Background Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis bronchiectasis as off-label treatment, without quantifiable effectiveness. Patients’perspective is an important part of healthcare quality. Due to internal procedures the pharmacy service supervises off-label treatments. Purpose To explore in a group of patients suffering from bronchiectasis, their perception of their last year and their current health status. Materials and methods Prospective study based on a survey given to patients treated with inhaled colistimethate for last year at least. Surveys were delivered between October 2012 and June 2013 containing 10 items about their current health status and the perceived changes in their physical and mental health during last year. A four-point scale was used for all questions (1 = never/poor health; 2 = sometimes/regular health; 3 = usually/good health; 4 = always/very good health). Colistimethate was dispensed once a month at the pharmacy service and the procedure for completing the survey was explained by a clinical pharmacist. The questionnaire could be completed by the patient himself or by a caregiver. Results 97 questionnaires were delivered, 67 (69%) were returned: 40 (41%) were useful and 27 weren’t completely filled in. Mean age was 72 years (32–93). 82.5% of patients referred to having bad or moderate health, however 52% believed their health was better than the previous year. During the last year 48% of patients had to reduce the working time (always) and 78% had less activity than desired (always) while 43% never or sometimes had difficulty performing certain activities. 72% had a perception of bad or very bad health, and almost all (95%) believed that their health was going to get worse. Relating to mental health 93% felt calm and quiet and only 40% never had moments of discouragement or depression. Conclusions It’s difficult to measure health benefits in chronic degenerative diseases. Despite their situation half of our patients believed their health had improved during last year. No conflict of interest.
Background Drug dosage modifications are a common clinical practise regarding Tumor Necrosis Factor (TNF) blockers, using posologies not specified on the authorised product information summary. This practise has a significant financial impact on the healthcare system. Purpose To revise and investigate actual drug dosages in our Hospital’s rheumatology service for conventional TNF blockers. Materials and Methods The Pharmacy Service analysed the internal data record for rheumatology patients treated during April 2012 and for at least one year with infliximab (IFX), etanercept (ETN) or adalimumab (ADA). Off-label indications were excluded. Therapeutic indication, initial and current posology were recorded. Results Number of patients by drug; IFX ETN ADA 128 152 121 Number of patients by indication: RA AS PA JIA 208 109 79 5 RA: Rheumatoid arthritis, AS Ankylosing spondylitis, PA psoriatic arthritis, JIA: Juvenile idiopathic arthritis Regarding posology, 261 patients (65%) were on a conventional dose (CD), 93 (23%) on a reduced dose (DR) and 47 (12%) on an increased dose (DI) Percentage of patients by drug on CD, DR or DI was; Treatment/posology CD DR DI IFX 33% 35% 32% ETN 79% 21% – ADA 82% 14% 4% Percentage of patients by indication was; Indication/posology CD DR DI RA 65% 19% 16% AS 59% 32% 9% PA 72% 24% 4% JIA 80% 20% – Conclusions Only 65% of patients using TNF blockers on rheumatology use a CD while a quarter of them have a reduced posology. Infliximab is the drug that requires more dosage modifications, on almost 2/3 of patients. AS and PA are the indications that allow more DR. Drug dosage revisions at the end of the first year of treatment allow an important number of patients to reduce their dose while controlling their disease and it is a relevant efficacy instrument. No conflict of interest.
Background When an unrelated donor is used for an allogeneic hematopoietic stem cell transplant (AlloHSCT) highly immunosuppressive treatment is needed during the early post-transplant period as prophylaxis against acute graft versus host disease (aGVHD). Tacrolimus is one the drugs used with a target level of 5–15 ng/mL. Purpose To compare the accuracy of real plasma tacrolimus levels with target levels in the immediate post-transplant period. Materials and methods A retrospective review was made between 2008/01/01 and 2013/09/30 of all aGVHD prophylaxis that included tacrolimus. Data were obtained from the electronic medical history records and the Pharmacy Unit intravenous database. Results Tacrolimus was used in 46 patients (17 women) with a median of 51 years old (17–69). First dose of tacrolimus was administered on day -1 at 0.03 mg/kg/day by continuous intravenous infusion. Only half of patients, 23 (50%), were within the therapeutic range when the first measure was made. Supratherapeutic levels were found in 15 patients and infratherapeutic in 8 patients. This first tacrolimus plasma level was obtained between day + 2 and + 11. Conditioning was done with myeloablative regimens (fludarabine-busulfan: 13 patients; total body irradiation and cyclophosphamide: 5 patients) and non myeloablative regimens (fludarabine-melphalan: 7 patients; fludarabine-busulfan: 17 patients; fludarabine-cyclophosphamide: 4 patients). Antibiotic prophylaxis was administered in all cases with ciprofloxacin and antifungal prophylaxis was fluconazole, voriconazole and caspofungin for 42, 3 and 1 patient, respectively. A direct relationship has not been found between the day of measurement, conditioning regimen, antibiotic or antifungal prophylaxis and the tacrolimus plasma level obtained. Conclusions There is great discordance between theoretical tacrolimus plasma levels and real levels. Renal function doesn’t affect tacrolimus pharmacokinetics, although it is potentially nephrotoxic, which might require dose adjustment. After this review a pharmacokinetic drug interaction among drugs used during conditioning or antibiotic or antifungal prophylaxis was excluded. A thorough investigation of how tacrolimus samples are obtained and handled is mandatory. No conflict of interest.
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