The comprehensive ASPs had long-term efficacy for reducing the use of the targeted broad-spectrum antibiotics, maintaining the antibiotic susceptibility of P. aeruginosa, and decreasing the prevalence of MRSA, without adversely affecting clinical outcome.

This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes.Methods: A before-after study was conducted to compare the data for one year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral thirdgeneration cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of ß-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillinresistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality.Results: The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. 4Conclusion: Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.

Alendronate, an oral bisphosphonate (e.g., Fosamax ), is eŠective in the treatment of osteoporosis, and the Fosamaxpackage insert advises that the bioavailability is reduced when taken with mineral water containing high levels of metal cations (Ca 2＋ , Mg 2＋ , etc.). However, standards regarding the water used when taking alendronate are unclear. In this study, the in‰uence of mineral water on the absorption of oral alendronate was investigated based on urinary excretion of its unchanged form in rats. Alendronate was diluted in each water sample and administered orally (0.7 mg/kg) to male Wistar rats after 24-hour fast. Urine samples were collected until 24 h after dosing. Urine samples were alkalinized, and alendronate in urine was precipitated as a calcium salt, followed by loading on an anion exchange cartridge. Eluted alendronate was derivatized with 9-‰uorenylmethoxycarbonyl (Fmoc) chloride and determined by HPLC with ‰uorescent detection. Cumulative urinary excretion recoveries of alendronate were calculated from the amounts of urinary excretion. Alendronate was rapidly excreted in theˆrst 6 h, and similar elimination rate constants were seen (from 0.28 to 0.45 h -1/2 ) among the water samples. Cumulative urinary excretion recoveries with tap water, evian  and 100％ deep ocean water were 0.98±0.17％, 0.80±0.18％ and 1.01±0.16％ (mean±S.E., n＝4). Those with Contrex (0.33±0.07％) were signiˆcantly lower when compared with ultrapure water (1.56±0.35％, p＜0.01). Theseˆndings suggest that the absorption of alendronate decreases based on the calcium concentration of mineral water. In conclusion, mineral water containing high levels of calcium is not recommended when alendronate is taken.

created a simplified 14-item protocol for resolving out-of-hospital prescription queries. The protocol was implemented in September 2016 in nine community pharmacies. If prescriptions were changed as per the new protocol or via typical query procedures, we asked community pharmacies to fax the changed prescriptions, and the hospital pharmacists, rather than medical doctors, modified the prescription history. To evaluate the effects of this simplified protocol, we examined the number of changed outpatient prescriptions and administered questionnaire surveys to community pharmacists and hospital-based medical doctors. The ratio of changed to total outpatient prescriptions decreased in January 2017 (4.1) compared with those in September 2016 (6.4). Ultimately, more than half of all outpatient prescriptions were changed by the protocol. Drug brand name changes accounted for 52 of the total changes during both September 2016 and January 2017, but the proportion of residual medicine adjustment increased from 12 in September 2016 to 26 in January 2017. Due to the questionnaire survey, 33 of surveyed medical doctors indicated that they knew or had heard of the protocol, and 54 responded that the protocol decreased the burden of addressing outpatient prescription queries. The community pharmacies reported that the burden of clarifying outpatient prescription queries decreased. In conclusion, implementation of the simplified protocol for outpatient prescription queries improved medical efficiency and may help promote cooperative streamlining of community patient pharmaceutical care services.