Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20% to 30%) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.

b W e read with great interest the recently published paper by Santa- . In that work, the authors measured the changes in the seasonal variation in penicillin use before and after the restrictions on over-the-counter (OTC) antibiotic sales went into effect in Mexico and Brazil in 2010.Santa-Ana-Tellez et al. (1) found that following the implementation of policies to restrict OTC sales of antibiotics, the seasonal variation in antibiotic usage decreased in Mexico but not in Brazil. On the basis of these findings, the authors concluded that in Mexico, the inappropriate use of penicillin may have diminished after the restrictions were enforced. However, the authors suggested that in Brazil, the increased use of penicillin with no change in the seasonal variation of penicillin use might indicate that further efforts are needed to reduce inappropriate antibiotic use.We would like to further discuss the results related to Brazil. We also evaluated the repercussions of antimicrobial control in Brazil (2). The unpublished data were collected from approximately 3,000 pharmacies (4.5% of Brazilian pharmacies) located in approximately 1,500 municipalities (27% of Brazilian municipalities). The information regarding pharmacy antibiotic sales was obtained from the Acode Electronic System, which is used by pharmacies associated with the Brazilian Pharmaceutical Federation (Febrafar), Sao Paulo, Brazil, to monitor the data on the acquisition and sale of medicines by these pharmacies.Amoxicillin, cephalexin, and azithromycin were the most commonly sold antibiotics in both the precontrol (December 2009 to November 2010) and postcontrol (December 2010 to November 2011 periods. The most significant reductions in the number of units sold were observed for the following classes of antibiotics: tetracyclines (Ϫ30.47%), sulfonamides (Ϫ28.54%), macrolides (Ϫ24.99%), and penicillins (Ϫ20.46%). There was a reduction in the number of units sold by the pharmaceutical establishments for all penicillins except amoxicillin in combination with clavulanic acid (Table 1).The trend of increased sales of penicillins observed in Brazil even after the implementation of restrictive measures reflects the growth of the Brazilian pharmaceutical market as a whole. Thus, it should not be understood as reflecting the ineffectiveness of the restrictive measures.In our study, the sale of amoxicillin was reduced by approximately 30% despite the pharmaceutical market growth. This change clearly shows that the restriction of sales in pharmacies resulted in decreased amoxicillin consumption, often associated with self-medication and OTC sales for the treatment of upper respiratory infections.In our study, the number of units of amoxicillin in combination with clavulanic acid sold increased by 9%, similar to the results reported by Santa-Ana-Tellez et al. (1); however, the increase was not statistically significant. A possible explanation is that this combination is more frequently associated with the use of prescribed antibiotics than self-medication, perhaps be...

The lack and/or nonuse of therapeutic protocols resulted in great differences in prescription patterns, thereby leading to therapeutic failure and recurrence of infections, which were situations frequently found in this study.

No abstract

BackgroundIn 2011, private pharmacies associated to the Brazilian Ministry of Health provided patients with two types of insulin (regular human insulin and isophane insulin or NPH) and three oral antidiabetic medications (5 mg glibenclamide and 500 and 850 mg metformin) free of charge. The aim was to evaluate the impact of the “Health Has No Price” Program [Saúde Não Tem Preço (SNTP)] for access to diabetes treatment medicines in Brazil.MethodsThis longitudinal and observational study is based on the number of units of oral hypoglycemic agents, insulin and insulin analogues supplied in 55,000 private pharmacies from February 1, 2010 to January 31, 2012. The number of tablets (oral hypoglycemic agents) and international units (insulins and insulin analogues) supplied in the first 12 months of the SNTP Program were compared with the number of tablets and international units supplied in the 12 months prior to its implementation.ResultsThe insulins in the SNTP program had the highest percentage change in the number of international units supplied; regular human insulin increased by 97.8 % and isophane insulin (NPH) by 78.0 %. Among the oral hypoglycemic agents, 5 mg glibenclamide increased by 65.9 %, and 500 and 850 mg metformin increased by 46.8 and 39.9 %, respectively, in the number of tablets dispensed in the first year of the SNTP Program. Among the hypoglycemic agents not available in SNTP, 4 mg glimepiride had the highest percentage increase in units supplied (19.2 %) in the same period. Among the insulin analogues, which were not available in the SNTP Program, insulin glulisine showed the greatest increase in units dispensed (34.2 %).ConclusionsThe SNTP Program contributed to increased access to medicines for the treatment of diabetes in Brazil.

No Brasil o PBM (Pharmacy BenefitsManagement

Introdução: A frequência de eventos adversos é alta em hospitais e esse contexto embasou a elaboração de metas, cujo cumprimento envolve a farmácia hospitalar (FH). Objetivo: Avaliar a participação da FH na gestão de risco no uso de medicamentos em 15 hospitais públicos do Distrito Federal (Brasil). Método: Estudo transversal cuja coleta de dados foi realizada de maio a novembro de 2016 e envolveu caracterização e hierarquização dos hospitais, avaliação das FH conforme indicadores relacionados à gestão de risco na utilização de medicamentos e cálculo dos percentuais de cumprimento das atividades previstas nos indicadores (variável desfecho) com posterior correlação a variáveis que poderiam influenciar seus resultados por meio de regressão linear. Resultados: A proporção média de apresentação dos itens previstos nos indicadores relacionados à gestão de risco foi de 28,3%. Menos da metade dos leitos ativos tinha dose individualizada como sistema de distribuição de medicamentos. Foram realizadas 48 notificações de farmacovigilância no período. Os parâmetros que influenciaram a variável desfecho foram: programação para capacitação de pessoal, horas de funcionamento da FH com farmacêutico, leitos ativos com dose individualizada e percentual de cumprimento dos serviços farmacêuticos (p < 0,05). Conclusões: Os resultados remetem à necessidade de adequação e monitoramento dos serviços visando intervenções racionais que busquem tornar o processo de utilização de medicamentos mais seguro, perpassando pela implantação de modelos de gestão relacionados à FH.