Medicamentos potencialmente inapropiados según criterios MARC, STOPP y PRISCUS en una cohorte de pacientes VIH+ de edad avanzada

Introducción: El aumento de la supervivencia de la población VIH+ va asociado a un aumento de las comorbilidades y el número de fármacos prescritos. Se ha observado que la prevalencia de medicamentos potencialmente inapropiados (MPI) en pacientes VIH es elevada. El objetivo de este estudio es determinar la prevalencia de la presencia de MPI según los listados Marc, STOPP y Priscus en pacientes VIH+ de edad avanzada. Material y métodos: Estudio observacional, unicéntrico y retrospectivo. Se incluyeron los pacientes VIH+ mayores de 65 años con tratamiento antirretroviral (TAR) activo y algún tratamiento crónico. Se realizó un análisis descriptivo expresando las variables cualitativas como porcentaje y las cuantitativas como mediana y percentil 25-75 e inferencial usando la prueba de Chi-cuadrado. Resultados: Se incluyeron 32 pacientes, 84,4% varones y mediana de edad de 70 años (RIC: 67-76). La mediana de comorbilidades fue 4 (RIC: 2-6) y el patrón de multimorbilidad más frecuente fue cardiometabólico (73,9%). En el TAR hubo predominio de biterapia (59,4%). El 75,0% de los pacientes presentaron polifarmacia siendo el 65,6% polifarmacia mayor. El patrón de polifarmacia predominante fue el cardiovascular (66,7%). El 34,4% presentaron carga anticolinérgica elevada. El porcentaje de MPI según el listado Marc, STOPP y Priscus fue de 71,9%, 37,5% y 12,5%, respectivamente (p<0,001). La presencia de algún MPI no se ve afectada por la edad, sexo o polifarmacia. Conclusión: Polifarmacia y MPI presentan una prevalencia elevada. Existe una gran variabilidad en el porcentaje de pacientes que presenta MPI según el listado aplicado. La edad, sexo y presencia de polifarmacia no son factores predisponentes a presentar MPI.Introduction and objectives: HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities and pharmacotherapeutic complexity. The prevalence of potentially inappropriate medication (PIM) is high in HIV patients. The aim of this study is to determine the prevalence of PMI according to Marc, STOPP and Priscus list in HIV+ older patients. Patients and methods: A retrospective observational single cohort study was conducted. Patients included were HIV patients over 65 years of age on active antiretroviral treatment and chronic concomitant medication. Quantitative variables were given as median and interquartile range (IQR). Qualitative variables were given as percentages (%). Inferential statistics was given using Chi-square test. Results: The sample consisted of 32 patients with a median age of 70 years (IQR: 67- 76), 84,4% males, were enrolled into the study. The median of comorbidities per patient was 4,0 (IQR: 2,0-6,0), the predominant pattern of multiborbidity was cardiometabolic (73,9%). There was a predominance of dual therapy (59,4%). A 75,0% of patients had polypharmacy, being major polypharmacy in 65,6% of cases. Regarding the pattern of polypharmacy, 66,7% had a cardio-metabolic pattern. A 34.4% had a high anticholinergic load. The percentage of PMI according to the Marc, STOPP and Priscus lists was 71.9%, 37.5% and 12.5%, respectively (p <0.001). The presence of any MPI is not affected by age, sex, or polypharmacy. Conclusions: Polypharmacy and PMI have a high prevalence. There is great variability in the percentage of patients with MPI according to the list applied. Age, sex, and presence of polypharmacy are not predisposing factors for presenting PMI.Universidd de Sevilla. Máster en Especialización Profesional en Farmaci

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally

Prevalencia de medicamentos potencialmente inapropiados según criterios Marc, STOPP y PRISCUS en una cohorte de pacientes VIH+ de edad avanzada. Proyecto COMMPI

Introduction. The objective is to determine the prevalence of potentially inappropriate drugs according to the Marc, STOPP, and PRISCUS lists in elderly HIV patients. Patients and methods. It was an observational, retrospective, and multicenter study. People living with HIV 65 years or older who underwent chronic concomitant treatment were included. Descriptive and multivariate analyzes were performed to study the association between polypharmacy and potentially inappropriate medication compliance. Results. A total of 55 patients were included, 81.8% men and a median age of 69 years (IQR: 67-73). The median number of comorbidities was 3 (IQR: 2-5) and the most frequent pattern of multimorbidity was cardiometabolic (62.9%). The predominant antiretroviral treatment was triple therapy (65.5%). Polypharmacy was present in 70.9% of the patients and 25.5% had major polypharmacy. The most frequent polypharmacy pattern was cardiovascular (69.2%). The percentage of potentially inappropriate medications according to the Marc, STOPP and PRISCUS lists was 65.5%, 30.9% and 14.5%, respectively (p<0.001). Adjusted for age and sex, polypharmacy was not independently associated with potentially inappropriate medication compliance in any of the lists. Conclusion. Polypharmacy and potentially inappropriate medications have a high prevalence. There is great variability in the percentage according to the list applied. Age, sex, and presence of polypharmacy are not predisposing factors to the presence of potentially inappropriate medications.Introducción. El objetivo de este estudio es determinar la prevalencia de medicamentos potencialmente inapropiados según los listados Marc, STOPP y Priscus en pacientes VIH+ de edad avanzada. Pacientes y métodos. Estudio observacional, transversal y multicéntrico. Se incluyeron aquellos pacientes VIH+ mayores de 65 años en tratamiento antirretroviral y tratamiento concomitante crónico. Para conocer la asociación entre polifarmacia y presencia de medicación potencialmente inapropiada se llevaron a cabo análisis descriptivos y multivariante. Resultados. Se incluyeron 55 pacientes (81.8% hombres); mediana de edad 69 años (RIQ 67-73). Todos presentaban alguna comorbilidad (mediana 3, RIQ 2-5). El patrón de multimorbilidad más frecuente fue cardio-metabólico (62.9%). La triple terapia fue el esquema de tratamiento antiretroviral predominante (65.5%) y el patrón de polifarmacia más frecuente fue el cardiovascular (69.2%). Se identificó presencia de polifarmacia en un 70,9% y un 25,5% polifarmacia mayor. El cumplimiento de algún criterio según el listado Marc, STOPP y PRISCUS observó en 65,5%, 30,9% y 14,5% de los pacientes (p<0.001). Según análisis multivariante se observa que la edad, sexo o presencia de polifarmacia no son factores determinantes de presencia de medicamentos inapropiados en los listados. Conclusión. La prevalencia de medicación potencialmente inapropiada según los listados utilizados fue alta, existiendo una gran variabilidad en la identificación entre las diferentes herramientas. Edad, sexo y polifarmacia no son factores predictivos de presencia de medicamentos potencialmente inapropiados

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B

Background There are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate.Objective To determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence.Methods We conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1-48, weeks 48-96, and weeks 96-144); and a Kaplan-Meier analysis to evaluate the evolution of persistence.Results A total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (

Escribimos nuestra historia : Aprendizaje Basado en Proyectos

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2017/2018. Modalidad ASe presenta una proyecto llevado a cabo en el CEIP Enrique Iglesias García (Badajoz) encuadrado en la metodología de trabajo por proyectos que pretende mejorar la adquisición de las destrezas básicas y un mejor conocimiento de Europa, su historia y su cultura. Además de estos objetivos generales se quería conseguir la ampliación de conocimientos de los docentes sobre la historia del hombre, la evolución de la Unión Europea y del mundo globalizado, el desarrollo de nuevos métodos para educar ciudadanos europeos comprometidos con valores como la democracia, la diversidad y la conservación del planeta, el desarrollo, dentro de las competencias básicas, de la lingüística, la matemática y la cultura, y crear un compromiso para una sociedad futura europea. El producto del proyecto fue un Big Book donde se reflejó todo lo aprendido. Hubo una participación destacable de la biblioteca del centroExtremaduraES

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64–81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p &lt; 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity