The level of understanding of taking medicine was examined at the start and the end of medicine-taking guidance, based on the estimation by pharmacists and inpatients. Six items for the estimation, such as``the way of taking medicines'' were evaluated using aˆve-grade system. The signiˆcant improvement was observed in all items, suggesting that inpatients' understanding is improved by the guidance. A markedly positive correlation was found between the estimation by inpatients and that by pharmacists ( p<0.001). This conˆrms the appropriateness of estimation by pharmacists. Inpatients whose estimation was signiˆcantly diŠerent from that by pharmacists (diŠerence of two grades or more) were examined to identify clear and potential problems with taking medicine. The problems were classiˆed into such seven categories as``types of medicine''. For each item with diŠerences in estimation (two grades or more), problems were biased in some speciˆc categories. On the basis of such a bias, a ‰ow chart was prepared to clarify problems. In addition, a standard pharmaceutical management and guidance services program was drafted, in which measures in observation, treatment and education against problems by pharmacists were described according to the frequency of occurrence. Information about the program available on the Internet enables its use by other hospitals.
Infections caused by multiple-drug-resistant Pseudomonas aeruginosa (MDRP) are a clinically signiˆcant problem. We reported here the eŠective use of combination therapy in a patient with infection caused by MDRP according to an interventional treatment strategy suggested by a pharmacist. The patient was a 70-year-old male who underwent allogeneic hematopoietic stem cell transplantation. On day 45 after transplant, MDRP was newly isolated from urine, but the diagnosis at that time was colonization. On day 61, the patient developed a fever ( 38.0°C). In addition, laboratory data showed that C-reactive protein (CRP) was also increased. At the medical team conference, the pharmacist proposed the following treatment strategy for this infection. Aztreonam and amikacin were intravenously administered at doses of 2 g/day and 800 mg/day, respectively. The subsequent clinical course was well controlled, but the infection recurred and was aggravated. Aztreonam and cipro‰oxacin were then intravenously administered at doses of 4 g/day and 600 mg/day, respectively, resulting in the alleviation of fever in the patient as well as a decrease in CRP and disappearance of MDRP isolates from urine on day 67; that is, MDRP infection was consequently well controlled. In conclusion, the combination therapy between aztreonam and amikacin, or cipro‰oxacin may be clinically useful for severe infections of MDRP in compromised hosts.
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