Vancomycin Utilization Evaluation in a teaching hospital: A case- series study in Iran.

Background: Increasing antimicrobial resistance is now a critical point of human being in the world. Especially wide spectrum antibiotics resistance germs like vancomycin-resistant enterococci (VRE) should be dealt as soon as possible as an emergency conflict. Our study tries to reveal the amount of irrational use of vancomycin in a teaching hospital in Iran. Methods: We elected the whole inpatients that received vancomycin between February 2007 and May 2008. Results: Forty four out of those 45 patients had inappropriate indication and dosing regimen of vancomycin (97.7%). The most use of vancomycin was recorded in hematology – oncology ward and then Intensive Care Unit (ICU). Culture responses were negative despite great clinical evidence of infection. Conclusion: Vancomycin irrational use was high compared to other countries and it could be concerned as a major health problem by health policy makers and physicians to deal. However more detailed researches are needed to reveal the other aspects of this problem. Implementation of antibiotic protocols and standard treatment guidelines are recommended

Assessment of Effectiveness and Adverse Effect of New Combination Chemotherapy (irinotecan, cisplatin, and dexamethasone) in Relapse and Refractory Hodgkin Lymphoma

Background: Chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) cannot cure all patients with Hodgkin lymphoma. In this study, we evaluated the efficacy and adverse effect of a new regimen consist irinotecan, cisplatin, and dexamethasone (ICD) in relapsed and refractory Hodgkin lymphoma as the second to fifth line of treatment. Materials and Methods: We performed a retrospective study in 26 relapsed or refractory patients with Hodgkin lymphoma receiving at least the first-line chemotherapy regimen (ABVD) and (ICD) as salvage therapy in Thaleghany Hospital from 2012 to 2018. This regimen consisted of irinotecan 65mg/m2 D1, D8, cisplatin 30mg/m2 D1, D8, and dexamethasone 40mg D1, 2, 8, and 9 was administered every 3 weeks for 6 cycles.  Treatment was discontinued in cases of disease progression or severe toxicity. Response to treatment was evaluated after two cycles. Patients with complete and partial remission were candidate high dose chemotherapy and autologous stem cell transplantation. Twenty-four patients were enrolled in the study. The mean age of 22 patients was 31.5 (19-67) years. Seven patients (29.1%) were in the first recurrence, and 17 (70.8%) were in the second or subsequent recurrence. Results: According to this study, three patients (12.5%) had complete response, 13 (45%) had partial response, four (16.6%) had stable disease, and four (16.6%) had progressive disease. Nine patients (37.5%) received high-dose chemotherapy and autologous stem cell support after ICD regimen. None of the cycles of chemotherapy were delayed due to treatment-related adverse event. Overall survival after six months in all patients was 91%, and mortality rate was 8.3% at the end of the study. Conclusion: The goal of salvage chemotherapy in relapsed or refractory Hodgkin Lymphoma is achieving CR or PR preparation patients for stabilization with BMT. Thus, we recommend ICD as one of the most effective protocols with overall response rate of 66% in this population.  

Effect of Memantine on Positive Sign in Patients with Schizophrenia and Schizoaffective Disorders: A Randomized Double Blind Placebo Controlled Trial

Background and purpose: Memantine is a medication used to treat moderate to severe Alzheimer’s disease. Memantine targeting the glutamatergic system specifically N-Methyl-D-Aspartate offer a novel approach in treatment of psychiatric disorders such as schizophrenia and schizoaffective disorder. The purpose of this study was to evaluate the efficacy and safety of memantine in combination with antipsychotics in patients with schizophrenia and schizoaffective disorder. Materials and methods: A double-blind, placebo-controlled trial was performed in patients aged 18-65 years old with confirmed diagnosis of schizophrenia and schizoaffective disorder. Those who were pregnant, allergic to memantine, and not willing to participate in the study were excluded. Participants were assigned to receive either memantine (5-20 mg/day) (n= 29) or placebo (n= 29), in addition to antipsychotic for 90 days. The Positive and Negative Syndrome Scale (PANSS) was completed at baseline and day 30 and 90. Results: The study showed no significant difference in reduction of PANSS scores for positive sign between the treatment group (6.32±7.17) and controls (4.17±6.25) (P=0.07). Conclusion: Memantine was found to have no effect on positive sign of schizophrenia and schizoaffective disorder.   (Clinical Trials Registry Number: IRCT: 201310083210N5

Effect of vancomycin as antibiotic lock technique in prevention of catheter associated infection in stem cell transplantation patients: Vancomycin lock after HSCT

Introduction: This trial assessed the efficacy of vancomycin lock solution in reducing catheter-related blood stream infections among bone marrow transplantation patients who were transplanted using tunneled catheters. Methods and Results: patients randomly received either heparin only (control group) or a mixture of 5 mg/ml vancomycin and 2500 U/ml heparin (antibiotic group) as catheter lock solution. Results: The control group, CRBSIs rates per1000 catheter-days was significantly lower (0.1609 vs 6.214 events; p=0.0265, Hazard ratio 4.924 %95 CI of ratio1.238-31.20) and BSI (Blood Stream Infection) rates per 1000 catheter-days was significantly lower (0.2744vs 3.644events; p=0.0073, Hazard ratio 7.209 %95 CI of ratio (0.03205-0.808)). More over, The cumulative infection-free catheter survival was significantly higher (log rank statistic 4.924 p=0.0265) in the antibiotic group and cumulative infection-free survival was significantly higher (log rank statistic 7.209 p=0.0073) in the antibiotic group compared with the control group. There is no significant difference in catheter removal incidence (27.27% in the antibiotic group vs 15.38% in the control group; p=0.245) between the two group. Conclusion: Vancomycin containing catheter lock solution is effective in reducing CRBSIs incidence and prolonging central vein catheter survival in Hematopoietic stem cell transplantation (HSCT) patients

Medication Errors in Administration of Chemotherapeutic Agents: an Observational Study: Medication Errors in Administration of Chemotherapeutic Agents

Chemotherapy medication errors may lead to potentially harmful consequences while most of them could be preventable. This study aims to determine the incidence and type of drug handling and administration errors among the nurses and to identify possible contributing factors. Setting of the study was a teaching hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. To attain the study objectives, an observational, cross-sectional study was performed in the haematology and oncology wards of the hospital. A checklist consisting of appropriate process of handling, preparation and administration of injectable chemotherapy agents was developed and used by a trained pharmacist. In addition, socio-demographic characteristics of nurses were recorded. The primary outcome was the number and type of medication errors in chemotherapy administration according to the prepared check lists. Overall, administration processes of 544 chemotherapy medications, consisting of 8322 error opportunities, were observed of which 2705 (32.5%) errors were detected. 52.8% (2926/5532), 15.5% (254/1635) and 26.5% (306/1155) of the errors were in the handling, preparation and injection stages, respectively. The top 5 drugs with the highest risk of errors were metotraxate 45.4% (20/44), fluorouracil 38.5% (439/1139), cyclophosphamide 37.1% (267/719), vincristine 34.8% (240/689) and etoposide 33.5% (125/373). Our results revealed a substantial occurrence rate of medication errors during preparation and administration of injectable chemotherapy agents, which are often made by nurses who fail to follow relevant nursing standards. This confirms that educational programs and advanced pharmaceutical care services are required for safe preparation and administration of intravenous chemotherapy agents

A 16 Month Survey of Cyclosporine Utilization Evaluation in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Abstract Objectives: Graft versus host disease (GVHD) is a life threatening reaction in the stem cell transplantation process. Nowadays Cyclosporine is the most commonly utilized agent for GVHD prophylaxis and it has a major role in successful transplantation. Cyclosporine has been applied for many years in this field but it could be stated that currently no general consensus is available for its optimal method of administration. Conditions related to cyclosporine administration and possible related adverse reactions observed closely in our patients with the aim of constructing a comprehensive practice guideline in the future. Patients and Methods: Allogeneic stem cell transplant recipients who have been taking cyclosporine were monitored during and after their hospitalization while recording all observations on predefined questionnaires on the basis of periodic clinical and laboratory examinations for a 16 month period. Results: Mean recorded duration of infusions was 1.44 ± 0.68 h and by twice daily administration, means intravenous and oral dose was 101.85 ± 22.03 mg and 219.28 ± 63.9 mg, respectively. A mean CsA trough level after about 12 h of specified unique doses was 223 ± 65 ng/mL. We found hypertension, nephrotoxicity, neurotoxicity, hypertension, and dyslipidemia in about 14, 20, 48, and 94 percent of patients. Conclusions: This study proposed that permanent guidance of healthcare team according to a fixed and standard method of cyclosporine administration routine with using efficient facilities and protocols would be helpful considerably for an optimal pharmacotherapy

Comparison of some physical parameters of different brands of acyclovir tablets marketed in Iran: Quality control of acyclovir tablets

Acyclovir is the nucleoside analogue of guanosine, which is used as an antiviral drug. Since the quality requirements set for a higher quality product are necessary, the purpose of this study was to investigate the quality control characteristics of selected Iranian brands of acyclovir 400 mg tablets. Different brands and batches of acyclovir tablets were collected and subjected to various quality control tests such as weight variation, friability, hardness, disintegration and dissolution. The results obtained for all the selected brands of acyclovir were in acceptable range and, it can be stated that all brands of acyclovir tablets met the specification in quality tests

Evaluation and improvement of venous thromboembolism prophylaxis pattern in patients admitted to orthopedic ward in a tertiary teaching hospital: Improvement of VTE prophylaxis

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE incidence in major orthopedic surgery ranges from 40% to 60%. Several risk factors are responsible for VTE incidences, such as age, obesity and immobility. This study was designed and performed to evaluate the process of thromboprophylaxis in patients undergoing orthopedic surgery with and without pharmacist intervention to improve prescribing. A total of 306 patients were randomly enrolled in the two phases of this study. To investigate the cause of VTE, 201 patients receiving no pharmacist interference as study phase one and 105 patients receiving pharmacist interference as study phase two were evaluated. Rate of occurrence of risk was calculated using the Caprine scoring system. The trend of prescription and the reasons for not prescribing the drugs under consideration for the patients, were investigated. As a subsidiary aim to the study and to increase economical productivity, the prescription of heparin instead of other anticoagulating drugs was suggested in pharmacotherapy consultation. In the first phase of the research, it was proven that 161 (80.1%) of the patients under consideration needed the prophylaxis but 40 (19.9%) of them did not. After the investigation, 171 (85.1%) of the patients according to the guideline and 30 (14.9%) without considering the guideline underwent prophylaxis. In the second phase of the research, 40 (38.1%) of the patients did not require prophylaxis treatment but 65 (61.9%) did. After investigation and drug interaction results, 96 (91.43%) according to the guideline and 9 without considering the guideline were treated with the prophylaxis drug. Despite the active presence and cooperation of pharmacists, 4.76% who did not need prophylaxis received it, and 6.15% who needed prophylaxis did not receive it despite the pharmacist's intervention. Moreover, 2.86% of patients who were prohibited from taking enoxaparin were allowed to take heparin after pharmacist intervention. This research showed that active cooperation between orthopedist and pharmacist in prescribing the required drug(s) is very low. For this reason, the continuous presence of a pharmaceutical group as well as changes in protocols can serve as an effective, logical step in the prescription of drugs