Background The number of patients infected by HIV and hepatitis has increased over the years. Some of them have swallowing difficulties that require the placement of nasogastric or gastrostomy tubes. These chronic treatments need high compliance rates to avoid antiviral drug resistance and, eventually, treatment failure. Purpose To review the existing antiviral drugs literature and develop administration recommendations for patients with swallowing problems. Materials and Methods Formulations and recommendations were obtained directly from the manufacturers, or by a PubMed search and a search on the Micromedex database, when information was not available. A guide published by SENPE with physicochemical and formulation properties of drugs was also checked. ResultsTable 1 shows the results. Extensive administration recommendations were found during literature searches but are not included in the present abstract. There was no information about the administration of adefovir, maraviroc or saquinavir through gastrostomy or nasogastric tube. Conclusions Treatment compliance is key to ensuring the success of chronic antiviral treatments and it is important to consider special situations, such as swallowing problems. This guide for nasogastric or enteral administration helps clinicians to choose the most appropriate treatment. Further research is needed to determine specific bioavailability data. Abstact DGI-024 Table 1Antiviral Drug Formulations and Administration Drug Solution available (mg/ml solution) Can be crushed/sprinkled abacavir 20 Yes didanosine 2 g/ml solution powder Use tablets, not capsules emtricitabine 10 Discouraged lamivudine 10, 5 Yes stavudine 1 Yes tenofovir Yes zidovudine 50 Discouraged efavirenz 30* Use capsules etravirine Yes nevirapine 10 Discouraged atazanavir 50 mg/1.5 g solution powder * Discouraged darunavir Yes fosamprenavir 50 indinavir Discouraged lopinavir/ritonavir 80/20 Discouraged nelfinavir Yes ritonavir 80 Discouraged tipranavir 100 raltegravir Yes abacavir/lamivudine ** abacavir/lamivudine/zidovudine ** zidovudine/lamivudine ** Yes tenofovir/emtricitabine Yes tenofovir/emtricitabine/efavirenz Discouraged boceprevir Discouraged telaprevir Discouraged ribavirin 40 Discouraged entecavir 0.05* telbivudine 20* Discouraged *Not in Spain **Individual drugs available in solution No conflict of interest.
Background Vancomycin is primarily effective against Gram-positive cocci. However, as it can only penetrate the tissue superficially, it is uncertain if it is really able to achieve concentrations of therapeutic benefit at the site of infection. Suboptimal concentrations have been associated with lack of clinical response and increased resistance. There are no clear criteria on pharmacokinetic parameters associated with a good response, although the most conservative proposals consider an AUC/MIC > 400, in pathological conditions such as pneumonia and meningitis. Some authors have described the failure to achieve these values with the usual doses when the MIC > 2. Purpose Our work evaluates the pharmacokinetic data of vancomycin in a group of 30 inpatients, and individual Bayesian estimates of the dose needed to overcome the described value of AUC/MIC > 400. Materials and MethodsWe estimated the kinetic parameters of a population of 30 patients with a staphylococcal infection through a Bayesian model with application v.1.0 Abbotbase Pharmacokinetic Systems. From each patient we obtained the MIC, and the dose required to obtain an AUC/MIC > 400. We calculated the percentage of patients who reached target values for AUC/MIC with a standard dose of 1 g/12 h and those receiving an individualised dose according to the kinetic parameters obtained by Bayesian setting. Maximum doses of 4 grammes/day were considered. ResultsMean clearance (CI 95%) obtained through Bayesian estimation was 3.91 l/h (3.2–4.6). Median MIC value was 1 mcg/ml. According to these data, 57% of patients would reach therapeutic AUC values with conventional dose. However, if the dose is set individually 90% of patients would reach the target value, with a mean calculated dose of 2300 mg (CI95%: 1550–3000). Conclusions Most patients with staphylococcal infections can be treated with vancomycin, which also contributes to cost reduction. A Bayesian approach shows better pharmacodynamic results than conventional dosing, with a 90% of patients successfully treated in a real setting. No conflict of interest.
TechnologyEur J Hosp Pharm 2013;20(Suppl 1):A1-238 A75anhydrous, 50 mL of sterile water and simple syrup. The phosphorus strength of 67.4 mg/mL is close to that of Phosphoneuro. For 12 weeks, the solution appeared unchanged, clear and colourless. pH about 4.14 remained constant. Sodium and phosphorus contents were stable and the observed values were within 10% of the theoretical values. Microbiological results were in accordance with European Pharmacopeia: viable aerobic bacteria ≤ 10 3 (CFU/ml), fungal ≤ 10 2 , no E.coli. Conclusions Microbiological compliance and physicochemical stability were verified at 12 weeks according to the standards of the European Pharmacopeia. After users had insisted, the French Regulatory agency urged Bouchara Recordati to produce Phosphoneuros again, effective in May 2012. This is an example of the hospital pharmacist's role in compounding drugs to allow patients to continue their treatment in case of shortages of commercial products.No conflict of interest. Background Information and communication technologies increase efficiency and safety in health systems. The SiMON protocol (Monitored Information System), developed by the R&D department of hospital's Computing Service, provides a tool for monitoring patients attending a particular consultation and is adaptable in line with the needs of each clinical service. Its main objective is to streamline care by automating patient information related to such consultation. Furthermore, it provides a record for future analysis of information collected, making it possible to export information, scorecards and predict comorbidities. Purpose To describe the implementation of SiMON in pharmaceutical monitoring of patients with viral diseases (HIV/HCV). ImplementatIon of a monItored InformatIon Materials and MethodsReview of antiretroviral technical datasheets, pegylated interferon, ribavirin and protease inhibitors (boceprevir/telaprevir) and of the necessary literature to collect criteria and general recommendations for treatment of these diseases, adverse drug effects, interactions between these drugs and others, and contraindications for use. Results In order to implement SiMON in the pharmaceutical monitoring of patients with HIV/HCV, the Pharmacy Service reviewed 15 datasheets of antiviral drugs. Usage alerts were established as well as recommendations for each drug that depend on patient data (83 alerts), prescribed dosage (34 alerts), laboratory test results (94 alerts) and interactions between different medicinal products (484 alerts). Each of these alerts can refer to a contraindication or usage precaution, with a possible recommendation to suspend treatment, adjust the dose or change the drug involved in the interaction for an alternative. We also collected 482 adverse drug effects that had to be structured in tree form so they could be encoded by the Computing Service. Conclusions The SiMON protocol, a tool that increases the efficiency of patient monitoring in a multidisciplinary way, makes it possible to record side effects and g...
BackgroundIn recent years, patient safety has become a Healthcare Systems’ priority. An expert panel has established the presence of a Hospital Pharmacist in hospital settings and their direct collaboration with nurses and doctors as a key factor in the safe use of medicines.1 PurposeWe wanted to investigate the effect that this integration is having on patient safety and whether cost savings are directly related.Material and methodsA pharmacist worked full-time on the General Surgery service for two months. The pharmacist took part daily in clinical sessions, patients’ visits, drug monitoring advice, discharge information, home medicines reconciliation, among other duties. All work carried out by the pharmacist was recorded. Cost saving derived from switching treatment and non-necessary drugs stopped by the pharmacist were calculated as (cost of initial treatment × days with the new treatment) – (cost of new treatment × days of treatment).Results166 patients were admitted to the Surgery Service during this period. The Pharmacist made at least one treatment recommendation in 56% of these patients which ended in a treatment change or drug monitoring by doctors. 108 treatment reconciliation reports were made (65% of patients) by pharmacist-patient interview. Because of these reports, 106 drugs were added to patients’ hospital treatment, 18% were drugs that guidelines recommended not to stop at admission. The treatment was changed for 37 drugs, and 19 unnecessary drugs were stopped. Direct cost savings derived from that switching and non-necessary drugs were in total €1,372 (€686/month).ConclusionHospital pharmacists play an important role as part of multidisciplinary teams, improving medical care and increasing treatment safety. Direct cost savings are also related to pharmacist clinical practice.References and/or Acknowledgements1 Top-priority actions for preventing adverse drug events in hospitals: recommendations of an expert panel. Am J Health Syst Pharm 1996;53:747–51No conflict of interest.
Conclusion and relevance DOAC use increased notably in our PC area during the SARS-CoV-2 pandemic. We found that 40.2% of patients treated with DOAC had at least one contraindication for the treatment. Interventions should be done to improve DOAC prescription and ensure patient safety.
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