IntroductionPolypharmacy and potentially inappropriate medication use is common in older adults and is associated with adverse outcomes such as falls and hospitalisations.Methods and analysisThis study is a pharmacist-led medication optimisation initiative using an electronic tool (the Drug Burden Index (DBI) Calculator) in four hospital sites in the Canadian province of Nova Scotia. The study aims to enrol 160 participants between the preintervention and intervention groups. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2013 checklist) was used to develop the protocol for this prospective interventional implementation study. A preintervention retrospective control cohort and a multiple case study analysis will also be used to assess the effect of intervention implementation. Statistical analysis will involve change in DBI scores and assessment of clinical outcomes, such as rehospitalisation and mortality using appropriate statistical tests including t-test, χ2, analysis of variance and unadjusted and adjusted regression methods.Ethics and disseminationEthics approval has been granted by the Nova Scotia Health Authority Research Ethics Board. The findings of this study will be published in peer-reviewed journals and presented at local, national and international conferences.Trial registration numberNCT03698487.
Background: Previous studies have described the use of cefazolin with probenecid to treat uncomplicated skin and soft-tissue infections. Some prescribers are extrapolating from this evidence to treat more invasive infections, which have a greater potential for poor outcomes, including treatment failure that could lead to increased morbidity and mortality. Information supporting cefazolin with probenecid as effective treatment in this context is needed.Objectives: To describe prescribing patterns and outcomes for patients who received cefazolin with probenecid for the treatment of bone and joint infections.Methods: This single-centre retrospective study involved adult outpatients for whom cefazolin and probenecid were prescribed for bone and joint infections between April 1, 2012, and March 31, 2017. Patient charts were reviewed, and data were collected for clinical and microbiological variables using a standardized data collection form.Results: In a total of 80 cases, the patient received cefazolin and probenecid for treatment of a bone or joint infection, of which 69 cases met the inclusion criteria. In most cases (n = 67), the patients were treated with cefazolin 2 g IV plus probenecid 1 g PO, both given twice daily. Completion of prescribed treatment occurred in 56 patient cases (81%), resolution of signs and symptoms in 53 (77%), readmission to hospital in 11 (16%), recurrence of infection in 6 (9%), and treatment failure requiring a change in therapy in 7 (10%).Conclusions: The effectiveness of cefazolin and probenecid for the treatment of bone and joint infections appears to be similar to that of standard treatment, as reported in the literature. Antibiotic effectiveness is difficult to determine conclusively in a retrospective analysis, so these results should be interpreted with caution, but they may stimulate further research.RÉSUMÉContexte : Des études précédentes ont décrit l’utilisation de la céfazoline et du probénécide pour traiter les infections cutanées et les infections de tissus mous. Quelques prescripteurs extrapolent ces éléments probants pour traiter des infections plus invasives, dont les résultats risquent d’être défavorables, comme un échec du traitement pouvant entraîner une morbidité et une mortalité accrues. De l’information supplémentaire étayant l’efficacité du traitement à l’aide de la céfazoline et du probénécide dans ce contexte est nécessaire.Objectifs : Décrire les modes de prescription et les résultats obtenus par des patients ayant reçu de la céfazoline et du probénécide pour traiter des infections osseuses et articulaires.Méthodes : Cette étude rétrospective unicentrique porte sur des patients ambulatoires adultes à qui on a prescrit de la céfazoline et du probénécide pour traiter des infections osseuses et articulaires entre le 1er avril 2012 et le 31 mars 2017. L’examen des dossiers médicaux des patients a permis la récolte de données sur les variables cliniques et microbiologiques à l’aide d’un formulaire de recueil de données standard.Résultats : Les patients, soit 80 cas en tout, ont reçu de la céfazoline et du probénécide pour traiter une infection osseuse ou articulaire et 69 de ces cas répondaient aux critères d’inclusion. Dans la plupart des cas (n = 67), les patients étaient traités avec de la céfazoline IV dosée à 2 g et du probénécide dosé à 1 g PO, les deux produits étant administrés deux fois par jour. Le traitement a été appliqué au complet dans 56 cas (81 %), la résolution des signes et des symptômes a eu lieu dans 53 cas (77 %), la réadmission à l’hôpital s’est produite dans 11 cas (16 %), les infections ont récidivé dans 6 cas (9 %) et le traitement s’est soldé par un échec et a nécessité un changement de thérapie dans 7 cas (10 %).Conclusions : L’efficacité de la céfazoline et du probénécide dans le traitement des infections osseuses et articulaires semble être similaire à celle des traitements standard, comme le rapporte la littérature scientifique. L’efficacité des antibiotiques est difficile à déterminer de façon concluante dans une analyse rétrospective, ces résultats doivent donc être interprétés avec prudence, mais ils pourraient stimuler des recherches supplémentaires.
Frailty represents one of the greatest challenges facing health-care systems in caring for an older population. 1,2 Knowledge around frailty and its association with negative health outcomes such as functional decline and mortality is increasing. 2,3 The definition and assessment of frailty have evolved over time, and there are numerous instruments for assessment. Currently, there is no consensus on which assessment tool is best. 4 With ageing comes an increased risk of multimorbidity and subsequent polypharmacy (multiple medication use). Like frailty, polypharmacy is associated with negative health outcomes and the definition (ie number of medications and/ or appropriateness of medications) is also variable. 5 Frailty and polypharmacy commonly co-exist in older adults. 6 There are plausible mechanisms of how polypharmacy may increase the risk of frailty, for example through cumulative adverse effects of multiple medications. 6 Several cross-sectional and longitudinal observational
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