Information technologies’ role in optimizing the application of drugs in clinical practice: a view of a clinical pharmacologist

Currently, the development and implementation of computerized medical decision support systems (CMDSS) is an effective tool aimed at optimizing drug therapy in clinical practice. It has been proven in clinical studies their use can increase the efficacy and safety of pharmacotherapy for a number of socially significant diseases. An active integration of CMDSS into medical information systems of medical organizations is required.

Amoxicillin in the treatment of acute respiratory infections in children: a dialogue between a microbiologist and a clinical pharmacologist

The article presents a modern view of amoxicillin in the treatment of acute respiratory infections in children from point of view of a microbiologist and clinical pharmacologist. Modern microbiological methods have changed the idea of the microbiota of the respiratory tract, however, the etiology of acute bacterial infections of the respiratory tract has not undergone significant changes – Streptococcus pneumoniae and Haemophilus influenzae are still the most common pathogens. Amoxicillin remains the drug of choice for most respiratory infections of bacterial etiology. Inhibitor-protected aminopenicillins (amoxicillin/clavulanate etc.) do not have advantages over amoxicillin in most cases of acute respiratory tract infections, but increase the risk of adverse events. Current data on macrolides, which are widely used in clinical practice, indicate the need to limit their use in acute infections of the respiratory tract due to the increase in resistance of S. pneumoniae and the absence of clinically significant activity against H. influenza. Current information on the resistance of S. pneumoniae and H. influenzae, as well as available data on the pharmacokinetics of amoxicillin, require a review of dosing approaches. The daily dose of amoxicillin in children with acute respiratory infections should not be less than 45–60 mg/kg, and in many cases (acute otitis media, infections caused by H. influenzae or penicillin-resistant S. pneumoniae strains), more than 90 mg/kg/day is required. Amoxicillin has a wide therapeutic range, and therefore the use of high doses of the drug is not associated with a decrease in the safety of therapy.

Medication errors reported in a tertiary care private hospital in Eastern India: a three years experience

Background: Medication errors (MEs) can cause significant harm to patients. The MEs identified through reporting processes currently report only a fraction of the actual number of MEs. Data about MEs is limited in India, especially from eastern and north-eastern parts of India. The objective of this study was to analyse the various types of Medication errors reported in a tertiary care private hospital in Eastern India. The aim was to determine the various factors associated with these errors and steps to be taken to reduce the MEs in this healthcare setup.Methods: We carried out a prospective passive surveillance study over the course of 3 years (2016-2018) on 50,822 admitted patients after obtaining approval from the Institutional Ethics Committee. A detailed root-cause analysis was performed for every reported error by a team of healthcare quality professionals and clinical pharmacists along with a clinical pharmacologist followed by appropriate preventive and corrective actions.Results: In our study, a total number of 88 medication errors were reported from a sample size of 50,822 (0.0017%). 61 of the reported MEs were administration errors (69.3%). Higher preponderance of medication errors was seen in male patients (53.1%) in comparison to female patients (46.9%).Conclusions: In this study gross under-reporting of MEs were observed which is in line with previously published studies in India. The reasons reported for gross under-reporting can function as an effective tool to ensure improved reporting of MEs and implementation of mitigation strategies.

Interdisciplinary risk assessment and delay of chemotherapy.

e14033 Background: In 2015, in our outpatient clinic, we implemented a breast cancer interdisciplinary team with the goal of identifying risk factors for chemotherapy delay. Evaluation of individual cases and care plans were made by a medical oncologist, clinical pharmacologist, psychologist, dietician and oncology nurse. Methods: 81 patients with breast cancer in neoadjuvant/adjuvant chemotherapy were prospectively evaluated from July 2018 until July 2019 for clinical risk: age, anthracyckine use, presence of symptoms grade >3, ASGPPP questionnaire for nutritional risk, psychological risk for pre existent issues or induce by treatment and IRPO questionnaire for screening, nursing evaluation for comunication, organization and understanding issues, and pharmacologist evaluation of polypharmacy and unknown drugs or routine use. Results: Of 81 patients evaluated and had finish treatment, 55 pts (67.9%) received adjuvant chemotherapy. Median age was 57.9 years (range:29-90.6y). We defined as risk factors for delay chemotherapy treatment: anthracycline-based chemotherapy (9.34 vs 2.58 d p:0.002), psychological risk (both risks combined) (8.1 vs 4.7 p:0.047), comunication, organization and understanding issues (15.25 vs 5.83 d p: 0.004), and unknown drugs that routinely uses (11 vs 5.34d p:0.012). Patients who needed extra nutritional and psychological appointment had greater delay in chemotherapy (Dietician: 9.636 vs 4.7 d P:0.01; Psyc: 9.1 vs 4.2d p:0.008). Conclusions: The chemotherapy scheme, psychological risk, difficulty in understanding and organizing, and unaware of the drugs used routinely uses were high risk factors for delayed chemotherapy and these patients should be handled more carefully.