Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study

Objective: We aimed to assess prescribing practices, compliance with guidelines, and outcomes for patients who were admitted to the authors’ institution with community-acquired pneumonia (CAP). Methods: We performed a single-center retrospective cross-sectional study of adults with CAP presenting during the 2019 influenza season. CAP severity was assessed using the CURB-65 risk score. The effect of CURB-65 risk score use on the rate of appropriate antimicrobial prescribing was assessed using the chi-square test and reported as odds ratio (OR). Fisher’s exact test was used to assess the relationship between prescribing appropriateness and patient outcomes. Results: Patients with low-risk CAP were most likely to be inappropriately prescribed antimicrobials (OR: 4.77; 95% confidence interval: 2.44–10.47). In low-risk CAP, the most common prescribing error was overuse of ceftriaxone. In high-risk CAP, the most common errors were ceftriaxone underdosing and missed atypical coverage with azithromycin. Overall, 80% of patients were considered to have been inappropriately prescribed antimicrobials. No effect on mortality was observed. Conclusions: In this study, we found low use of CAP risk scores and low adherence to antimicrobial prescribing guidelines for CAP at the authors’ institution

Effectiveness and safety of opicapone in Parkinson’s disease patients with motor fluctuations: the OPTIPARK open-label study

Background The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. Methods OPTIPARK (NCT02847442) was a prospective, open-label, single-arm trial conducted in Germany and the UK under clinical practice conditions. Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3 (Germany) or 6 (UK) months in addition to their current levodopa and other antiparkinsonian treatments. The primary endpoint was the Clinician’s Global Impression of Change (CGI-C) after 3 months. Secondary assessments included Patient Global Impressions of Change (PGI-C), the Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Questionnaire (PDQ-8), and the Non-Motor Symptoms Scale (NMSS). Safety assessments included evaluation of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). Results Of the 506 patients enrolled, 495 (97.8%) took at least one dose of opicapone. Of these, 393 (79.4%) patients completed 3 months of treatment. Overall, 71.3 and 76.9% of patients experienced any improvement on CGI-C and PGI-C after 3 months, respectively (full analysis set). At 6 months, for UK subgroup only (n = 95), 85.3% of patients were judged by investigators as improved since commencing treatment. UPDRS scores at 3 months showed statistically significant improvements in activities of daily living during OFF (mean ± SD change from baseline: − 3.0 ± 4.6, p < 0.0001) and motor scores during ON (− 4.6 ± 8.1, p < 0.0001). The mean ± SD improvements of − 3.4 ± 12.8 points for PDQ-8 and -6.8 ± 19.7 points for NMSS were statistically significant versus baseline (both p < 0.0001). Most of TEAEs (94.8% of events) were of mild or moderate intensity. TEAEs considered to be at least possibly related to opicapone were reported for 45.1% of patients, with dyskinesia (11.5%) and dry mouth (6.5%) being the most frequently reported. Serious TEAEs considered at least possibly related to opicapone were reported for 1.4% of patients. Conclusions Opicapone 50 mg was effective and generally well-tolerated in PD patients with motor fluctuations treated in clinical practice. Trial registration Registered in July 2016 at clinicaltrials.gov (NCT02847442)

Usage and monitoring of intravenous tobramycin in cystic fibrosis in Australia and the United Kingdom

Aim: To characterise usage and monitoring of intravenous tobramycin in cystic fibrosis (CF) patients in Australia and the UK. Methods: An anonymous, online survey of healthcare professionals caring for CF patients was conducted. Survey questions were designed to obtain information on tobramycin dosing, therapeutic drug monitoring and toxicity monitoring. Results: The survey was sent to pharmacists and clinicians in 73 CF centres. Responses were received from 32 and 40 healthcare professionals, from Australia and the UK, respectively. Once-daily dosing of tobramycin was the preferred administration regimen for 93.8 and 67.5% of participants in Australia and the UK, respectively. Among them 68.8% of Australian and 55% of UK participants initiated tobramycin therapy at a dose of 10 mg/kg/day or greater. Australian participants most commonly adjusted tobramycin dosage using log-linear regression analysis (40.6%) or trough measurements (28.1%). UK participants most commonly adjusted tobramycin dosage using trough (55%) or peak and trough measurements (37.5%). In 90.6% of Australian and 95% of UK participants practices, serum creatinine was routinely monitored during admission. Standard pure tone audiometry was performed by 15.6% of Australian and 17.5% of UK participants and high-frequency pure tone audiometry was performed by 15.6% of Australian and 10% of UK participants, once or twice a year. Conclusions: Many discrepancies exist between Australia and the UK and within each country with respect to monitoring of intravenous tobramycin in CF patients. Greater ototoxicity monitoring is likely necessary in both countries. Further education of health professionals about the existence of national guidelines and guidance on how they can be applied in practice is likely required