Anatomical Therapeutic Chemical Classification Research Articles

Angiotensin II Receptor Blockers Reduce Tau/Aß42 Ratio: A Cerebrospinal Fluid Biomarkers' Case-Control Study.

(1) Background: The role of antihypertensives in Alzheimer's Disease (AD) prevention is controversial. This case-control study aims to assess whether antihypertensive medication has a protective role by studying its association with amyloid and tau abnormal levels. Furthermore, it suggests a holistic view of the involved pathways between renin-angiotensin drugs and the tau/amyloidß42 ratio (tau/Aß42 ratio); (2) Methods: The medical records of the participant patients were reviewed, with a focus on prescribed antihypertensive drugs and clinical variables, such as arterial blood pressure. The Anatomical Therapeutic Chemical classification was used to classify each drug. The patients were divided into two groups: patients with AD diagnosis (cases) and cognitively healthy patients (control); (3) Results: Age and high systolic blood pressure are associated with a higher risk of developing AD. In addition, combinations of angiotensin II receptor blockers are associated with a 30% lower t-tau/Aß42 ratio than plain angiotensin-converting enzyme inhibitor consumption; (4) Conclusions: Angiotensin II receptor blockers may play a potential role in neuroprotection and AD prevention. Likewise, several mechanisms, such as the PI3K/Akt/GSK3ß or the ACE1/AngII/AT1R axis, may link cardiovascular pathologies and AD presence, making its modulation a pivotal point in AD prevention. The present work highlights the central pathways in which antihypertensives may affect the presence of pathological amyloid and tau hyperphosphorylation.

Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study

IntroductionFew if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive...

Prevalence and Correlates of Polypharmacy, and Drug Utilization Pattern in a Semi-urban Population: Results from the Pars Cohort Study.

Although polypharmacy is considered a major predictor of irrational use of drugs, little is known about polypharmacy in developing regions. We aimed to indicate the prevalence and correlates of polypharmacy and to determine the medication profile at the population level in southern Iran. In this cross-sectional study, we analyzed data from participants of the Pars Cohort Study (PCS) (aged above 40 years, N=9269). Polypharmacy was defined as using five or more medications concurrently. A Poisson multivariable model was applied to estimate the adjusted prevalence ratios (APRs) of various risk factors. The Anatomical Therapeutic Chemical (ATC) classification system was used for classifying medications. Prevalence of polypharmacy was 10.4%, (95% CI: 9.75; 11.08) and it was higher among females (15.0%), older adults (age≥65 years) (16.0%), and individuals with more than two chronic conditions (31%). Being female, educated, married, and not having a low socio-economic class were independently associated with a higher likelihood of polypharmacy. The most prevalent medications among female participants were sex hormones and modulators of the genital system (58.4%), drugs for acid-related disorders (14.6%), and anti-anemic preparations (13.6%,). On the other hand, males were using acid-related disorders (14.6%), anti-inflammatory and anti-rheumatic products (7.8%), and beta-blocking agents (6.3%). The prevalence of polypharmacy in our sample was relatively low, especially among males. Cardiovascular drugs, acid suppressants, hormonal contraceptives, and anti-anemic preparations are drug classes with the highest contribution to polypharmacy.

Effect of the chronic medication use on outcome measures of hospitalized COVID-19 patients: Evidence from big data.

Concerns about the role of chronically used medications in the clinical outcomes of the coronavirus disease 2019 (COVID-19) have remarkable potential for the breakdown of non-communicable diseases (NCDs) management by imposing ambivalence toward medication continuation. This study aimed to investigate the association of single or combinations of chronically used medications in NCDs with clinical outcomes of COVID-19. This retrospective study was conducted on the intersection of two databases, the Iranian COVID-19 registry and Iran Health Insurance Organization. The primary outcome was death due to COVID-19 hospitalization, and secondary outcomes included length of hospital stay, Intensive Care Unit (ICU) admission, and ventilation therapy. The Anatomical Therapeutic Chemical (ATC) classification system was used for medication grouping. The frequent pattern growth algorithm was utilized to investigate the effect of medication combinations on COVID-19 outcomes. Aspirin with chronic use in 10.8% of hospitalized COVID-19 patients was the most frequently used medication, followed by Atorvastatin (9.2%) and Losartan (8.0%). Adrenergics in combination with corticosteroids inhalants (ACIs) with an odds ratio (OR) of 0.79 (95% confidence interval: 0.68-0.92) were the most associated medications with less chance of ventilation therapy. Oxicams had the least OR of 0.80 (0.73-0.87) for COVID-19 death, followed by ACIs [0.85 (0.77-0.95)] and Biguanides [0.86 (0.82-0.91)]. The chronic use of most frequently used medications for NCDs management was not associated with poor COVID-19 outcomes. Thus, when indicated, physicians need to discourage patients with NCDs from discontinuing their medications for fear of possible adverse effects on COVID-19 prognosis.

Pharmacovigilance-based drug repurposing: searching for putative drugs with hypohidrosis or anhidrosis adverse events for use against hyperhidrosis

BackgroundDrug repurposing refers to the application of existing drugs to new therapeutic indications. As phenotypic indicators of human drug response, drug side effects may provide direct signals and unique opportunities for drug repurposing.ObjectivesWe aimed to identify drugs frequently associated with hypohidrosis or anhidrosis adverse reactions (that is, the opposite condition of hyperhidrosis) from the pharmacovigilance database, which could be potential candidates as anti-hyperhidrosis treatment agents.MethodsIn this observational, retrospective, pharmacovigilance study, adverse event reports of hypohidrosis or anhidrosis in the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) were assessed between January 2004 and December 2021 using reporting odds ratio (ROR) estimates and categorized by the World Health Organization Anatomical Therapeutic Chemical (ATC) classification code. The onset time of drug-associated hypohidrosis or anhidrosis was also examined.ResultsThere were 540 reports of 192 drugs with suspected drug-associated hypohidrosis or anhidrosis in the FAERS database, of which 39 drugs were found to have statistically significant signals. Nervous system drugs were most frequently reported (187 cases, 55.82%), followed by alimentary tract and metabolism drugs (35 cases, 10.45%), genitourinary system and sex hormones (28 cases, 8.36%), and dermatologicals (22 cases, 6.57%). The top 3 drug subclasses were antiepileptics, drugs for urinary frequency and incontinence, and antidepressants. Taking disproportionality signals, pharmacological characteristics of drugs and appropriate onset time into consideration, the main putative drugs for hyperhidrosis were glycopyrronium, solifenacin, oxybutynin, and botulinum toxin type A. Other drugs, such as topiramate, zonisamide, agalsidase beta, finasteride, metformin, lamotrigine, citalopram, ciprofloxacin, bupropion, duloxetine, aripiprazole, prednisolone, and risperidone need more investigation.ConclusionsSeveral candidate agents among hypohidrosis or anhidrosis-related drugs were identified that may be redirected for diminishing sweat production. There are affirmative data for some candidate drugs, and the remaining proposed candidate drugs without already known sweat reduction mechanisms of action should be further explored.

MedLexSp – a medical lexicon for Spanish medical natural language processing

BackgroundMedical lexicons enable the natural language processing (NLP) of health texts. Lexicons gather terms and concepts from thesauri and ontologies, and linguistic data for part-of-speech (PoS) tagging, lemmatization or natural language generation. To date, there is no such type of resource for Spanish.Construction and contentThis article describes an unified medical lexicon for Medical Natural Language Processing in Spanish. MedLexSp includes terms and inflected word forms with PoS information and Unified Medical Language System^{circledR } (UMLS) semantic types, groups and Concept Unique Identifiers (CUIs). To create it, we used NLP techniques and domain corpora (e.g. MedlinePlus). We also collected terms from the Dictionary of Medical Terms from the Spanish Royal Academy of Medicine, the Medical Subject Headings (MeSH), the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT), the Medical Dictionary for Regulatory Activities Terminology (MedDRA), the International Classification of Diseases vs. 10, the Anatomical Therapeutic Chemical Classification, the National Cancer Institute (NCI) Dictionary, the Online Mendelian Inheritance in Man (OMIM) and OrphaData. Terms related to COVID-19 were assembled by applying a similarity-based approach with word embeddings trained on a large corpus. MedLexSp includes 100 887 lemmas, 302 543 inflected forms (conjugated verbs, and number/gender variants), and 42 958 UMLS CUIs. We report two use cases of MedLexSp. First, applying the lexicon to pre-annotate a corpus of 1200 texts related to clinical trials. Second, PoS tagging and lemmatizing texts about clinical cases. MedLexSp improved the scores for PoS tagging and lemmatization compared to the default Spacy and Stanza python libraries.ConclusionsThe lexicon is distributed in a delimiter-separated value file; an XML file with the Lexical Markup Framework; a lemmatizer module for the Spacy and Stanza libraries; and complementary Lexical Record (LR) files. The embeddings and code to extract COVID-19 terms, and the Spacy and Stanza lemmatizers enriched with medical terms are provided in a public repository.

Assessment and Improvement of Drug Data Structuredness From Electronic Health Records: Algorithm Development and Validation

Digitization offers a multitude of opportunities to gain insights into current diagnostics and therapies from retrospective data. In this context, real-world data and their accessibility are of increasing importance to support unbiased and reliable research on big data. However, routinely collected data are not readily usable for research owing to the unstructured nature of health care systems and a lack of interoperability between these systems. This challenge is evident in drug data. This study aimed to present an approach that identifies and increases the structuredness of drug data while ensuring standardization according to Anatomical Therapeutic Chemical (ATC) classification. Our approach was based on available drug prescriptions and a drug catalog and consisted of 4 steps. First, we performed an initial analysis of the structuredness of local drug data to define a point of comparison for the effectiveness of the overall approach. Second, we applied 3 algorithms to unstructured data that translated text into ATC codes based on string comparisons in terms of ingredients and product names and performed similarity comparisons based on Levenshtein distance. Third, we validated the results of the 3 algorithms with expert knowledge based on the 1000 most frequently used prescription texts. Fourth, we performed a final validation to determine the increased degree of structuredness. Initially, 47.73% (n=843,980) of 1,768,153 drug prescriptions were classified as structured. With the application of the 3 algorithms, we were able to increase the degree of structuredness to 85.18% (n=1,506,059) based on the 1000 most frequent medication prescriptions. In this regard, the combination of algorithms 1, 2, and 3 resulted in a correctness level of 100% (with 57,264 ATC codes identified), algorithms 1 and 3 resulted in 99.6% (with 152,404 codes identified), and algorithms 1 and 2 resulted in 95.9% (with 39,472 codes identified). As shown in the first analysis steps of our approach, the availability of a product catalog to select during the documentation process is not sufficient to generate structured data. Our 4-step approach reduces the problems and reliably increases the structuredness automatically. Similarity matching shows promising results, particularly for entries with no connection to a product catalog. However, further enhancement of the correctness of such a similarity matching algorithm needs to be investigated in future work.

Analysis of Antibacterial Usage Pattern as per ATC/DDD WHO Coding Methodology to Match in Various Clinical Department of Tertiary Care Hospital

The WHO advises using the Defined Daily Dose (DDD) as a unit of measurement and the Anatomical Therapeutic Chemical (ATC) classification system for tracking and researching drug use. The main objective of the study is to examine changes in drug utilization. Evaluate interventions on prescribing patterns of antibiotics at The Oxford medical college hospital and research Centre. Patient demographics and drug charts are collected using specified case report form for a period of 6 months using random sampling method. Case report form includes patient demographics, laboratory data, diagnosis, and drug chart with frequency, dose, dosage and route of administration. Out of 183 cases analyzes 45.4% were female and 54.7% were male. Most of the cases were in the group of 20 to 31. Average duration of hospitalization in our study population was around 5 days. A total of 299 antimicrobial were prescribed in 183 cases. Cephalosporins were the most preferred antibiotic followed by other antibiotic class. Ceftriaxone was the most common drug among the cephalosporin. Antibiotic prescribing in the hospital is empirical, we would like to recommend that antibiotic selection should be based on the results of cultural and sensitivity testing whenever possible. The percentage of drug prescribed in generic form was found to be less. We recommend larger scope prospective study to emphasize on ensuring of rational use of antibiotics.

Analysis of Medication Errors Reported by Community Pharmacists in the Republic of Korea: A Cross-Sectional Study

Background and objectives: We aimed to describe medication-related incidents or medication errors (MEs) reported by community pharmacists and analyze the prevalent medications involved. Materials and Methods: We extracted ME reports from databases comprising patient safety incidents reported to the Korean Pharmaceutical Association between January 2013 and June 2021. Medications were analyzed according to the second (therapeutic subgroup) and fifth (chemical substance) levels of the Anatomical Therapeutic Chemical classification. Results: A total of 9046 MEs were identified, most of which were near miss reports (88.3%). Among the errors that reached the patients (521 cases), harmful incidents accounted for 76.8%. Most MEs occurred during prescription (89.5%), while harmful MEs occurred mainly during dispensing (73.3%). In the prescription step, wrong drugs (44.8%), dosing errors (27.0%), and wrong durations (14.0%) were common. Anti-inflammatory and anti-rheumatic products (M01), drugs for acid-related disorders (A02), and antihistamines for systemic use (R06) were the most frequently reported medication classes involved. Harmful incidents were most common for dosing errors (31.0%) and wrong drugs (26.8%) and were common with warfarin, levothyroxine, and glimepiride. Conclusions: The MEs reported by community pharmacists were mainly prescribing errors, most of which were rectified before reaching patients. The prevalent medications involved in harmful errors include anti-diabetic, anti-thrombotic, and anti-inflammatory agents.

OntoloViz: a GUI for interactive visualization of ranked disease or drug lists using the MeSH and ATC ontologies.

Structured vocabularies for drugs and diseases represent, besides their primary use for annotating scientific literature or scientific information in general, a valuable resource for visualizing aggregated information. The Medical Subject Headings (MeSH) and Anatomical Therapeutic Chemical (ATC) ontologies are widely used structured vocabularies for diseases and drugs, respectively. Their hierarchical tree-like structure can be used as a basis for creating intuitive visual displays for specific diseases and drugs within their higher-order classifications. Such displays are helpful means to contextualize diseases and drugs in various settings such as in drug repositioning. However, there are few tools that can harness the potential of these structured ontologies to create informative visual representations without extensive programming and data processing skills. We have developed OntoloViz, a Graphical User Interface (GUI) for visualizing annotated lists of drugs or diseases in the context of their MeSH or ATC ontologies in an intuitively interpretable sunburst layout. Minimum input is a list of disease or drug names. Users in addition have the option to specify numerical parameters for the input lists to enhance the visualization, e.g. to visualize term frequencies. The GUI allows values to be propagated upwards in the respective ontology tree structure thus facilitating exploration of gene and drug lists. We present two use cases for OntoloViz, namely (i) a graphical representation of clinically tested drugs for coronavirus disease (COVID-19) based on ATC Classification and (ii) a graphical representation of literature annotation of human diseases on the MeSH ontology. The OntoloViz package can be retrieved from PyPi. The source code along with test data, template, and documentations are available at GitHub (https://github.com/Delta4AI/OntoloViz).

Use of Non-Formulary Medicines at a Kenyan Private Hospital

Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs; with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.

Agentes antitrombóticos utilizados por pessoas idosas: prevalência e fatores associados

Abstract Objective To analyze the types and prevalence of use of antithrombotic drugs by older people and associated factors. Method A cross-sectional study of community-dwelling older people was carried out in the city of Goiânia, Midwest Brazil. The pharmacological classification of antithrombotic drugs was performed according to the Anatomical Therapeutic Chemical (ATC) classification. Bivariate and multivariate analyses were performed with a significance level of 5%. Results 212 older people participated in the study and the prevalence of antithrombotic drug use was 27.8%. The most used types were acetylsalicylic acid (ASA) (n= 49; 83%), Clopidogrel (n=6; 10.1%) and Cilostazol (n=4; 6.7%). Associated factors were the 70-79 years age group (p<0.001) and polypharmacy (p<0.001). Conclusion The proportion of antithrombotic use by the participants was high and the most used drugs posed a risk of complications and drug-drug interactions. Attention should be heightened in individuals aged >70 years and in use of polypharmacy and efforts must be made to clinically monitor these users of antithrombotic drugs therapy.

National Trends in Statin Use in Lithuania from 2010 to 2021.

Objective: In Lithuania, no comprehensive national research on statin utilization and trends has yet been undertaken. Nonetheless, this knowledge is critical for the healthcare system to identify key areas for development. We aimed to analyze trends in statin utilization in Lithuania from the past 12 years considering changes in reimbursement policies and the publication of updated international CVD prevention guidelines. Methods: We performed a retrospective, descriptive study of statin utilization in Lithuania from 2010 to 2021. The data were obtained from PharmaZOOM LT, an independent software supplier with nationwide coverage on pharmaceutical market data. The data coverage was 95%. We used anatomical therapeutic chemical (ATC) classification for data extraction and calculated defined daily doses (DDDs) according to the ATC/DDD Toolkit of World Health Organization according to statin dose in a pill. Results: Statin use increased overall from 8.28 DDD/TID in 2010 to 96.06 DDD/TID in 2021. The annual growth rate in sales of statin DDD/TID was 22.28%. The increase was mostly due to the increase in moderate- and high-intensity statins. The increases coincided with changes in reimbursement policy or the publication of international guidelines. Polypill use in Lithuania began steadily increasing after 2016 and reached 19.37% of the total DDD/TID of statins in 2021. Conclusions: The use of statins has increased dramatically in Lithuania over the last decade. Changes in statin reimbursement regulations in the country, as well as worldwide cardiovascular preventive recommendations aiming at lower LDL-C objectives, fueled the progress.

Health Outcomes in Women Victims of Intimate Partner Violence: A 20-Year Real-World Study.

Intimate partner violence is characterized by violent actions against a person perpetrated by his or her former or current partner, regardless of cohabitation. It most frequently affects women, and one of its most relevant outcomes is the health problems associated with the experience of repeated violence. Thus, the main objective of this study is to analyse the prevalence of health problems among women for whom there was a medical suspicion of being victims of intimate partner violence. The specific objectives are to analyse the prevalence of (a) health risk behaviours; (b) traumatic injuries and intoxications; (c) mental health conditions; and (d) somatic diseases. We conducted a real-world, retrospective, observational, cross-sectional and multicentric study based on secondary data analyses of electronic health records and health care register data in patients of the Local Healthcare Unit of Matosinhos (between 2001 and 2021). The identified data were extracted from electronic health records corresponding to the Health Insurance Portability and Accountability Act Safe Harbor Standard. Information was obtained considering the International Classification of Diseases, the International Classification of Primary Care, and the Anatomical Therapeutic Chemical Classification System, as well as clinical notes (according to previously defined keywords). Considering all information sources, 1676 cases were obtained. This number means that just 2% of the women observed at this health care unit were suspected of being victims of intimate partner violence, which is far from the known statistics. However, we found much higher rates of all health risk behaviours, trauma and intoxication cases, mental health conditions, and somatic disorders we looked for, when compared to the general population. Early detection of these cases is mandatory to prevent or minimize their related health outcomes.

CONSUMPTION DETAILS OF SYSTEMICALLY ACTING ANTIVIRAL AND ANTIMICROBIAL PREPARATIONS IN PERIOD OF NOVEL CORONAVIRUS INFECTION SPREAD IN RETAIL SECTOR OF SAMARA REGION PHARMACEUTICAL MARKET

An analysis of the medicinal preparation consumption structure in the period of the COVID-19 pandemic in the pharmacy network reflects the existing outpatient practice and makes it possible to draw generalized conclusions about its compliance with the pharmacotherapy standards.The aim. Comparative analysis of population consumption of antimicrobial and antiviral medicines sold in the retail pharmacies of the Samara region in 2015–2021.Materials and methods. The study was conducted in the retail sector of the Samara region pharmaceutical market. The material of the study was the information on the list of items and dispensing volumes of antibacterial and individual antiviral drugs during the novel coronavirus infection spread (in 2020) in the network of the Samara region pharmacies. The data are compared with the indicators of the drug sales in 2015–2019. Methods of retrospective, comparative, graphical, methodological, content analyzes and statistical methods of analyses were used.Results. The authors have established a significant distortion in the consumption of systemic antimicrobial preparations in the Samara region pharmacy segment in the period of 2015–2019 with the predominance of the ATC (Anatomical Therapeutic Chemical Classification System) J01D group, primarily cephalosporins (38%), mainly by the parenteral administration route. The share of macrolides (J01F) consumption in volume terms was 14.9%, of fluoroquinolones (J01M) – 11.3%, beta-lactam antibiotics with beta-lactamase inhibitors – 10.7%, beta-lactam antibiotics penicillins (J01C) – 8.1%. Compared to 2019, in 2020, under the conditions of the COVID-19 pandemic, the total consumption of AMPs increased by 2.1 times. In the “Other beta-lactam antibiotics” group with a predominant proportion of cephalosporins, there was an increase by 3.2 times, in the “Macrolides and lincosamides” group – by 3.5 times, in “Quinolone derivatives” – by 2.6 times. The noted facts should be assessed as the phenomenon that can have a direct impact on the growth of an antibiotic resistance on a population scale. Among antivirals, the largest consumption increase was noted for oseltamivir and rimantadine. In absolute terms, the volume of antiviral preparations consumption in 2020 increased by 2.4 times, which was accompanied by an increase in the cost of one package by 55.8%.Conclusion. In the period of spreading a novel coronavirus infection, a significant increase in the consumption of antimicrobial and antiviral preparations (up to 20 times for certain pharmacotherapeutic groups and names) was notified, which may negatively affect the growth of the antibiotic resistance in the population.

1806. The gap in the amount of monthly antimicrobial use according to the data source: Electronic Health Record Data vs. National Health Insurance Claim Data in Korea

Abstract Background Korea has single health insurance system and insurance claim information on almost all medical practices in Korean hospitals is collected and processed by the Health Insurance Review and Assessment Service (HIRA). Since information about prescription of almost all hospitals is available in National Health Insurance (NHI) claim data, recently established the Korea National Antimicrobial Use Analysis System (KONAS) has been using NHI claim data as data source. The purpose of this study is to validate the accuracy of NHI claim data. Methods Data on all antimicrobial agents prescribed in four tertiary-care hospitals in Korea between January 2019 and December 2019 were obtained using NHI claim data extracted by HIRA and data extracted by common data model based on electronic health record (EHR) in each hospital. Antibiotics and antifungal agents according to the Anatomical Therapeutic Chemical class J01 and J02 were included while antiviral, antitubercular, antiparasitic, and topical antimicrobial agents were excluded. Antimicrobial consumption was measured as days of therapy (DOT) and standardized to per 1,000 patient-days. The ratio of monthly antimicrobial consumption calculated using the NHI claim data compared to that calculated using the common data model was demonstrated (HIRA/EHR ratio). Results The monthly HIRA/EHR ratio of broad-spectrum antibiotics predominantly used for hospital-onset infections was 1.08-1.12 and that of broad-spectrum antibiotics predominantly used for community-acquired infections was 1.11-1.21. The monthly HIRA/EHR ratio of other antimicrobial classes are as follows: antibacterial agents predominantly used for resistant gram-positive infections 1.15-1.31, narrow-spectrum beta-lactam agents 1.00-1.05, antifungal agents predominantly used for invasive candidiasis 1.00-1.27, and antibacterial agents predominantly used for extensive antibiotic-resistant gram-negative bacteria 0.70-1.09. Conclusion The monthly antimicrobial consumption calculated using NHI claim data differs from that calculated using EHR data by up to 30%. It would be desirable to establish a system that can analyze and monitor antimicrobial consumption using EHR data in each hospital in Korea in the future. Disclosures Hyunki Woo, BS, Evidnet Inc.: Employee changhui Kim, BS, Evidnet Inc.: Employee.

A nationwide study on consumption of opioid analgesics in Iran from 2000 to 2018.

Opioid analgesics play a unique role in pain management. National opioid consumption studies could provide indirect evidence of pain management in a country. National, regional, and global opioid consumption have been studied in other countries so far; however, conducting a focused study to illuminate the consumption of opioid analgesics over the past decades in Iran seemed necessary. The main objective of this study was to determine the consumption of opioid analgesics and explore the trend of their use during 19years in Iran. Iran pharmaceutical wholesale data were used to extract the annual consumption figures of the opioid analgesics in group N02A of the World Health Organization (WHO) Anatomical Therapeutic Chemical classification and were available in Iran (morphine, fentanyl, pethidine, and oxycodone as strong opioids and, tramadol and pentazocine as weak opioids), from 2000 to 2018. Using Defined Daily Dose (DDD) by WHO and Oral Morphine Equivalent (OMEQ), the amount of annual consumption was determined in DDD/1000 inhabitants/Day (DID) and OMEQ (mg)/1000 inhabitants/Day (OID). Total opioid analgesic utilization based on DID and OID increased 31.12-fold (from 0.0196 to 0.61) and 21.06-fold (from 1.97 to 41.5mg) over 19years, respectively with a significant sharp increase from 2003 to 2006 (ß = 1.78 (DID), P value < 0.001). Medications that constituted 70% of annual opioid analgesics utilization were morphine in 2000, compared to tramadol in 2018. The annual weak and strong opioids share were 86.7% and 13.2% in 2018, respectively. Despite considerable growth in the consumption of opioid analgesics in Iran over nearly two decades, the consumption amount remained low, which might signal sub-optimal pain management. On the other hand, misuse and abuse seem to be the main reason behind significant increases in the consumption of opioid analgesics with less controlled distribution.

Statin use improves survival of patients with known or suspected lower extremity artery disease on all ankle brachial index levels.

Background: Statin medication improves the prognosis of patients with lower extremity artery disease (LEAD). Research has previously focused on patients with a lowered ankle brachial index (ABI) excluding patients with a normal or elevated ankle brachial index. The aim of this study was to analyze the impact of statin use on survival and cardiovascular mortality in patients with LEAD of different severity depicted by the ABI level. Patients and methods: 4128 ABI measurements by trained and experienced nurses between 2000 and 2009 were combined with medication data from the Social Insurance Institution and causes of death data from the national causes of death registry. End of follow-up was set at the end of 2014. The data of statin use included all statin medication with the Anatomical Therapeutic Chemical (ATC) classification codes between C10AA01 and C10AA08. Results: 1956 (47.4%) patients had statin medication. Statin use was associated with improved overall survival and amputation free survival (AFS) on all ABI levels. When adjusted for age, sex and diabetes the greatest overall survival benefit from statin use was for the patients with ABI>1.3 (hazard ratio, HR: 0.67, 95% CI: 0.48-0.94, p=0.020, reference group statin non-users) and ABI 0.9-1.3 (HR: 0.78, 95% CI: 0.65-0.94, p=0.008). In propensity score matched pairs statin treatment was associated with significantly lower all-cause mortality (p<0.0001), cardiovascular mortality (p=0.034), cerebrovascular mortality (p=0.003) and embolic stroke related mortality (p=0.001) in patients with ABI >1.3 or <0.9. Overall survival benefit was significant in females with ABI<0.5 and in males across several ABI levels. Conclusions: According to our study, statins seem to improve overall and amputation free survival regardless of ABI level. Statin use was associated with lower mortality from cerebrovascular disease, overall mortality and in the propensity score matched patients with ABI<0.9 or >1.3 with cardiovascular mortality.

Medication errors in cancer therapy: Reports from German hospital pharmacists between 2008 and 2019.

Since medication errors can have severe consequences, the development of methods to improve patient safety is becoming increasingly important. The aim of this evaluation was to identify frequent medication errors in oncology as well as characteristic correlations in the various error patterns. In addition, the implementation rate of the proposed pharmaceutical intervention was determined in order to assess the benefit of a clinical pharmacist in the field of oncology. The evaluation was based on a data-set from a national documentation system for medication errors and interventions (DokuPIK) used by hospital pharmacists in the field of oncology from 2008 to 2019, namely 6684 reported cases in oncology, representing about 5% of all reports in DokuPIK. The most frequently reported errors were incorrect doses (22% of reported errors), followed by interactions (14%); in 10% of errors the prescription/documentation was incomplete/incorrect. The intervention suggested by the pharmacist was implemented in 97% of the cases. Based on the respective Anatomical Therapeutical Chemical Classification (ATC codes), drugs (or groups of drugs) were identified that were reported frequently in connection with medication errors, namely carboplatin and cyclophosphamide as anticancer drugs pantoprazole as non-anticancer drug. Frequently occurring medication errors in the field of oncology were identified, facilitating the development of specific recommendations for action and prevention strategies. The implementation of an electronic prescription software is particularly recommended for the avoidance of dosage errors in chemotherapy.

Association between air pollution levels and drug sales for asthma and allergy in 63 million people in metropolitan France

Introduction Air pollution is known to have an impact on respiratory health. However, the assessment of this relationship is far from complete and is rarely extended to the country level. We used drug sales data, both Over-The-Counter (OTC) and prescription drugs, to assess exhaustively the impact of air pollution on asthma and allergy at the national level in France. Methods The WHO Anatomical Therapeutic Chemical (ATC) classification system was used to describe the distribution of sales of drugs of class R03 (Drugs for obstructive airways diseases, overall for asthma) and R06 (Antihistamines for systemic use). We performed a Quasi-Poisson regression model with a generalized additive model (GAM) to estimate the relationship (Relative Risks and 95% Confidence Interval) between drug sales and air pollutants, that is Particulate Matter with a diameter less than 2.5 micrometers (PM2.5) and less than 10 micrometers (PM10) and Nitrogen dioxide (NO2), as assessed using the high-resolution CHIMERE dispersion model. We designed unadjusted and adjusted single-pollutant models as well as two-pollutant models. Results PM2.5, PM10, and NO2 were significantly and positively associated with sales of R03 and R06 class drugs, after adjustment for potential confounders. Results were confirmed in the two-pollutant model for PM10 and NO2 but not for PM2.5. Conclusions Our study confirms the presence of an association between major air pollutants and the sales of drugs against asthma and allergies. Further studies on larger databases and over several years are necessary to confirm and better understand these results.