failing the first line antiemetic therapy. In 40% of patients the antiemetic regimen was changed to the study drug in cycle 2 and in 25% in cycle 3, demonstrating that aprepitant is not used as first-line antiemetic. Only 5 patients received radiotherapy combined with chemotherapy and only in 4 was alcohol intake recorded. Conclusions In our hospital aprepitant is mainly used in chemotherapy regimens that include anthracyclines in combination with cyclophosphamide. It is prescribed after first line antiemetic regimen failure; meeting the indications established by Drug and Therapeutics Committee. However, it would be advisable to cheque the antiemetic guidelines periodically for compliance with reference guides such as NCCN, ASCO, MASCC etc.No conflict of interest.
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