Las estatinas en el tratamiento de la enfermedad del alzheimer

La enfermedad de Alzheimer es el tipo más común de demencia y su prevalencia se ha incrementado significativamente en los últimos años. Se trata de una enfermedad neurodegenerativa que ocasiona una gran preocupación en la sociedad, debido al grave deterioro cognitivo que experimentan aquellas personas que la padecen; es por ello que se están realizando numerosas investigaciones para lograr un tratamiento efectivo para esta patología, y así, mejorar la calidad de vida de todos los pacientes que la sufren. Recientes estudios valoran la posibilidad de emplear las estatinas, fármacos indicados para el tratamiento de la hipercolesterolemia, en el Alzheimer, ya que podría existir cierta conexión entre el mecanismo de acción de estos fármacos y la fisiopatología de la enfermedad. El objetivo principal de este estudio ha sido recopilar la información más relevante sobre la eficacia del uso de las estatinas en el tratamiento del Alzheimer. Para ello, se ha llevado a cabo una búsqueda bibliográfica en las principales bases de datos biomédicas de estudios que evaluasen la eficacia de las estatinas en el Alzheimer, acotando dicha búsqueda a los últimos 16 años. Se encontraron un total de 705 artículos, de los cuales 14 de ellos fueron los seleccionados para su estudio: 7 ensayos clínicos, 2 meta-análisis y 5 revisiones sistemáticas. Tras evaluar los distintos estudios elegidos, se han realizado unas tablas donde se muestran las principales características de interés de los mismos. Tras examinar dichos artículos, se concluye que los estudios más recientes y de mayor validez científica no han obtenido resultados que reflejen una mejora en la cognición de aquellos pacientes diagnosticados de Alzheimer, por lo que, a día de hoy, y según la búsqueda realizada en este trabajo, las estatinas no parecen ofrecer ventajas o beneficios significativos en el tratamiento de la enfermedad de Alzheimer.Universidad de Sevilla. Grado en Farmaci

Systematic review of the efficacy of statins for the treatment of Alzheimer's disease

Alzheimer's disease (AD) is the most common type of dementia. Recent studies have assessed the possibility of using statins as treatment for AD. However, their efficacy is not clear. In this study, we collected the most relevant information about the efficacy of statins for the treatment of AD. We conducted a systematic literature search using MEDLINE, EMBASE and The Cochrane Library. We included clinical trials, meta-analyses and systematic reviews that analysed the efficacy of statins in AD. We also extracted the characteristics and efficacy results of the studies selected. Of the 304 articles identified, 13 complied with the inclusion criteria. The scientific quality of studies was high and their results indicated that there were no significant differences in the main efficacy variables between statins and placebo treatment for AD. Therefore, according to the available scientific evidence, statins have not shown an improvement in cognition and do not appear to offer significant benefits to patients with AD

Application of new indicators to assess the quality of antimicrobial use in intensive care units

This study explored the feasibility of a bundle of indicators aimed at assessing the quality of antimicrobial use in intensive care units (ICUs) through an observational prospective study spanning 12 quarters (January 2019-December 2021) in a 1290-bed teaching hospital in Spain. Members of the antimicrobial stewardship programme team selected the indicators to analyse the quality of antimicrobial use based on consumption data from a list proposed in a previous study. Antimicrobial use in the ICU was measured as defined daily dose (DDD) per 100 occupied bed-days. Trends and points of change were analysed with segmented regression. The intravenous macrolides/intravenous respiratory fluoroquinolones ratio in the ICU increased progressively, although not significantly, by 11.14% per quarter, likely related to prioritization of the use of macrolides in serious community-acquired pneumonia and the coronavirus disease 2019 pandemic. A remarkable upward trend of 2.5% per quarter was detected in the anti-methicillin-susceptible Staphylococcus aureus/anti-methicillin-resistant S. aureus agents ratio in the ICU, which could be explained by the low prevalence of methicillin-resistant S. aureus at the study centre. Patterns of amoxicillin-clavulanic acid/piperacillin-tazobactam ratio and diversification of anti-pseudomonal beta-lactams showed an increment in use over the study. The use of these novel indicators provides additional information for the current analysis of DDD. Implementation is feasible, and led to the detection of patterns that agree with local guidelines and cumulative antibiogram reports, and foster targeted improvement actions within antimicrobial stewardship programmes.A.B.G. receives financial support from Subprograma Juan Rodés, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spain (JR21/00017). G.P. receives a grant from the Plan Andaluz de Investigación, Desarrollo e Innovación, Consejería de Transformación Económica, Industria, Conocimiento y Universidades, Junta de Andalucía, Spain (Grant PAIDI2020/POSTDOC_21_00831). L.H. and M.M. receive financial support from Subprograma Río Hortega, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spain (CM19/00152 and CM21/00115).Peer reviewe

Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice

Paediatric Antimicrobial Defined Daily Dose Study Group KiDDDs.Currently, there is no validated method for estimating antimicrobial consumption in the neonatal population, as it exists for adults using Defined Daily Doses (DDD). In neonatology, although there are different methods, each one with advantages and disadvantages, there is no unified criterion for use. The aim of this study is to validate the neonatal DDD designed as a new standardised form of antimicrobial consumption over this population.M.M.-T. received financial support from the Subprograma Río Hortega, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spain (CM21/00115). The project has been carried out without financial funding but is supported by the Spanish Society of Hospital Pharmacy (SEFH), the Working Group on Pharmaceutical Care in Infectious Diseases of the SEFH (Afinf) and Spanish working group on paediatric pharmacy of the SEFH (gefp).Peer reviewe

Factibilidad de la implementación de una estrategia de desprescripción en la práctica clínica en pacientes pluripatológicos de edad avanzada. Estudio LESS-CHRON PROJECT

El envejecimiento poblacional y la mejora en las condiciones higiénico-sanitarias han provocado un aumento de la prevalencia de pacientes con enfermedades crónicas, concomitantes y de larga duración. Así, destacan los pacientes pluripatológicos (PPP) o con multimorbilidad, que representan hasta el 40% de los pacientes que pertenecen a la unidad de Medicina Interna y que se caracterizan por consumir gran cantidad de recursos sanitarios. Además, presentan alta complejidad y vulnerabilidad, lo que se traduce en una mayor dependencia, peor calidad de vida, necesidad de ingresos hospitalarios frecuentes y una elevada mortalidad. A todo lo anterior, se suma que estos pacientes están en su mayoría polimedicados, por lo que se encuentran expuestos a numerosos efectos adversos e interacciones, además de presentar mayor dificultad en la adherencia a los tratamientos. Consecuencia del alto grado de polifarmacia, sufren una alta carga terapéutica, lo que favorece la aparición de síndromes geriátricos, deterioro cognitivo y fragilidad, entre otros. En línea con lo expuesto, es frecuente que este grupo de pacientes tenga una alta prevalencia de prescripciones potencialmente inadecuadas de medicamentos (PIM), que hacen referencia a aquellos fármacos que están prescritos de forma innecesaria por diversos motivos, generando más riesgos que beneficios. La existencia de PIM afecta a la seguridad de los pacientes, pudiendo producir reacciones adversas, siendo muchas de ellas prevenibles. En la actualidad, se ha establecido que el abordaje de los PPP debe ser a través de una atención sanitaria centrada en la persona, donde la formación de un equipo multidisciplinar y el tener en cuenta las preferencias de los pacientes son elementos clave. El papel del farmacéutico dentro del equipo es fundamental, ya que la revisión exhaustiva de la medicación en estos casos ha demostrado reducir muchos de los problemas de salud asociados. De este modo, se han desarrollado diferentes estrategias para ayudar a la optimización farmacológica, entre las que encontramos la adecuación terapéutica, conciliación, adherencia y desprescripción. Este trabajo se centra concretamente en una de ellas, la desprescripción. Este término fue definido como la revisión y evaluación del plan terapéutico a largo plazo, que 18 permita suspender, sustituir o modificar la dosis de fármacos, que fueron prescritos adecuadamente, pero que, bajo ciertas condiciones clínicas, pueden considerarse innecesarios o con una relación beneficio-riesgo desfavorable. Para poder realizar esta actividad de forma sistemática y estructurada, se han diseñado herramientas de ayuda a la desprescripción. El grupo de investigación “Farmacoterapia y Cronicidad” (Chronic- Pharma), formado por un equipo multidisciplinar de médicos y farmacéuticos del Hospital Universitario Virgen del Rocío, creó en 2017 los criterios LESS-CHRON. Se trata de una lista de 27 escenarios que ofrecen oportunidades de desprescripción, organizados por sistemas fisiológicos. Esta herramienta ha sido sometida a un estudio de fiabilidad intra e interobservador. Sin embargo, los criterios aún no han sido validados ni implantados en la práctica clínica más allá de estudios aislados con objetivos muy específicos. El objetivo principal del presente trabajo fue analizar la factibilidad de implementar en la práctica clínica habitual una estrategia de desprescripción basada en los criterios LESS-CHRON, en una población mayor, con pluripatología y polimedicada

An Unusual Case of Allergic Reaction to Anakinra in a Patient with Tumor Necrosis Factor Receptor-1 Associated Periodic Syndrome (TRAPS) and Subsequent Canakinumab Treatment

Tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is a rare hereditary systemic autoinflammatory disease (SAID). Treatment is based on corticosteroids, but often requires the addition of a biologic drug (anti-TNF agent, IL-1 receptor antagonist, etc) to achieve symptom control. The addition of the second drug is not clearly defined and must take into account the characteristics and preferences of the patient. We describe a patient with TRAPS and an allergic reaction to anakinra which was difficult to manage clinically while alternative treatment was being identified

Target Attainment and Clinical Efficacy for Vancomycin in Neonates: Systematic Review

Vancomycin is commonly used as a treatment for neonatal infections. However, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen and defining the most appropriate PK/PD parameter correlated with the efficacy. A recent guideline recommends AUC-guided therapeutic dosing in treating serious infections in neonates. However, in clinical practice, trough serum concentrations are commonly used as a surrogate PKPD index for AUC24. Despite this, target serum concentrations in a neonatal population remain poorly defined. The objective is to describe the relationship between therapeutic regimens and the achievement of clinical or pharmacokinetic outcomes in the neonatal population. The review was carried out following PRISMA guidelines. A bibliographic search was manually performed for studies published on PubMed and EMBASE. Clinical efficacy and/or target attainment and the safety of vancomycin treatment were evaluated through obtaining serum concentrations. A total of 476 articles were identified, of which 20 met the inclusion criteria. All of them evaluated the target attainment, but only two assessed the clinical efficacy. The enormous variability concerning target serum concentrations is noteworthy, which translates into a difficulty in determining which therapeutic regimen achieves the best results. Moreover, there are few studies that analyze clinical efficacy results obtained after reaching predefined trough serum concentrations, this information being essential for clinical practice.LHH was supported by the Instituto de Salud Carlos III, Subprograma Rio Hortega (grant CM19/00152).Ye

Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship.Vancomycin is used to treat a wide variety of infections within the pediatric population. In adults, continuous infusion of vancomycin (CIV) has been evaluated as an alternative to intermittent infusion of vancomycin (IIV) with potential advantages. In children, the use of CIV is increasing; however, data is currently limited. The objective is to provide efficacy and safety evidence for CIV within this population. The review was carried out following PRISMA guidelines. A bibliographic search was performed for studies on PubMed and EMBASE. Clinical trials and observational studies that reported clinical efficacy and/or target attainment of CIV in pediatrics were included. Articles were reviewed to assess their design and target population, characteristics of vancomycin treatment and the main findings in terms of safety and efficacy. A total of 359 articles were identified, of which seven met the inclusion criteria. All of them evaluated the target attainment, six assessed safety but only three assessed clinical efficacy. The best administration method for this antibiotic within the pediatric population is still unknown due to limited evidence. However, studies conducted thus far suggest pharmacokinetic advantages for CIV. Further investigation is required, in particular for studies comparing IIV with CIV for clinical efficacy and toxicity outcomes.L.H.-H. was supported by the Instituto de Salud Carlos III, Subprograma Rio Hortega (grant CM19/00152)

Association between Vancomycin Pharmacokinetic Parameters and Clinical and Microbiological Efficacy in a Cohort of Neonatal Patients

Vancomycin pharmacokinetic/pharmacodynamic (PK/PD) targets have not been validated in the neonatal population as no specifically designed studies are available. The main goal of this study was to analyze the therapeutic vancomycin regimen, the 24-h area under the curve (AUC24), and the trough plasma concentration (Ct) obtained that achieved clinical and microbiological effectiveness in a cohort of neonates. This was an observational, prospective, single-center study covering a period of 2 years. Eligible patients were neonates and young infants who were undergoing treatment with intravenous vancomycin for ≥72 h with ≥1 Ct available. The primary outcome was the association of Ct and AUC24 with clinical and microbiological efficacy at the beginning (early clinical evolution [ECE]) and the end (late clinical evolution [LCE]) of treatment with vancomycin. A total of 43 patients were included, 88.4% of whom were cured. In ECE, the cutoff points of the receiver operating characteristic (ROC) curve were 238 mg · h/L (sensitivity of 61% and specificity of 88%) for AUC24 and 6.8 μg/mL (sensitivity of 61% and specificity of 92%) for Ct. In LCE, the Ct value was 11 μg/mL, with a sensitivity of 80% and a specificity of 92%. In this analysis, AUC24 was not considered a good predictor. Logistic regression showed that a vancomycin Ct of ≤6.8 μg/mL was associated with an unfavorable ECE (P = 0.001), being 18 times more likely to progress poorly compared to those with higher levels. AUC24 and Ct are good predictors of ECE in this population. Concentrations close to 7 μg/mL and an AUC24 of around 240 mg · h/L 48 h after antibiotic initiation seem to be sufficient to achieve clinical cure in most cases.Peer reviewe

Impact of medication reconciliation on health outcomes: An overview of systematic reviews

Background Recent systematic reviews and meta-analyses suggest that medication reconciliation (MR) is effective in decreasing the risk of medication discrepancies. Nevertheless, the association between MR and subsequent improved healthcare outcomes is not well established. Objectives This systematic review of reviews set out to identify published systematic reviews on the impact of MR programs on health outcomes and to describe key components of the intervention, the health outcomes assessed and any associations between MR and health outcomes. Methods PubMed, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS were searched from inception to May 2019. Systematic reviews of all study designs, populations, intervention providers and settings that measured patient-related outcomes or healthcare utilization were considered. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Two investigators performed study selection, quality assessment and data collection independently. Results Five systematic reviews met the inclusion criteria: 2 were rated as low quality and 3 as critically low quality. Reviews included primary studies in different settings (hospitals, the community and residential aged care facilities) that reported the impact of MR on mortality, length of stay, Emergency Department (ED) visits, readmissions, physician visits and healthcare utilization. Only one review reported results on mortality. However, healthcare utilization, which usually included ED visits and readmissions, was communicated in all reviews. Meta-analyses were conducted in all reviews except one. Medication reconciliation was not consistently found to be associated with improvements in health outcomes. Conclusions Few systematic reviews support the value of MR in achieving good patient-related outcomes and healthcare utilization improvements. The quality of the systematic reviews was low and the primary studies included commonly involved additional activities related to MR. There was no clear evidence in favor of intervention in mortality, length of stay, ED visits, unplanned readmissions, physician visits and healthcare utilization