with LIN and after at least 3 days of combined therapy were analysed by liquid chromatography (HPLC). Oral VCZ clearance (CL/F in L/h) was estimated before (CL/Fb) and during treatment with LIN (CL/Fd LIN). It was assumed as VCZ therapeutic range 1.5-4.5 mcg/mL in Candida spp. infections and 2-4.5 mcg/mL in Aspergillus spp. Demographic variables (age, sex), treatment (dosing schedule, date and time of each administration), clinics (diagnosis, microbiological information, etc.) and kinetics (date and time of each sample extraction) were collected. Results Five patients were analysed with a median age of 67 years (range: 57-73), all of them males. Mean daily dose ±SD administered were 454.5±157.2 mg (VCZ) and 1,200 mg (LIN). Serum baseline concentration of VCZ before LIN was 2.7±0.8 mcg/mL. CL/Fb and CL/Fd of VCZ were, respectively, 6.3±1.7 L/h and 22.09±11.74 L/h, which represents a large increase of 250%. VCZ and LIN interaction generated infra-therapeutic VCZ concentrations in 80% of patients (n=4). Three patients had to change anti-infective treatment and two patients required increased VCZ dose up to 75% to reach at least the lower limit of the therapeutic range. Conclusion Adding LIN to VCZ treatment increases VCZ clearance between 250%-700% and serum antifungal concentrations decrease clinically. This translates into a loss of effectiveness in antifungal treatment in 80% of cases. Therefore, the use of this combination is contraindicated and if clinically there is no other alternative, VCZ pharmacokinetic monitoring is recommended to ensure the effectiveness of antifungal treatment.
Background Etanercept is a soluble tumour necrosis factor receptor fusion protein used in a variety of arthropathies. A new administration device (pen) has recently been marketed. Purpose To evaluate pain differences and preference between the etanercept syringe and pen as well as the relation between pain and demographic and anthropometric factors. Materials and Methods All patients with the etanercept pen from 1 January 2012 to 31 March 2012 who had previously used the syringe were chosen. Gender, age, Body Mass Index (BMI), diagnosis, self-administration, pain perception (0 = no pain; 10 = maximum pain) and device preference were recorded. Statistical analysis: Student’s t-test and variance analysis were used for comparisons of means, chi-square and Fisher’s test for proportions, and non-parametric tests for pain. Results109 patients (43% men; 57% women) met inclusion criteria. Mean age was 54 ± 13.5 years and mean BMI 26.5 ± 4.8 kg/m². 58.7% had Rheumatoid Arthritis, 19.3% Ankylosing Spondylitis, 1.8% Juvenile Idiopathic Arthritis, 16.5% Psoriatic Arthritis and 3.7% Psoriasis. 82% self-administrated the pen, and 71% the syringe. The median pain with the syringe was 3 [interquartile range (IQR): 2–6] and with the pen was 4 [IQR: 2–5] (P = 0.008). 65% reported the same pain with both devices. 35% reported differences in pain and most of them (71%) had much pain (>5) with the pen and little pain (<5) with the syringe. There was a statistically significant association of pain with gender: women had more pain with the pen (P = 0.03), but less with the syringe (p > 0.05). There was no association with BMI, age or diagnosis. 59% preferred the pen, 25% the syringe, and 16% did not mind. Conclusions An association of pain with pen device and female gender was found. However there was no association with BMI, age or diagnosis. Acceptance of the pen and self-administration were higher even though pain was greater, so it is necessary to maintain both devices to assure adherence. No conflict of interest.
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.
BackgroundA drug adjustment programme for patients with renal disease was started in 2013 in our hospital.In this system, information from the electronic prescription programme is linked (using an Access application) with information sent by the laboratory (creatinine) and with a list of drugs that may require renal adjustment. Afterwards, an adjustment warning for the physician is added to the electronic prescription programme.PurposeTo assess the acceptance by the physicians of pharmaceutical interventions in drug dosing in renal disease.Material and methodsThis prospective descriptive study was conducted in a tertiary university hospital with 1,200 beds. The study period was 39 days (from January 21st to March 20th, 2014).The pharmaceutical interventions were recorded during daily practice.The following data were collected: date of pharmaceutical intervention, clinical chart number, medical service, age, sex, creatinine, glomerular filtration rate, adjusted drug, adjustment warning.Finally, the degree of acceptance of these interventions by the physicians was reviewed.ResultsDuring the study period, 153 patients (mean age 75.3 years, 78 male and 75 female) were included and 271 renal adjustment interventions were performed (mean: 7 interventions per day).The degree of acceptance of the interventions was: accepted 84 (31.0%), partially accepted 25 (9.2%), not assessable 49 (18.1%), not accepted 112 (41.3%) and other (not an appropriate intervention) 1 (0.4%). Excluding not assessable and inappropriate interventions (finally 221 interventions), the result was: accepted 84 (38.0%), partially accepted 25 (11.3%) and not accepted 112 (50.7%).ConclusionThe acceptance of pharmaceutical interventions by the physicians is approximately 40%, which is relatively low. One of the reasons of this low acceptance could be the location of the adjustment warning.Finally, it is necessary to consider what could be done to improve the acceptance of this type of pharmaceutical interventions.References and/or AcknowledgementsNo conflict of interest.
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