Anatomical Therapeutic Chemical Research Articles

Enhancing Transparency in Defining Studied Drugs: The Open-Source Living DiAna Dictionary for Standardizing Drug Names in the FAERS.

In refining drug safety signals, defining the object of study is crucial. While research has explored the effect of different event definitions, drug definition is often overlooked. The US FDA Adverse Event Reporting System (FAERS) records drug names as free text, necessitating mapping to active ingredients. Although pre-mapped databases exist, the subjectivity and lack of transparency of the mapping process lead to a loss of control over the object of study. We implemented the DiAna dictionary, systematically mapping individual free-text instances to their corresponding active ingredients and linking them to the World Health Organization Anatomical Therapeutic Chemical (WHO-ATC) classification. We retrieved all drug names reported to the FAERS (2004-December 2022). Using existing vocabularies and string editing, we automatically mapped free text to ingredients. We manually revised the mapping and linked it to the ATC classification. We retrieved 18,151,842 reports, with 74,143,411 drug entries. We manually checked the first 14,832 terms, up to terms occurring over 200 times (96.88% of total drug entries), to 6282 unique active ingredients. Automatic unchecked translations extend the standardization to 346,854 terms (98.94%). The DiAna dictionary showed a higher sensitivity compared with RxNorm alone, particularly for specific drugs (e.g., rimegepant, adapalene, drospirenone, umeclidinium). The most prominent drug classes in the FAERS were immunomodulating (37.40%) and neurologic drugs (29.19%). The DiAna dictionary, as a dynamic open-source tool, provides transparency and flexibility, enabling researchers to actively shape drug definitions during the mapping phase. This empowerment enhances accuracy, reproducibility, and interpretability of results.

Effects of antineoplastic and immunomodulating agents on postvaccination SARS-CoV-2 breakthrough infections, antibody response, and serological cytokine profile

BackgroundDespite immunization, patients on antineoplastic and immunomodulating agents have a heightened risk of COVID-19 infection. However, accurately attributing this risk to specific medications remains challenging.MethodsAn observational cohort study from December...

Drug Utilization Evaluation of Analgesics Using Defined Daily Dose (DDD) and Defined Daily Dose/100 Bed-Days in the Surgical Department of a Teaching Hospital

Objective The objective of the study was to perform the drug utilization evaluation of analgesics in the Department of General Surgery at a teaching hospital by using Anatomical and Therapeutic classification ATC code and Defined daily dose DDD100 bed days. Methods A prospective observational study was conducted in the Department of General Surgery at a teaching hospital for a period of three months. Descriptive statistics were used in which quantitative variables were presented in proportions and percentages. Consumption of analgesics in the department was measured by using the technical unit of measurement Defined Daily Dose DDD and DDD100 bed-days.Results A total of 606 subjects were included in the study. The majority of patients in the Department of General Surgery were males 360 59.4 and the female subjects were 246 40.6. Paracetamol 1g IV was observed to be the most used analgesic in this department with the units consumed being 4811 48.63. Aceclofenac 100 mg oral drug was the least used analgesic with units consumed at 29 0.29. The DDD100 bed-days for each analgesic with ATC code was calculated and analysed.Conclusion Drug utilization evaluation of analgesics in the Surgery department of the hospital based on DDD and the DDD100 bed-days measurement showed that parenteral forms of analgesics like Paracetamol Tramadol and Diclofenac were consumed more than the oral dosage forms of these drugs. The study also revealed that consumption of drugs like Tramadol and Pregabalin in the oral dosage forms was low in the hospital included in the study which shows rationality in the use of controlled drugs

Defined Daily Dose (DDD): An Essential Metric in the Antimicrobial Stewardship Programmes (AMSPs) in the Healthcare Sector

Antimicrobial stewardship programmes (AMSPs) decrease antimicrobial resistance, optimize usage of antimicrobials, and enhance patient outcomes. The Anatomical Therapeutic Chemical (ATC) is the foundation of the World Health Organization (WHO) global methodology, which groups the pharmacologically active substances of antimicrobials according to their therapeutic, pharmacological, and chemical characteristics and the organ or system on which they work. Since varied unit doses of daily administration of antimicrobials are prescribed, it is best to utilize a standard approach to measure antimicrobial intake. The Defined Daily Dose (DDD) is awarded to active ingredients with an active ingredient code currently in effect. It is the anticipated average daily maintenance dose of an antimicrobial drug or substances used for their primary indication in adults. The ATC/DDD approach was created to enhance patient care by tracking antimicrobial usage and conducting research. Healthcare facilities would benefit immensely from establishing an antimicrobial stewardship programme, and more research is required to determine the baseline of antimicrobial consumption in the country.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Prevalence, prescription patterns, and quality of life of anaemia in adults with chronic renal disease

Introduction and aim. Anaemia is a chronic kidney disease (CKD) condition characterised by a decline in glomerular filtration rate (GFR) and impaired kidney function. The aim of this study was to assess the prevalence, prescribing patterns, and quality of life of anaemia in patients with chronic renal disease who were adults (>18 years of age) at a tertiary care hospital. Material and methods. Data on demographic characteristics, laboratory results, medication prescriptions, and quality of life assessments were collected. Statistical tests were performed to determine associations between anaemia prevalence and factors like age, gender, and CKD stage. The study included 132 patients, with a gender distribution of 89 men and 43 women. Results. The most frequently prescribed drugs are epoetin (15.06%), multivitamins (14.82%), iron (10.65%), folic acid (10.22%), calcium carbonate (8.17%), calcitriol (5.6%), and omeprazole (4.22%). The cardiovascular system, blood disorders, and blood-producing organs come after the gastrointestinal tract and metabolism in the first anatomical level of the ATC classification. Conclusion. It suggests hospital audits and recommendations for improved prescription practices. Further investigation into anaemia causes and drug class appropriateness is needed, and implementing improvements could potentially improve health outcomes.

Descriptive analysis on disproportionate medication errors and associated patient characteristics in the Food and Drug Administration's Adverse Event Reporting System.

Medication errors (MEs) are a major public health concern which can cause harm and financial burden within the healthcare system. Characterizing MEs is crucial to develop strategies to mitigate MEs in the future. To characterize ME-associated reports, and investigate signals of disproportionate reporting (SDRs) on MEs in the Food and Drug Administration's Adverse Event Reporting System (FAERS). FAERS data from 2004 to 2020 was used. ME reports were identified with the narrow Standardised Medical Dictionary for Regulatory Activities® (MedDRA®) Query (SMQ) for MEs. Drug names were converted to the Anatomical Therapeutic Chemical (ATC) classification. SDRs were investigated using the reporting odds ratio (ROR). In total 488 470 ME reports were identified, mostly (59%) submitted by consumers and mainly (55%) associated with females. Median age at time of ME was 57 years (interquartile range: 37-70 years). Approximately 1 out of 3 reports stated a serious health outcome. The most prevalent reported drug class was "antineoplastic and immunomodulating agents" (25%). The most common ME type was "incorrect dose administered" (9%). Of the 1659 SDRs obtained, adalimumab was the most common drug associated with MEs, noting a ROR of 1.22 (95% confidence interval: 1.21-1.24). This study offers a first of its kind characterization of MEs as reported to FAERS. Reported MEs are frequent and may be associated with serious health outcomes. This FAERS data provides insights on ME prevention and offers possibilities for additional in-depth analyses.

Mapping potentially inappropriate medications in older adults using the Anatomical Therapeutic Chemical (ATC) classification system.

Potentially inappropriate medications (PIMs) in older adults are medications in which risks often outweigh benefits and are suggested to be avoided. Worldwide, many distinct guidelines and tools classify PIMs in older adults. Collating these guidelines and tools, mapping them to a medication classification system, and creating a crosswalk will enhance the utility of PIM guidance for research and clinical practice. We used the Anatomical Therapeutic Chemical (ATC) Classification System, a hierarchical classification system, to map PIMs from eight distinct guidelines and tools (2019 Beers Criteria, Screening Tool for Older Person's Appropriate Prescriptions [STOPP], STOPP-Japan, German PRISCUS, European Union-7 Potentially Inappropriate Medication [PIM] list, Centers for Medicare & Medicaid Services [CMS] High-Risk Medication, Anticholinergic Burden Scale, and Drug Burden Index). Each PIM was mapped to ATC Level 5 (drug) and to ATC Level 4 (drug class). We then used the crosswalk (1) to compare PIMs and PIM drug classes across guidelines and tools to determine the number of PIMs that were index (drug-induced adverse event) or marker (treatment of drug-induced adverse event) drug of prescribing cascades, and (2) estimate the prevalence of PIM use in older adults continuously enrolled with fee-for-service Medicare in 2018 as use cases. Data visualization and descriptive statistics were used to assess guidelines and tools for both use cases. Out of 480 unique PIMs identified, only three medications-amitriptyline, clomipramine, and imipramine and two drug classes-N06AA (tricyclic antidepressants) and N06AB (selective serotonin reuptake inhibitors), were noted in all eight guidelines and tools. Using the crosswalk, 50% of classes of index drugs and 47% of classes of marker drugs of known prescribing cascades were PIMs. Additionally, 88% of Medicare beneficiaries were dispensed ≥1 PIM across the eight guidelines and tools. We created a crosswalk of eight PIM guidelines and tools to the ATC classification system and created two use cases. Our findings could be used to expand the ease of PIM identification and harmonization for research and clinical practice purposes.

PDATC-NCPMKL: Predicting drug's Anatomical Therapeutic Chemical (ATC) codes based on network consistency projection and multiple kernel learning

The development and discovery of new drugs is time-consuming and needs lots of human and material resources. Therefore, discovery of novel effects of existing drugs is an important alternative way, which can accelerate the process of designing “new” drugs. The anatomical Therapeutic Chemical (ATC) classification system recommended by World Health Organization (WHO) is a basic research area in this regard. A novel ATC code of an existing drug suggests its novel effects. Some computational models have been proposed, which can predict the drug-ATC code associations. However, their performance is not very high. There still exist spaces for improvement. In this study, a new recommendation system (named PDATC-NCPMKL), which incorporated network consistency projection and multi-kernel learning, was designed to identify drug-ATC code associations. For drugs or ATC codes, several kernels were constructed, which were fused by a multiple kernel learning method and an additional kernel integration scheme. To enhance the performance, the drug-ATC code association adjacency matrix was reformulated by a variant of weighted K nearest known neighbors (WKNKN). The reformulated adjacency matrix, drug and ATC code kernels were fed into network consistency projection to generate the association score matrix. The proposed recommendation system was tested on the ATC codes at the second, third and fourth levels in drug ATC classification system using ten-fold cross-validation. The results indicated that all AUROC and AUPR values were close to or exceeded 0.96. Such performance was higher than some existing computational models. Some additional tests were conducted to prove the utility of adjacency matrix reformulation and to analyze the importance of drug and ATC code kernels.

Monitoring the Use of Antibiotics in Children Patients Acute Respiratory Infection Using ATC/DDD Method

The use of antibiotics needs to be monitored because it is known that excessive use of antibiotics can increase resistance in the community and this has become a focus both nationally and globally. This study aims to evaluate the use of antibiotics in patients with acute respiratory infection at Hasanuddin University Hospital using the ATC/ DDD analysis method. The research design used a cross-sectional study design with retrospective data collection. The sample in this study was patient medical record data from January-December 2021, taken from total sampling and met the inclusion and exclusion criteria. Descriptive statistics are used to present and analyze data. Evaluation of the use of antibiotics by quantitative methods ATC/DDD (Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD), DDD/1000/ patient/day. The results showed that the most widely used antibiotic was ampicillin (280 mg) 32.96 DDD/1000 patients/day and the lowest was cefadroxil (150 mg) 1.45 DDD/1000 patients/day. Antibiotics with the highest DDD / 100-patient days value and exceeding the WHO DDD standard were ampicillin antibiotics from the penicillin group with a DDD / 100 patient-day value of 32.96 DDD /100 patient-days.

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data.

Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality. Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.

The analysis of unused medications and other products returned by patients to selected public pharmacies in Poland

The issue of expired and unused medications is a significant matter worthy of analysis. The study focused on the analysis of pharmaceutical products returned to public pharmacies, with particular emphasis on expired drugs and those returned within their expiration date, along with an economic assessment of the returned products. The research methodology relied on the analysis of products returned by patients to public pharmacies in the Mazovian voivodeship. The analysis encompassed the content of containers containing expired medications in terms of their expiration date, pharmaceutical form, active ingredient, ATC classification, drug availability category, and monetary value. The analyzed products belonged to various categories, including: medicines, dietary supplements, medical devices, specialized medical foods, cosmetics, biocidal products, and hygiene items. The study revealed that 75.75% of the returned products were drugs. Among the most frequently returned active ingredients was paracetamol, and prescription medications were the predominant category among the returned products. The most commonly returned therapeutic products belonged to the groups related to the Gastrointestinal and Metabolism, Respiratory System, and Nervous System. The economic evaluation showed that the value of returned products was significantly lower for expired items compared to those within their expiration date. The total value of the returned products amounted to 42 218.07 PLN. In summary, the issue of medication waste presents a challenge that requires a comprehensive approach, such as public education and the proposal of efficient solutions. Keywords: unused drugs, drug wastage, expired drugs.

A full-document analysis of the semantic relation between European Public Assessment Reports and EMA guidelines using a BERT language model

In the European Union, the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMA) develop guidelines to guide drug development, supporting development of efficacious and safe medicines. A European Public Assessment Report (EPAR) is published for every medicine application that has been granted or refused marketing authorisation within the EU. In this work, we study the use of text embeddings and similarity metrics to investigate the semantic similarity between EPARs and EMA guidelines. All 1024 EPARs for initial marketing authorisations from 2008 to 2022 was compared to the 669 current EMA scientific guidelines. Documents were converted to plain text and split into overlapping chunks, generating 265,757 EPAR and 27,649 guideline text chunks. Using a Sentence BERT language model, the chunks were transformed into embeddings and fed into an in-house piecewise matching algorithm to estimate the full-document semantic distance. In an analysis of the document distance scores and product characteristics using a linear regression model, EPARs of anti-virals for systemic use (ATC code J05) and antihemorrhagic medicines (B02) present with statistically significant lower overall semantic distance to guidelines compared to other therapeutic areas, also when adjusting for product age and EPAR length. In conclusion, we believe our approach provides meaningful insight into the interplay between EMA scientific guidelines and the assessment made during regulatory review, and could potentially be used to answer more specific questions such as which therapeutic areas could benefit from additional regulatory guidance.

Polypharmacy and pattern of medication use among patients with gastroesophageal reflux disease: results from Pars Cohort study

BackgroundGastroesophageal Reflux Disease (GERD) is a common chronic condition. Its chronic nature may affect the pattern of medication use. This study aimed to investigate the prevalence, associated factors, and patterns of polypharmacy and medication use among GERD patients in southwestern Iran.MethodsWe used data from the Pars Cohort Study. We classified drugs using the Anatomical Therapeutic Chemical classification system. The Lexicomp® database was used to assess potential drug-drug interactions. Multivariable Poisson regression was applied. Adjusted prevalence ratio (PR) and its 95% confidence interval (CI) were estimated.ResultsA total of 9262 participants were included. Among 2,325 patients with GERD, age-standardized prevalence of polypharmacy was 9.5% (95% CI: 7.5%, 11.6%) in males, and 19.3% (95% CI: 17.2%, 21.4%) in females. The PR of experiencing Polypharmacy by GERD patients compared to non-GERD patients was 1.82 (95% CI: 1.61, 2.05%). Multimorbidity (PR: 3.33; CI: 2.66, 4.15), gender (PR: 1.68; CI: 1.30, 2.18), and metabolic syndrome (PR: 1.77; CI: 1.45, 2.15) were associated with polypharmacy among GERD patients. Drugs for acid-related disorders were the most common used drugs among men, women and elders. We found that 13.9%, 4.2%, and 1.1% of GERD patients had type C, D and X drug interactions, respectively.ConclusionGERD is correlated with a higher prevalence of polypharmacy. Among GERD patients, females, those with multi-morbidities, and those with metabolic syndrome may be affected more by polypharmacy. Considering the fairly high rate of interactions identified, a review of the medication list is essential when approaching GERD patients, and physicians must check for medications that may worsen GERD.

Diabet hastalarında polifarmasi ve ilaç ilaç etkileşimleri

Background: Diabetes mellitus is a chronic disease. The aim of our study was to evaluate drug- drug interactions and polypharmacy in diabetic patients. 
 Methods: Patients with type 2 diabetes attending our internal medicine and endocrinology policlinics from April 2019 to July 2019 were included to the study. It was designed as a prospective, descriptive and cross-sectional study. The socio-demographic characteristics of diabetic individuals, the drugs they use in the treatment of diabetes, and other accompanying diseases were evaluated according to the ATC classification. In this study, interactions between multiple drugs and polypharmacy were examined. 
 Results: The study population consisted of 526 patients between the ages of 18-87/years (59 ± 11). 69.6% of the patients were women.83.8% of the patients had chronic diseases accompanying diabetes. The most common chronic diseases were hypertension (53.6%), hyperlipidemia (41.4%) and coronary artery disease (27.2%), respectively. 45.01% of the patients were using five or more drugs. The mean number of drugs was found to be 4.49 ± 1.93. Among the drugs used by the patients, 787 drug-drug interactions were found in a total of 429 (81.5%) patients. The average number of interactions was 3.89 ± 3.6 for interaction A 15.2% (n = 81), 16.2% (n = 85) for interaction B, 69.8% (n = 367) for interaction C was, 47.9% (n = 252) for interaction D, and 0.4% (n = 2) for interaction X. The most frequent interaction was found between acetylsalicylic acid and insulin and metformin and angiotensin converting enzyme inhibitors. 
 Conclusions: Both the polypharmacy rate and drug-drug interaction rate are high in diabetic patients. The most common type of interaction is type C and type D drug-drug interaction. Attention should be paid to drug-drug interactions in the treatment of diabetes patients.

Assessment of the Prescribing Pharmacist's Role in Supporting Access to Prescription-Only Medicines-Metadata Analysis in Poland.

In 2020, pharmacists in Poland received additional authority to prescribe drugs. In this study, we analyzed prescribing after the implementation of this new responsibility. We assessed how the new regulation works in practice and what it means for the healthcare system in the area of access to prescription-only medicines. Data analysis included information on the prescriptions written, the type of substance according to the ATC classification, and data on the prescribing pharmacists. The study used over 2.994 million e-prescriptions written by pharmacists in Poland, which were made available by the e-Health Center. The largest group of drugs prescribed were drugs used in the treatment of cardiovascular diseases, accounting for 25% of all prescribed medications during the time of the analysis. The next prescription groups were for drugs used in gastrointestinal diseases and metabolic disorders, and those acting on the central nervous system, the respiratory system, and the musculoskeletal system. Among pharmaceutical prescriptions, 73% were pharmaceutical prescriptions issued in pharmacies at full price to the patient. The results indicate that pharmacists are eager to use their permission to prescribe drugs in authority situations. Almost three million records showed improved patient access to medicines in the healthcare system (approximately 5% of repeat prescriptions for all patients during the study period). These data confirm the possibility of cooperation between physicians and pharmacists in strengthening the efficiency of the patient healthcare system. An important conclusion from this work is the need to create the possibility for the pharmacist to access the information resources of the implemented Internet Patient Account system, including therapeutic indications for the drugs used.

Evaluation of the use of antibiotics using the anatomical therapeutic chemical/defined daily dose and Gyssens methods in pneumonia patients at a tertiary care general hospital in Medan

Background: The impact of irrational antibiotic usage in pneumonia patients is an increase in resistance, an increase in drug side effects, and a failure of therapy that causes patients' health to deteriorate, lowering their quality of life and raising their treatment costs. The primary objective of this study is to assess the extent to which antibiotics are being used rationally in the inpatient facility of a private tertiary care hospital located in Medan. Methods: The present study employs an observational design with a prospective cross-sectional approach, carried out within the timeframe of September to November 2022. The evaluation of antibiotic utilization was conducted utilizing the anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology and the Gyssens methodology. Results: The findings of the study indicate that a significant proportion of individuals diagnosed with pneumonia fell between the age range of 46 to 55 years, comprising 23.4% of the overall patient population. Moreover, the male gender was found to be the most prevalent, accounting for 55.81% of the 278 patients who satisfied the inclusion criteria. The findings from the evaluation of antibiotic utilization, employing the ATC classification system and DDD methodology, yielded a rate of 145.72 DDD per 100 days of care. Ceftriaxone exhibited the highest value, reaching 87.59 DDD/100 days of treatment. The evaluation of the Gyssens approach yielded a total of 254 patients who were administered antibiotics in an appropriate manner (category 0), while 24 patients were found to have received unsuitable antibiotics (categories I-VI). Conclusions: Based on the findings of this study, it can be inferred that the utilization of antibiotics within the hospital under investigation remains inadequate in terms of both quantity and quality.

Medication reconciliation on admission in paediatric chronic patients: A multicentre study

IntroductionMedication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. ObjectivesTo describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. MethodologyProspective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. Results1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. ConclusionsThe findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.

Estimating antibiotics consumption in a tertiary care hospital in Islamabad using a WHO’s defined daily dose methodology

BackgroundAntibiotics have helped to reduce the incidence of common infectious diseases in all modern healthcare systems, but improper use of antibiotics including their overuse and misuse can change the bacteria so much that antibiotics don’t work against them. In case of developing imposable selective pressure with regard to the proportion of hospitalized patients who receive antibiotics, the quantity of antibiotics that are prescribed to them, and the proportion of patients who receive antibiotic treatment is one of the major contributors to the rising global health issue of antimicrobial resistance. Concerning the levels of antibiotic consumption in Pakistani hospitals, there is negligible research data available.AimThis study aimed to evaluate five-year inpatient antibiotic use in a tertiary care hospital in Islamabad using the World Health Organization (WHO) Recommended Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology.MethodIt was a descriptive study involving a retrospective record review of pharmacy records of antibiotics dispensed (amount in grams) to patients across different specialties of the hospital from January 2017 to December 2021 (i.e., 60 consecutive months). The antibiotic consumption was calculated by using the DDD/100-Bed Days (BDs) formula, and then relative percent change was estimated using Microsoft Excel 2021 edition.ResultA total of 148,483 (77%) patients who received antibiotics were included in the study out of 193,436 patients admitted in the hospital. Antibiotic consumption trends showed considerable fluctuations over a five-year period. It kept on declining irregularly from 2017 to 2019, inclined vigorously in 2020, and then suddenly dropped to the lowest DDD/100 BDs value (96.02) in the last year of the study. The overall percentage of encounters in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the WHO standard reference value (< 30%). WATCH group antibiotics were prescribed (76%) and consumed more within inpatient settings than Access (12%) and Reserve (12%) antibiotics.ConclusionThe hospital antibiotic consumption data is well maintained across different inpatient specialties but it is largely non-aligned with WHO AWaRe (Access-Watch-Reserve) antibiotics use and optimization during 2017–2021. Compared to the WHO standard reference figure, the overall percentage of antibiotics encountered was higher by about 47%. Antibiotic consumption trends vary with a slight increase in hospital occupancy rate, with positive relative changes being lower in number but higher in proportion than negative changes. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence.

Low-density lipoprotein cholesterol reduction and short-term incidence of ASCVD in the population-based cohort study LATINO

Abstract Background/Introduction In Portugal, 25,000 people die from atherosclerotic cardiovascular diseases (ASCVD) every year, accounting for more than 20% of all deaths in 2019. Reducing low-density lipoprotein cholesterol (LDL-C) is an effective intervention to lower the risk of CV events, including ischemic stroke (IS), coronary heart disease (CHD) and Peripheral Artery Disease (PAD). Purpose This study aims to assess the extent of ASCVD risk prevention associated with different levels of LDL-C lowering in an unselected population in Portugal. Methods We used electronic health records to conduct a population-level retrospective cohort study of individuals aged 40–80 years who were followed in 1 hospital and 14 primary care facilities in Portugal from 1/1/2012 to 31/12/2020. Patients started being followed when they fulfilled criteria to be exclusively characterised as high CV risk at the index date (defined according to the ESC/EAS 2019 guidelines). This analysis focused on the 24-month risk of developing ASCVD, by percentual LDL-C reduction between 360 and 540 days from the maximum LDL-C. The primary endpoint of ASCVD included the risk of IS, CHD or PAD, as defined by the corresponding ICD-9-CM/ICD-10-CM codes. IS, CHD and PAD were also analysed separately as secondary endpoints. LDL-C values were obtained from laboratory results and CV and diabetes medications’ use from prescription data registered according to the Anatomical Therapeutic Chemical Classification System recorded. A Cox regression model adjusted for sex, age, all relevant CV risk variables, risk-enhancing factors, and CV and diabetes medications was developed. Results The total cohort at 24 months of follow-up consisted of 21,101 observations corresponding to 16,055 distinct patients. Higher LDL-C percentual reduction was associated with a lower risk of ASCVD, with adjusted hazard ratios (aHR) (95% confidence intervals (CI)) of 0.82 (0.66-1.02), 0.86 (0.66-1.11) and 0.44 (0.24-0.79) per reduction of ]0,30%], ]30,50%] and ]50,90%] of LDL-C respectively, versus having no reduction or increase. IS was the secondary endpoint that contributed the most to the reduction of risk of ASCVD with an aHR (95% CI) of 0.89 (0.69-1.15), 0.67 (0.47-0.96) and 0.41 (0.19-0.86) for the same corresponding LDL-C reduction categories. However, these results were not statistically significant for PAD or CHD when assessed isolated. Conclusion This real-world evidence study shows that, independently of age, sex, and other CV risks and medications, reductions of &amp;gt;50% in LDL-C significantly reduced by 56% the risk of ASCVD at 24 months in high CV risk patients. This reduction was more striking for ischemic stroke. Therefore, LDL-C reductions &amp;gt;50% should be a paramount objective in public health policies worldwide.