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Background:The main objective of the present systematic review is to identify potential risk factors for adverse drug reactions (ADRs) through prospective cohort studies in pediatric inpatients. Methods: The data search was done in the following electronic databases PubMed/MEDLINE; Scopus; LILACS and Web of Science from the earliest record until 31 May 2015. Two reviewers independently screened each study and one of them assessed the methodological quality according to the Newcastle-Ottawa scale for cohort studies. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies. Results:The only risk factor observed in all studies was the increase in the number of prescription drugs. However, other factors were identified, such as the increase in the length of stay or the number of low-or high-risk drugs prescribed, use of general anesthesia and oncological diagnosis. The cumulative incidence of ADR was 16.4% (95% confidence interval: 15.6 to 17.2). The main professional responsible for ADR identification was the pharmacist and the dominant category among the ADRs were gastrointestinal disorders. In addition, analgesics, antibacterial agents and corticosteroids were the drug classes commonly associated with ADRs. The methodology used in this study was tried to homogenize the data extracted; however, this was not sufficient to correct the discrepancies so it was not possible to perform a meta-analysis. Conclusions:The increase in the number of prescription drugs was the main risk factor in this population. However, additional studies are required to identify the risk factors for ADRs in pediatric inpatients.

A review based on personal experience and evidence of literature. Eur J Endocrinol 2005;153:723-735. 4. Randeva HS, Schoebel J, Byrne J et al. Classical pituitary apoplexy: Clinical features, management and outcome. Clin Endocrinol (Oxf) 1999;51:181-188. 5. Shimon I, Benbassat C, Hadani M. Effectiveness of long-term cabergoline treatment for giant prolactinoma: Study of 12 men. Eur J Endocrinol 2007;156:225-231. 6. Webster J, Piscitelli G, Polli A et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 1994;331:904-909. 7. Orrego JJ, Chandler WF, Barkan AL. Rapid re-expansion of a macroprolactinoma after early discontinuation of bromocriptine.To the Editor: Population aging is a worldwide phenomenon that has contributed to the growing number of residents in long-term care facilities (LTCFs). This elderly population has more symptoms and chronic diseases and uses more medications than younger people. Recently, the literature has shown the importance of multidisciplinary staff in the care of older adults. The active participation of the pharmacist is essential to the management of complex drug therapy regimens and the reduction of drug-related morbidity and mortality in this population. 1 Therefore, this review aimed at analyzing the research quality of pharmaceutical interventions in elderly residents of LTCFs. METHODSA search was conducted to identify intervention studies involving pharmacists in LTCFs. The Medline, Scopus, Scielo, and LILACS databases were reviewed from January 1988 to December 2008, using pharmacists, elderly, pharmaceutical services, multidisciplinary approach, nursing homes, and long-term care facilities as keywords.The subsequent screening process was performed in three stages. Titles and abstracts were compared with the following predefined inclusion criteria to determine the relevance of the theme: if the study was performed in a LTCF, if the study involved intervention, and if the intervention process involved the participation of a pharmacist. Studies that focused on intervention with a single medication (or medication group) or a specific disease and that were not conducted entirely in a LTCF were excluded, as were those that were not written in English or did not provide the full text.The studies that satisfied the inclusion criteria for data extraction were carefully examined regarding the following variables: scenario of the study, type of study, professionals participating in the intervention process, type of intervention used, and its results. RESULTSAt the end of the review, only seven articles met the specific inclusion criteria (Table 1). Five articles were controlled clinical trials, 2-6 only one of which was not randomized. 5 One of the articles was classified as longitudinal, with evaluation of the study group before and after interventions, 7 whereas another study did not describe its methodology. 8 In three of the seven studies, the pharmacist was the only provider in the int...

PurposeThe present study aims to identify the risk factors for adverse drug reactions (ADR) in pediatric inpatients.MethodsA prospective cohort study in one general pediatric ward in a hospital in Northeast Brazil was conducted in two stages: the first stage was conducted between August 17th and November 6th, 2015, and the second one between March 1st and August 25th, 2016. We included children aged 0–14 years 11 months hospitalized with a minimum stay of 48 hours. Observed outcomes were the ADR occurrence and the time until the first ADR observed. In the univariate analysis, the time to the first ADR was compared among groups using a log-rank test. For the multivariate analysis, the Cox regression model was used.ResultsA total of 173 children (208 admissions) and 66 ADR classified as “definite” and “probable” were identified. The incidence rate was 3/100 patient days. The gastro-intestinal system disorders were the main ADR observed (28.8%). In addition, 22.7% of the ADR were related to antibacterials for systemic use and 15.2% to general anesthesia. Prior history of ADR of the child [hazard ratio (HR) 2.44; 95% confidence interval (CI) 1.19–5.00], the use of meglumine antimonate (HR 4.98; 95% CI 1.21–20.54), antibacterial for systemic use (HR 2.75; 95% CI 1.08–6.98) and antiepileptic drugs (HR 3.84; 95% CI 1.40–10.56) were identified risk factors for ADR.ConclusionsWe identified as risk factors the prior history of ADR of the child and the use of meglumine antimonate, antibacterial for systemic use and antiepileptic drugs.

Background According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials. Methods This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018. Results During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days. Conclusions The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.

Resumo Esse estudo tem como objetivo refletir sobre os Determinantes Sociais da Saúde na cidade de Belém (PA) e a atuação da Atenção Primária à Saúde no enfrentamento à pandemia de COVID-19. A partir da utilização de dados secundários e da caracterização do município, foi possível refletir sobre os aspectos de habitação, saneamento básico e renda da população na distribuição dos casos de COVID-19 na cidade. Evidenciou-se que as desigualdades sociais entre os Distritos Administrativos são preponderantes, todavia não houve a elaboração de um plano de ação que considerasse os impactos de COVID-19 nas populações em vulnerabilidade social. Ao investigar o papel da Atenção Primária à Saúde no controle da pandemia, percebe-se que a baixa cobertura da Estratégia Saúde da Família aliada às ações desarticuladas entre município e estado podem ter contribuído para o agravamento epidemiológico da COVID-19 em Belém. O plano de contingência não conseguiu implementar políticas contundentes para o controle da doença, focando na medicalização e nas ações hospitalocêntricas para os casos graves, enquanto as unidades de saúde foram subutilizadas, faltando estabelecer um fluxo coordenado de cuidados para os pacientes com a COVID-19, uma doença fortemente atrelada às iniquidades sociais.

Objective To evaluate unlicensed and off‐label prescription and use of drugs to children in primary health care. Methods This is a systematic review that was written based on Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA). The studies were extracted from the databases: LILACS, PubMed/MEDLINE, and Scopus. Studies in English, Spanish or Portuguese with abstract available regarding the use and prescription of off‐label and unlicensed drugs to children aged 0‐18 years in primary health care were included. The evaluation of the titles, abstracts and Full‐text were performed independently by two reviewers, and the divergences were resolved by a third reviewer. Results Six studies were included. The incidence of off‐label prescription varied from 29.5% to 51.7% in relation to the total number of drugs prescribed. The prevalence of off‐label drugs ranged from 31.7% to 93.5% in relation to the total number of drugs prescribed. It was observed a higher proportion of off‐label prescription related to age and dose. For unlicensed drugs, there was a small variation in incidence between 2.4% and 3.9%, relative to the total number of prescriptions, or between 2.4% and 10.0%, relative to the sample size. It was observed a higher proportion of unlicensed prescription related to children under 2 years of age. Conclusions The unlicensed and off‐label prescription of drugs is recurring in the pediatric population of primary health care. It is necessary to have better information on these drugs by the regulatory agencies and the pharmaceutical industries for rational use of drugs in children.