Profile of drug interactions in hospitalized children

Introduction: The expected therapeutic response may be affected by the presence of drug interactions. With the high number of reports on new drug interactions, it has been difficult for health professionals to keep constantly updated. For this reason, computer systems have helped identify such interactions. Objectives: To verify the rate and profile of drug interactions in medical prescriptions to hospitalized pediatric patients. Methods: A descriptive study investigated prescriptions to hospitalized pediatric patients. The study included patients between 0 and 12 years old, containing 4 or more drugs in their prescriptions. The analysis of interaction and incompatibility possibilities in prescribed drugs used Micromedex / Drug-Reax® program. Results: From 2005 to 2006, 3,170 patients were investigated, and 11,181 prescriptions were analyzed, a mean value of 3.5 prescriptions/patient. In total, 6,857 drug interactions were found, which corresponds to 1.9 interaction/prescription. Among them, relevance to ampicillin and gentamicin, found in 220 (3.2%) prescriptions. In total, 2,411 drug incompatibilities in via y were found, a mean value of 0.5/prescription, with emphasis on vancomycin and cefepime, found in 243 (10.0%) prescriptions. Conclusion: The presence of drug interactions is a permanent risk in hospitals. This way, the utilization of computer programs, pharmacotherapy monitoring of patients and the pharmacist presence in the multidisciplinary team are some manners of contributing to hospitalized patients’ treatment.Introducción: La respuesta terapéutica esperada puede modificarse por la presencia de interacciones medicamentosas. Con el elevado número de comunicaciones de nuevas interacciones medicamentosas, ha sido difícil para los profesionales de la salud mantenerse constantemente actualizados. Por este motivo, los ordenadores han ayudado a identificar estas interacciones. Objetivos: Verificar la tasa y el perfil de las interacciones medicamentosas en las prescripciones médicas a pacientes pediátricos hospitalizados. Métodos: Un estudio descriptivo investigó las prescripciones a pacientes pediátricos hospitalizados. El estudio incluyó pacientes entre 0 y 12 años, que tenían 4 o más medicamentos en sus prescripciones. El análisis de las interacciones y las incompatibilidades posibles en los medicamentos prescritos utilizó el programa Micromedex / Drug- Reax®. Resultados: De 2005 a 2006, se investigó a 3.170 pacientes y se analizaron 11.181 prescripciones con una media de 3,5 recetas/paciente. En total se encontraron 6.857 interacciones medicamentosas, que corresponden a 1,9 interacciones/prescripción. Entre ellas, se encontró relación a ampicilina y gentamicina en 220 (3,2%). En total, se encontraron 2.411 incompatibilidades de vía, con una media de 0,5 por prescripción, con énfasis en vancomicina y cefepime, encontradas en 243 (10,0%). Conclusión: La presencia de interacciones medicamentosas es un riesgo permanente en hospitales. Así que, la utilización de un programa informático, el seguimiento farmacoterapéutico de los pacientes y la presencia de un farmacéutico en el equipo multidisciplinario son algunas de las maneras de mejorar el tratamiento de los pacientes hospitalizados

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation : pharmaceutical care contribution

Background: Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration. Objective: This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT. Methods: The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range. Results: Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004). Conclusion: The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant

Development of risk score to hospitalized patients for clinical pharmacy rationalization in a high complexity hospital

The aim of the present research was to build a tool to classify patients according to drug theraphy risk so as to rationalize the use of clinical pharmaceutical resources in hospital settings. Risk factors selected in the literature available were carefully revised to be included in the score. The selected factors were submitted to univariate and then to multivariate analysis. The significant results were included in the final score model, which divided the hospitalized patients into three groups: low risk, moderate risk and high risk. After that, the score was applied in the hospital and a "risk classification" map was created of the various sectors of the Hospital de Clínicas de Porto Alegre. The score was applied to 1442 patients in nine different areas of the hospital, with 398 (27.6 %) of them presenting high risk, 612 (42.4 %) moderate risk and 432 (29.9 %) low risk. The high risk units were: Pediatric Oncology, the Intensive Care Unit (ICU) for adults and the Pediatric Intensive Care Unit (PICU). The clinical and surgical units, the Protected Environment Unit (PEU) and the Neonatal Intensive Care Unit (NICU) were classified as moderate risk and the pediatric hospitalization unit as low risk. Considering the patients with renal and/or hepatic problems, cardiac and/or pulmonary problems and immunosuppression and/or immuno deficiency, 50.2 %, 61.5 % and 52.6 %, respectively, presented high score, with all of them taking at least one risk drug.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Microbiological findings in febrile neutropenic patients in a tertiary hospital of Southern Brazil

Background: Neutropenia is a major risk factor for infection. The prevalence of Gram-negative bacteria decreased in the early nineties, while the frequency of Gram-positive bacteria increased from between 55 to 70% of all bacteremia episodes. Even more recently there has been a resurgence of Gram-negative infections. The aim of this report is to describe the microbiological findings in a cohort of febrile neutropenic patients in a tertiary teaching hospital of Southern Brazil. Methods: This was a cohort study designed to evaluate the implementation of a clinical protocol for treatment of febrile neutropenic patients. Prospectively included in our study were patients with febrile neutropenia (FN) admitted between January 2004 and December 2005 at the Hospital de Clínicas of Porto Alegre. Historical controls were selected from patient visits recorded between March 2001 and April 2003 ‒ or recorded before the clinical protocol was introduced. Results: During the 2004-2005 and 2001-2003 study periods, 164 and 159 pathogens were documented, respectively. In 93 of 190 episodes (48.9%), and 84 of 193 episodes (43.5%) there were documented microbiological infections. Fungal infection was documented in very few episodes (6.1 vs. 5.7%). We also observed a 52.8% prevalence of Gram-positive and a 47.2% prevalence of Gram-negative bacteria in the 2001‒2003 period. Observed in the 2004‒2005 period were 38.1% Gram-positive and 61.9% Gram-negative bacteria (P=0.012). There was also a significant increase in Pseudomonas aeruginosa prevalence in the second study period (1.9 to 11.6%; P<0.001). Six isolates (31.6%) were discovered to be multi-resistant in the 2004‒2005 period versus none in the first period. The prevalence of Oxacillin-resistant Staphylococcus was 53.5 and 65.8% in the first and second periods, respectively (P=0.23). Conclusion: These documented pathogens are the most commonly observed in febrile neutropenic patients, but the emergence of multidrug-resistant Pseudomonas aeruginosa is of some concern