Antibiotic consumption in Portugal: 2010 and 2011

The use of antibiotics has contributed to a marked decrease in morbidity caused by communicable and infec- tious diseases over the past few years. The aim of our study is to evaluate the use of antibiotics in clinic in 2010 and 2011, considering two different methodologies: the defined daily dose per 1000 inhabitants per day (DHD) and the number of packages per 1000 inhabitants per day (PHD)

Evolution of outpatient antibiotic use in mainland Portugal 2000-2009

Introduction: In the latest years, the increasing resistance to antibiotics has become a serious public health issue. The resistance to antimicrobial agents is multifactorial although several studies have shown that the large use of antibiotics for therapeutical and prophylactic purposes, and particularly their misuse, is one factor that contributes most to this problem. Aim: To assess the evolution of antibiotic consumption in Portugal, Health Regions and Districts of Portugal, from 2000 to 2009. Material and Methods: Descriptive observational study using as source of information a database of outpatient antibiotic prescription provided by Infarmed, National Authority of Medicines and Health Products. Antibiotic consumption is estimated up from medical prescription, and expressed in DDD/1000 inhabitants/day (DHD). Results: From 2000 to 2009 antibiotic total consumption varied between 24,12 DHD and 22,03 DHD, which means a decrease by 8,65%. The use of tetracyclines (J01A), cephalosporins (J01D), sulphonamides (J01E), quinolones (J01M) and other antibacterials (J01B, J01G and J01X) decreased during the aforesaid time period. By contrast, there was an increase in the use of the combination penicilin and beta-lactamases inhibitor, and macrolides (J01F). Between 2000 and 2009 there was a significant decrease in the use of outpatient cephalosporins ( - 43,50%). Most notable is the large reduction of the use of cephalosporins between 2000 and 2009 (-43.50%) and also the decrease in the consumption of quinolones (-15.31%). Conclusion: Although there has been a decrease in the use of antibiotics in Portugal, their consumption is still high. The current study provides information that may be useful to regional Health Authorities in order to develop educational activities, for the population or health professionals, which can promote the rational use of antibiotics.info:eu-repo/semantics/publishedVersio

Development of a platform to align education and practice: bridging academia and the profession in Portugal

Limited fitness for practice may result from a mismatch between education and practice. Aiming to meet the common interests of academics and practitioners, the Portuguese Pharmaceutical Society (PPS) developed the Education and Practice Platform (EPP). The EPP includes one representative from each pharmacy faculty, and all Councils of Speciality Boards of Practice. Brainstorming with involved parties enabled sharing of interests, concerns and identifying a common path. Aims, mission, vision and values were set. The EPP's mission is to: act as an enabler to foster the quality and adequacy of education through sharing best practices, ultimately leading to facilitate professional integration, and to foster quality development in teaching practices with recognition for autonomy in freedom to teach and to learn. Its vision is an alignment of education and practice with the PPS' statutes to ensure validation of the competences defined for each practice area, and compliance with international guidance. Key performance indicators (KPIs) were set. Activities developed include the creation of a national forum to discuss education and practice, development of workshops on teaching methods and pharmacy internships, enhanced representation in international events and response to global and national requests. Ongoing work focuses on the creation of a common training framework in hospital and community pharmacy practice adapted to Portugal. The EPP is a worldwide case study, encouraging the development of discussion contributing to an open climate of sharing best practices, indirectly leading to foster a better alignment between education and practice. Many of these results are so far intangible in scientific terms but worth describing.info:eu-repo/semantics/publishedVersio

Patterns of prescription of antibiotics in the Algarve: patient characteristics and spread of treatment

RESUMO - O aparecimento de microrganismos multirresistentes, quer nos humanos quer nos animais, sugere a necessidade imperativa de intervenção no padrão de utilização dos antibióticos. O conhecimento do padrão de prescrição é imprescindível para fundamentar a revisão das práticas clínicas e de ensino no sentido de promover a prescrição racional dos antibióticos. Objetivo: Caracterização do perfil de prescrição de antibióticos de uso sistémico em consulta de medicina geral e familiar na região do Algarve. Material e métodos: Trata-se de um estudo de prescrição-indicação com desenho transversal. De um universo de 280 médicos a exercer nos centros de saúde do Algarve, foram selecionados 70 médicos de medicina geral e familiar, dos quais aceitaram participar 60. Os doentes foram incluídos no estudo de forma consecutiva até ao preenchimento da quota de doentes (20 doentes por médico), sempre que durante uma consulta de rotina ou de urgência básica fosse necessário prescrever um antibiótico de uso sistémico. Alguns médicos não preencheram esta quota. Resultados: Cerca de 80% dos médicos selecionados enviaram pelo menos uma ficha de registo de prescrição de antibióticos, dos quais 41,5% tinham 55 ou mais anos de idade e 52% eram mulheres. Foi avaliada uma amostra de 925 doentes em que 534 (59,6%) eram do género feminino. Verificou-se que em todos os grupos etários as penicilinas foram os antibióticos mais prescritos atingindo um valor de quase 70% no grupo etário dos 0-14. Apesar de serem também o grupo mais prescrito nos mais velhos, representam apenas cerca de 40%. Os macrólidos foram também frequentemente prescritos em todos os grupos etários. Quanto à distribuição da prescrição em função do género, verificou-se que quer no género masculino quer no género feminino as penicilinas foram os antibióticos mais prescritos. No género masculino os macrólidos surgem em segundo lugar na prescrição, seguidos das quinolonas e das cefalosporinas, enquanto no género feminino são as quinolonas, seguidas dos macrólidos e das cefalosporinas. As infeções da pele foram as infeções com menor grau de dispersão da terapêutica quando se analisou simultaneamente DU50 e DU90. Conclusões: O padrão de prescrição dos antibióticos é semelhante a outros descritos na literatura. No entanto, realça-se o alto nível de prescrição de quinolonas e de cefalosporinas de 3. a geração e o baixo recurso a penicilinas sensíveis às betalactamases, a nitrofurantoína e a fosfomicina trometamol. As infeções da pele são as infeções com menor grau de dispersão da terapêutica quando se analisa simultaneamente DU50 e DU90.ABSTRACT - The appearance of multi-resistant micro-organisms, whether in humans or animals, suggests an urgent need to intervene in the patterns of use of antibiotics. Knowledge of patterns of prescription is indispensable to support the review of clinical practices and teaching in order to promote rational prescription of antibiotics. Objective: Characterisation of the profile of prescription of antibiotics for systemic use in General and Family Practitioners’ consultations in the region of the Algarve. Material and methods: This is a cross-sectionally designed study of indicative prescription. 70 General and Family Practitioners were selected from a total of 280 doctors working at Health Centres in the Algarve, of whom 60 accepted the invitation to participate. The patients were included in the study in a consecutive way up to the patient quota (20 patients per doctor), whenever it was necessary to prescribe an antibiotic for systemic use during a routine or basic emergency consultation. Results: Approximately 80% of the doctors selected sent at least a record of antibiotic prescription, of whom 41.5% were 55 years old or more and 52% were female. A sample of 925 patients was analysed, of whom 534 (59.6%) were female. It was noted that in all age groups, penicillin was the most prescribed antibiotic, reaching a level of nearly 70% in the 0-14 age group. Although this was also the type of antibiotic most prescribed in older patients, it was only prescribed to about 40% of the sample. Macrolides were also often prescribed in all age groups. With regard to prescription in relation to gender, it was noted that penicillin was the most prescribed antibiotic, both for males and females. For prescriptions given to males, macrolides were in second place, followed by quinolones and cefalosporines, while for females it was quinolones, followed by macrolides and cefalosporines. Skin infections were the infections which occurred least often, when we analysed DU50 and DU90 simultaneously. Conclusions: The pattern of antibiotic prescription is similar to that described in other studies. However, we noted the high level of prescription of quinolones and 3 Rd generation cefalospirines and the low level of use of penicillins sensitive to beta lactamases, nitrofurantoin and fosfomycin trometol. Skin infections were the infections which occurred least often, when we analysed DU50 and DU90 simultaneously.info:eu-repo/semantics/publishedVersio

O uso dos antibióticos no Algarve:padrão de utilização, conhecimentos, crenças e comportamentos

Tese de doutoramento, Farmácia (Farmacoepidemiologia), Universidade de Lisboa, Faculdade de Farmácia, 2013Being aware of the evolution of antibiotic consumption and its pattern of use is essential as a platform to develop action plans which may contribute to their appropriate use. Therefore, four studies were conducted and their main conclusions are the following: 1) Evolution of antibiotic consumption in Algarve and continental Portugal from 2000 to 2009 – noteworthy was the decrease in the consumption of antibiotics, particularly cephalosporins and quinolones. In the Algarve, the antibiotic consumption in 2009 was similar to the one in continental Portugal, except for cephalosporins and quinolones with higher consumptions in that region; 2) Antibiotic prescribing profile in Family and General Practice consultation in the region of Algarve – it stands out for a) the low use of antibiotics considered first option, in tonsillitis and urinary infection, and b) the high level of prescription of quinolones and third-generation cephalosporins from the total prescription of cephalosporins; 3) Development and validation of a questionnaire to assess the population´s knowledge, beliefs, attitudes and behaviours towards the use of antibiotics – an assessment tool with good psychometric properties has been developed; 4) Knowledge, beliefs, attitudes and behaviours about antibiotic use – around 15% of the respondents didn’t comply, partially or fully, with the therapeutic treatment. The self-medication values found are higher than the ones in other Portuguese studies; women, the age group between 35 and 49, the respondents with higher education level and having a profession considered intellectual, as well as the unemployed and respondents who have health systems other than the National Health System showed more appropriate attitudes towards the use of antibiotics. These findings show the need for an intensified promotion of the rational use of antibiotics, and provide significant information for the development of strategies suited to the distinctive reality of Algarve.Conhecer a evolução do consumo e o padrão de utilização dos antibióticos, é fundamental como plataforma para o desenvolvimento de planos de ação que possam contribuir para o seu uso apropriado. Assim, realizaram-se quatro estudos, cujas principais conclusões são: 1) Evolução do consumo de antibióticos no Algarve e em Portugal Continental entre 2000 e 2009 – salienta-se o decréscimo no consumo de antibióticos, em particular de Cefalosporinas e de Quinolonas. No Algarve o consumo de antibióticos apresentava-se em 2009 semelhante ao consumo de Portugal Continental, à exceção de cefalosporinas e de quinolonas com consumos superiores nesta região; 2) Perfil de prescrição de antibióticos em consulta de Medicina Geral e Familiar na região do Algarve – destaca-se (a) o baixo recurso a antibióticos considerados de primeira opção, na amigdalite e nas infeções urinárias e (b) o alto nível de prescrição de quinolonas e de cefalosporinas de 3ª geração do total de prescrições de cefalosporinas; 3) Desenvolvimento e validação de um questionário para avaliação de conhecimentos, crenças, atitudes e comportamentos da população quanto ao uso de antibióticos – desenvolveu-se um instrumento avaliativo com boas propriedades psicométricas; 4) Conhecimentos, Crenças, Atitudes e Comportamentos da população algarvia relativamente aos antibióticos – cerca de 15% de inquiridos não cumpriu parcial ou totalmente o regime terapêutico. Os valores de automedicação encontrados são superiores aos valores encontrados noutros estudos portugueses; as mulheres, o grupo etário dos 35 aos 49 anos, os inquiridos com maior grau de escolaridade, com profissão considerada intelectual, os desempregados e os inquiridos que têm outro sistema de saúde para além do Sistema Nacional de Saúde apresentavam atitudes mais adequadas perante o uso dos antibióticos. Estes achados demonstram a necessidade de uma intensa promoção do uso racional dos antibióticos e fornecem informação significativa para a elaboração de estratégias adequadas à realidade particular do Algarve.Fundação para a Ciência e a Tecnologia (FCT, SFRH/BD/60249/2009

Analysis of pharmacotherapeutic profile in patients with type 2 diabetes mellitus

In the past years, the antimicrobial resistance has been increasing, partly due to its misuse, and this has been considered as a threat for the public health by WHO. The aim of this study was to evaluate behaviours and attitudes of antibiotics use among adults in the south region of Portugal, Algarve, particularly self-medication and knowledge about these drugs

Cessação do tabagismo na farmácia comunitária: determinantes do sucesso de uma prática da vida real

The objectives of this study are to report the contribution of pharmacists to smoking cessa tion and study the determinants of smoking cessation success in eight pharmacies in Portugal (south) between 2009 and 2019. A real-life study was conducted with a sample of smokers who participated in pharmacist consultations. The sample included 135 smokers (average age of 47.9 ± 1.21 years), 79 (58.5%) of whom were male. In parallel with the motivation and behavioral approach, 116 (85.9%) smokers received pharmacological therapies: 108 (80.0%) were treated with nicotine replacement products and eight (5.9%) with non-nicotine medications. The interventions resulted in 70 (51.9%) smokers complying with the quit day, of whom 59 (43.7%) were smoking-abstinent at the end of the first month. Success rates were reduced to 32.6%, 28.1%, and 20.7% at the end of the 3rd, 6th, and 12th months, respectively. Smoking cessation was more successful for the participants receiv ing pharmacological therapies (Fisher’s exact test, p < 0.001) and those who participated in more pharmacist consultations (χ 2 = 59.994, p < 0.001) and more telephone sessions (χ 2 = 17.845, p < 0.001). Pharmacists can contribute significantly to the promotion of smoking cessation. Smokers who are more thoroughly followed up by pharmacists showed increased success rates when compared with smokers having fewer sessions with pharmacists.info:eu-repo/semantics/publishedVersio

Adherence to Antibiotic Therapy in the Algarve Region

Introduction: The non-adherence to antibiotic therapy, including omission of doses and change of dose interval, may lead to reduced levels of antibiotic plasma concentrations that are insufficient to inhibit the replication of microorganisms, but nevertheless high enough to exert selective pressure. As a consequence, non-adherence to therapeutic can lead to poor therapeutic results and to the emergence of resistant microorganisms, and these may play an important role in antimicrobial resistance, as the overuse of antibiotics. This study aims to evaluate the level of adherence to antimicrobial therapy instituted in the population of the Algarve, in the three months prior to the interview, investigating their relationship with the social demographic characteristics and information received on antibiotics. Material and Methods: This is an observational, descriptive and cross-sectional study, which studied adherence to therapy in the adult population of the Algarve Region. To achieve this purpose, we developed a questionnaire for assessing the level of adherence to antimicrobial therapy administered in the ninety days preceding the questionnaire. The survey was distributed in town hall, supermarkets, hotels, municipal markets, restaurants, sports groups and seniors Universities. Bivariate analyses were performed using the Chi-square and Fisher exact tests. The level of statistical significance was established whenever p < 0.05. The statistical analysis was conducted using the SPSS software v. 21. Results: A total of 1192 respondents were included in the study, where 48.7% were male. The participants’ mean age was 46.6 years. Most of them received information on the dosage of the antibiotic. However, of 227 respondents, 57.3% reported they have not been informed about possible adverse reactions and of 230 respondents, 40.6% said they have not been informed about taking care of the administration of antibiotics. To study adherence to treatment, the respondents were asked if they had taken antibiotics in the three months prior to completing the questionnaire. Two hundred and fifty nine of the respondents (21.7%) answered affirmatively. It should be noted that among 247 of the respondents, 36 (14.6%) partially fulfilled or not fulfilled the recommendations, regarding the number of days of drug administration. The biggest difficulty was following the recommendations regarding the interval between doses, as 59 respondents (25%) reported that partially fulfilled or not fulfilled. Conclusions: The data show the importance of some determinants in adherence to antimicrobial therapy, and the need for intervention in specific groups in order to improve adherence to therapy

Probing pharmacists' interventions in Long-Term Care: a systematic review

Key summary pointsAim To investigate pharmacists' interventions and impact at institutional Long-Term Care (LTC) settings, particularly the therapeutic outcomes in elderly populations. Findings LTC pharmacists deliver a comprehensive set of activities, especially in clinical pharmacy (e.g. medication review, deprescribing) and education, addressing elderly populations under LTC and their therapeutic needs. Message Pharmacists' expertise in medicines optimisation is a useful resource in improving healthcare towards institutionalised LTC patients, often a geriatric population. Purpose Long-Term Care (LTC) systems have experienced recent developments driven by changes in healthcare and demography (e.g. population ageing). As well, pharmacists are changing from traditional roles to more patient-oriented services. The present study aimed to identify and assess pharmacists' and/or pharmacy-based interventions in institutional LTC settings, also mapping relevant medications. Methods The review was undertaken in general accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using three main literature databases (PubMed, Scopus, and Web of Knowledge). A set of 16 keywords, divided into three domains (professional, type of care and type of setting), were combined into search equations. Selected studies were assessed through the Quality Assessment Tool for Quantitative Studies. Results Twenty-six studies met the inclusion criteria, out of 794 initial hits. Most studies (12) described pharmacist/pharmacy-driven interventions assessing Medication Management Reviews' impact in different endpoints or outcomes. Other studies (3) assessed pharmacists' interventions on specific medication groups. Good Administration Practices, new pharmaceutical care models, antibiotic stewardship programs, and studies assessing other pharmacists' interventions, such as pharmacy-managed informatics and education, were addressed by 11 other papers. Six studies were classified as Strong after quality assessment. Conclusion LTC is a clinically complex type of care benefiting from interdisciplinary work. Despite the overall lower quality of the identified studies, pharmacists perform in a wide array of LTC areas. The broad implementation of pharmaceutical activities in institutional LTC settings opens opportunities to optimise medicines' use

Urinary tract infections: outpatient antibiotic use and antimicrobial resistance in the Algarve region

Background and objective: Microbial resistance to antibiotics continues to emerge as a significant global health concern. The misuse of antibiotics is an important factor contributing to the development of antibiotic resistance by bacteria. Urinary tract infection is among the most common bacterial infections, being Escherichia coli the main etiological agent