BackgroundSeveral classifications to identify and avoid use of potentially inappropriate medications (PIMs) in the elderly have been published. To what extent these classifications match each other and whether there are differences in the prevalence of PIM use at admission, during the inpatient stay and at discharge are largely unreported.ObjectivesTo determine the PIM prevalence in elderly patients at a university hospital, with a special focus on different classification systems and the chronological sequence, and to examine a possible association between PIM use and the reason for admission, as well as severe side effects and consequences of PIM use during hospitalization.MethodsOn the basis of the criteria provided by FORTA (Fit for the Aged), PRISCUS (Latin for ‘time-honoured’) and STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions), medication in patients over the age of 65 years was screened retrospectively within four point prevalence analyses at admission, during the inpatient stay and at discharge. Evaluation of a possible association between PIM use and the primary diagnosis or severe side effects during hospitalization was performed according to an analysis using the World Health Organization Uppsala Monitoring Centre system for standardized case causality assessment.ResultsOf 200 patients, 176 (88 %) received at least one PIM at admission, during the inpatient stay and/or at discharge (116 patients according to FORTA, 113 according to PRISCUS and 138 according to STOPP). When the PIM prevalence was compared between the three different sets of criteria, STOPP identified significantly more patients receiving PIMs than FORTA (P = 0.022) and PRISCUS (P = 0.010). At the patient level and at the drug level, the use of PIMs increased during the inpatient stay; however, the PIM prevalence was similar at admission and at discharge, both at the patient level and at the drug level.ConclusionMedication is rated significantly differently by FORTA, PRISCUS and STOPP. In addition, a significant rise in prescribing of PIMs during the inpatient stay illustrates that a reduction in PIM use during the inpatient stay is essential, as it is known that avoiding PIM use in older adults is one strategy to decrease the risk of adverse events.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-016-0085-2) contains supplementary material, which is available to authorized users.
Severe infectious complications remain the main cause of mortality in leukemia patients due to a long period of profound neutropenia. Standardized regimens for antimicrobial, antifungal, and antiviral prophylaxis and therapy in neutropenic patients have improved infection-associated mortality. Nevertheless, many patients are refractory to these multidrug approaches. Tigecycline is a last-resort antibiotic with a broad-spectrum activity; unfortunately, clinical experience in multidrug-resistant febrile neutropenia is limited. The aim was to evaluate the efficacy of tigecycline treatment in comparison to standard treatment in this patient cohort. In this single center analysis, we analyzed the clinical courses of 73 patients with acute leukemia and diagnosis of febrile neutropenia resistant to hospital-based multidrug escalation levels who continued on a standard approach without antibiotics as the last resort (n = 30) or were switched to tigecycline in addition to carbapenem treatment (n = 43). We observed comparable overall response rates (decrease in C-reactive protein or resolution of fever) in both patient cohorts. Switching the antibiotic approach to tigecycline showed lower absolute sepsis (33% vs. 47%, p = 0.235) and infection-associated mortality rates (5% vs. 13%, p = 0.221). Prospective larger randomized studies are necessary to underline these results and to be able to generate reliable statistics.
Background Certain drugs are classified as potentially inappropriate medication (PIM) for the elderly because they bear an increased risk of adverse drug events resulting in major safety concerns. Several classifications have been published to identify and avoid PIM. For this study FORTA [1] (fit for the aged), PRISCUS [2] (Latin: time-honoured) and STOPP [3] (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) criteria have been chosen as the most relevant ones. PurposeThe aims are to determine which PIM are taken by elderly patients at University Medical Center Hamburg-Eppendorf (UKE) and how the prevalence of PIM changes from admission to discharge. Materials and MethodsBased on the criteria provided by FORTA, PRISCUS and STOPP, medication of patients >65 years is screened within three point prevalence analyses at admission, during inpatient stay and at discharge, respectively. Medication is recorded and correlated to diagnoses and reason for admission. Patients are included in the study if they were admitted via the emergency department with at least five drugs prescribed on admission. Results 660 patients were screened until 10/2012. 107 patients met the inclusion criteria, 63% of them were female, 64% (68/107) received at least one PIM at admission (48, 29 and 50 patients as defined by FORTA, PRISCUS and STOPP, respectively; multiple classifications possible), 82% (88/107) received PIM during inpatient stay (59 FORTA, 62 PRISCUS, 55 STOPP) and 57% (61/107) at discharge (40 FORTA, 27 PRISCUS, 48 STOPP). Zopiclone was the most often (29%) prescribed PIM during inpatient stay. Conclusions Data of the interim analysis show that a high proportion of inpatients received PIM. Once the data acquisition is completed, further evaluation is needed to determine the consequences of PIM use, the correlation to reason for admission, which classification is best to detect PIM in hospitals and how the use of PIM at UKE can be minimised. References M. Wehling, H. Burkhardt: Arzneitherapie für Ältere, Springer, 2. Auflage, 2011 Dtsch Arztebl Int, 2010;107(31–32):543–51 Int J Clin Pharmacol Ther, 2008 Feb;46(2):72–83 No conflict of interest.
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