Anatomical Therapeutic Chemical Research Articles

Adverse drug reaction detected as a result of taking a combined antiseptic medicine

Antiseptic drugs (R02AA) are the most commonly used symptomatic drugs for the treatment of patients with symptoms of catarrhal pharyngitis. According to the ATC classification, 311 medicines belong to the group of antiseptic drugs. Such a variety of drugs accounts for the problem of choice and, as a result, a decrease in the effectiveness of the treatment and the manifestation of a large number of side effects. The purpose of the research: to conduct an informational and analytical study of a combined antiseptic that caused an adverse drug reaction in a patient diagnosed with pharyngitis.

Public procurement of antineoplastic agents used for treating breast cancer in Brazil between 2013 and 2019

BackgroundBreast cancer is the most common cancer among women in Brazil and the country’s public health care system is the main care provider. Timely treatment can increase the chance of cure, prevent metastasis and improve quality of life. Effective public procurement of antineoplastic agents can therefore improve access to drug therapy. This study investigates patterns in the procurement of selected antineoplastic agents used for treating breast cancer by public bodies and avoidable expenditure on these drugs between January 2013 and December 2019.MethodsWe selected antineoplastic agents used for adjuvant or preoperative chemotherapy listed in the 2018 Breast Cancer Diagnosis and Treatment Guidelines and included in category L of the WHO Anatomical Therapeutic Chemical classification system. We analyzed regular purchases of antineoplastic agents registered in the Integrated General Services Administration System (SIASG), considering purchased quantity, unit price, date of purchase and procuring entity. Prices were inflation-adjusted to July 2019 based on the National Consumer Price Index.ResultsA total of 10 antineoplastic agents were selected. Trastuzumab and tamoxifen accounted for the largest share of total spending and largest volume of purchases, respectively. The Ministry of Education was the largest purchaser in volume terms of all the drugs studied, except trastuzumab 440 mg, where the category “Other Institutions” accounted for most purchases, and vinorelbine 20 mg, where the Ministry of Health made most purchases. The category “Other Institutions” accounted for the largest share of total spending. Total avoidable expenditure was R$99,130,645. Prices paid for medicines and avoidable expenditure were highest in the Ministry of Defense.ConclusionsThe differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastic agents could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.

Pattern of Antibiotic Prescriptions in Chinese Children, A Cross-Sectional Survey From 17 Hospitals Located Across 10 Provinces of China.

Use of Broad-spectrum antibiotics is related closely to increasing antimicrobial resistance. Reports on antibiotic prescriptions for Chinese children were rare. We described the prescribing patterns of antibiotic prescriptions for Chinese children from 2017 to 2019 based on the Anatomical Therapeutic Chemical Classification (ATC classification); the Access, Watch, and Reserve (AWaRe) classification from the World Health Organization (WHO), and the Management of Antibiotic Classification in China. A 1-day point-prevalence survey (PPSs) on antibiotics prescribing for Chinese children was conducted in hospitalized children from 17 centers in 10 Chinese provinces from 1 September 2017 to 30 November 2019. A total of 4,982 antibiotic prescriptions for Chinese children were included in the analysis. There were 76 types of antibiotic agents in total, 22 (28.9%) of which accounted for 90% of all antibiotic prescriptions. The top-three antibiotics prescribed for children were azithromycin (684, 13.7%), ceftriaxone (508, 10.2%) and latamoxef (403, 8.1%). Third-generation cephalosporins (1,913, 38.4%) were the most commonly prescribed antibiotic classes. On the basis of the AWaRe classification, the Watch group antibiotics accounted for 76.3% and Access group antibiotics accounted for 12.1% of all antibiotic prescriptions. On the basis of the China classification, we showed that 26.5% of antibiotic prescriptions were in the Unrestricted group, 53.6% in the Restricted group, and 14.5% in the Special group. The proportion of antibiotics included in the Watch group and the Special group was high in children in China. The AWaRe classification and China classification for antibiotic prescriptions could be used to supply detailed data for antibiotic stewardship as a simple metric.

Clinical factors associated with increased length of stay and readmission in patients with medication-related hospital admissions: a retrospective study.

Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required. To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission. A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs<2 days) and readmission. There were 125 patients who met inclusion criteria (median age=64 [interquartile range, 45-75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48-10.33 and aOR 3.24, 95% CI 1.05-10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05-6.57 and aOR 3.20, 95% CI 1.17-8.75, respectively). This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.

Obat Off-label pada Pasien Pediatri Rawat Jalan: Penelitian Observasi Retrospektif di RSUD Dr. H. Abdul Moeloek Lampung

Several medications are prescribed for infants and children, but adequate information about these drugs are unavailable. Previous studies also revealed that the use of off-label drug is prevalent among pediatric outpatients. Therefore, this study aimed to determine the prevalence of off-label drug use in pediatric outpatients at Dr. H. Abdul Moeloek Lampung Hospital from January–June 2019. This observational descriptive was conducted using simple random and retrospective sampling methods. Drugs were identified using a brochure, British National Formulary for Children (BNF), and Specialist Health Science Formulary from the Indonesian Pediatrician Association (IDAI), followed by classification with the Anatomical Therapeutical Chemical (ATC). The results showed that there were 120 samples, of which 56% are males, while 42% are within the age range of 6–12 years. The most common diagnoses were SNRS, followed by epilepsy and anemia. A total of 393 drugs were used in this study and analgesic-antipyretic was the most prescribed. The prevalence of off-label drug usage in pediatric patients was 19.6%, where the off-label age was higher (16.29%) than indication (2,81%) and doses (0,5). Furthermore, most of these medications were for the cardiovascular, respiratory, digestive, and metabolic systems. There has been a 19,6% prevalence in the use of off-label drug among pediatric outpatients, where off-label age was the highest, and most of the medication are used for the treatment of the cardiovascular system.

Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case

BackgroundThe analysis of statutory health insurance (SHI) data is a little-used approach for understanding treatment and care as well as resource use of lung cancer (LC) patients in Germany. The aims of this observational, retrospective, longitudinal analysis of structured data were to analyze the healthcare situation of LC patients in Germany based on routine data from SHI funds, to develop an algorithm that sheds light on LC types (non-small cell / NSCLC vs. small cell / SCLC), and to gain new knowledge to improve needs-based care.MethodsAnonymized billing data of approximately four million people with SHI were analyzed regarding ICD-10 (German modification), documented medical interventions based on the outpatient SHI Uniform Assessment Standard Tariff (EBM) or the inpatient Operations and Procedure Code (OPS), and the dispensing of prescription drugs to outpatients (ATC classification). The study included patients who were members of 64 SHI funds between Jan-1st, 2015 and Dec-31st, 2016 and who received the initial diagnosis of LC in 2015 and 2016.ResultsThe analysis shows that neither the cancer type nor the cancer stage can be unambiguously described by the ICD-10 coding. Furthermore, an assignment based on the prescribed medication provides only limited information: many of the drugs are either approved for both LC types or are used off-label, making it difficult to assign them to a specific LC type. Overall, 25% of the LC patients were unambiguously identifiable as NSCLC vs SCLC based on the ICD-10 code, the drug therapy, and the billing data.ConclusionsThe current coding system appears to be of limited suitability for drawing conclusions about LC and therefore the SHI patient population. This makes it difficult to analyze the healthcare data with the aim of gathering new knowledge to improve needs-based care. The approach chosen for this study did not allow for development of a LC differentiation algorithm based on the available healthcare data. However, a better overview of patient specific needs could make it possible to modify the range of services provided by the SHI funds. From this perspective, it makes sense, in a first step, to refine the ICD-10 system to facilitate NSCLC vs. SCLC classification.

P1596: PREDIAGNOSTIC ANTIMICROBIAL USE IN CLL, MM, FL AND DLBCL

Background: Chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and multiple myeloma (MM) are B-cell lineage malignancies all sharing an immune dysfunction leading to an increased risk of infection. CLL, FL and MM are preceded by indolent precursor states; more specifically monoclonal B-cell lymphocytosis (MBL), in situ follicular neoplasia (ISFN), and monoclonal gammopathy of uncertain significance (MGUS), respectively. MBL, ISFN and MGUS may be detected decades prior to overt malignancy. Although CLL and FL may transform into DLBCL, evidence for a premalignant DLBCL precursor is scarce. We have previously demonstrated an increased use of antibiotics up to 20 years prior to CLL diagnosis (Andersen et al. Leukemia. 2020). Whether patients with DLBCL, FL or MM share the same trait as patients with CLL remains unknown. Aims: To assess use of antimicrobials for patients with FL, DLBCL and MM prior to diagnosis Methods: We included all patients diagnosed with CLL since 2008, small lymphocytic lymphoma (SLL), DLBCL, FL and symptomatic MM since 2005 through Danish national patient registries (DCLLR, LYFO and DaMyDa; https://www.rkkp.dk/). We analyzed patients with CLL and SLL jointly, as they are recognized as the same disease entity and treated similarly. Likewise, patients with FL grade 3b are clinically similar to DLBCL, thus patients with FL treated with R-CHOP-like regimens within 3 months of diagnosis were considered grade 3b and analyzed together with DLBCL. Data on antimicrobial (AM) prescriptions (Rx) were retrieved from the Danish national database for reimbursed prescriptions (DNDRP) using WHO ATC codes. To characterize the use of prediagnostic AM use, we included AM Rx from January 2004 until date of diagnosis. Patients with multiple malignancies were classified according to the first occurring diagnosis. Statistical analyses were performed using R software. Results: We followed 21,822 patients for a mean of 9.8 person-years prior to diagnosis (SD+/- 4.8), from which a total of 138,805 AM Rx were identified for 18,840 (86.3%) distinct patients. Within the cohort, 6377 (29.2%) were diagnosed with CLL accounting for 42,107 (30.33%) AM Rx, 5803 (26.6%) were diagnosed with MM accounting for 38,417 (27.7%) AM Rx, 6735 (30.9%) were diagnosed with DLBCL accounting for 41,623 (30.0%) AM Rx, and 2907 (13.3%) were diagnosed with FL accounting for 16,658 (12.0%) AM Rx. Thus, 2982 (13.7%) patients had no Rx prior to diagnosis of whom 989 (33.2%) had DLBCL, 775 (26.0%) had CLL, 722 (24.2%) had MM, and 496 (16.6%) had FL. Stratified by disease, patients later diagnosed with CLL and MM accounted for more AM Rx than patients later diagnosed with DLBCL and FL (45.0% vs 41.6% vs 37.8% vs 35.4% with >3 AM Rx, respectively; Table 1). In particular, more penicillin and macrolide were prescribed prior to diagnosis of CLL and MM compared to patients later diagnosed with DLBCL and FL. Image:Summary/Conclusion: These preliminary results indicate a higher rate of infections, as assessed by number of AM Rx, in individuals later developing CLL and MM compared to individuals later developing DLBCL and FL. Thus, MM and CLL seems to be prone to immune dysfunction also prior to diagnosis. Whether immune dysfunction plays a role in development of the disease or is due to the premalignant MBL and MGUS warrants further investigations.

Prevalence of exposure to pharmacogenetic drugs by the Saudis treated at the health care centers of the Ministry of National Guard

BackgroundThe drugs impacted by genetic variants are known as pharmacogenetic (PGx) drugs. Patients’ responses to these drugs may vary according to the variability in patients’ genetic makeup. Hence, exploring the pharmacogenes that affect drug treatment is vital to ensure optimal therapy and patients’ safety. This study aimed to describe the usage rate of PGx drugs and the frequency of relevant variants in the Saudi population. MethodologyPrescription patterns over seven years (2015–2021) for Saudi patients on PGx drugs treated at the Ministry of National Guard-Health Affairs (MNG-HA) were investigated. Only registered drugs in the MNG-HA formulary (n = 78) were included. The patients were subgrouped into four age groups: ≤24, 25–44, 45–64, and ≥65 years. Further subgrouping was made according to gender and drugs’ therapeutic categories following anatomical therapeutic chemical (ATC) classification.Furthermore, an online searching was carried out to identify the pharmacogenes reported in the literature among healthy Saudis. The search included 45 genes that may affect drug outcomes based on evidence rated by either CPIC (A-B levels) or PharmGKB (1–2 levels). ResultsThe screened patients were 1,483,905. Patients on PGx drugs accounted for 46.7% (n = 693,077 patients). The analgesic group was the most prescribed drug category (47%), which included ibuprofen (20.5%), celecoxib (6.3%), tramadol (5.8%), and others. Cardiovascular agents were the second-most utilized drug class (24.4%). Omeprazole was the second most commonly used medication (11.1%) but ranked third as a class (gastroenterology). Females used PGx drugs more frequently than males (53.5% versus 46.5%) and a higher usage rate by patients aged 45–64 years (31.3%) was noted. The cytochrome P450 genes (CYP2C9, CYP2C19, and CYP2D6) were estimated to impact responses of 54.3% (n = 1,156,113) of the used drugs (27.2% are possibly affected by CYP2C9, 12.8% by CYP2C19, and 14.3% by CYP2D6). Thirty-five pharmacogenes that characterize Saudi population and their variants’ allele frequencies were identified from previous reports. This study presents the largest reported number of genes that may affect drug therapies among Saudis. ConclusionThis study confirmed that a high percentage of Saudi patients use PGx drugs and various genotypes of certain pharmacogenes are inherited by the Saudi population.

Mental, Neurological, and Somatic Comorbidities and Their Treatment in Persons With Intellectual Disability.

Persons with intellectual disability (ID) often suffer from significant comorbidities. As data have been lacking until now, the present report is the first one containing outpatient data on the prevalence of ID in Germany, its comorbidities, and outpatient (drug) treatment. This study is based on the nationwide outpatient billing data and drug prescription data of all SHI-insured adults (SHI, statutory health insurance) (age 18-109) who were seen at least once in an outpatient medical practice in 2018. Patients with at least two F70-F79 diagnoses in two quarters were included in the study group (SG) (n = 324 428). A random sample of patients without ID served as the control/comparison group (CG) (n = 648 856). The odds ratios (SG vs. CG) for comorbidities, prescriptions of selected classes of drugs, and involvement of medical specialties were each analyzed by multivariate logistic regression. The prevalence of ID was 0.55%. ID was found to be associated with a variety of comorbidities. The highest odds ratios [OR] were for infantile cerebral palsy (OR: 121.71; 95% confidence interval: [111.67; 132.67]), autism spectrum disorders (OR: 83.85 [75.54; 93.08]), and developmental disabilities (OR: 61.34 [58.86; 63.94]). The most frequently prescribed drug categories (as classified by the anatomic-therapeutic-chemical (ATC) convention) were psychoactive drugs (antipsychotic, anxiolytic, and hypnotic drugs and sedatives) and antiepileptic drugs (OR: 10.40 [10.27; 10.53] and 9.90 [9.75; 10.05], respectively). Both general practitioners (OR: 2.64 [2.59; 2.69]) and medical specialists were consulted by the SG more frequently than by the CG; the type of specialist most commonly consulted was in the neuropsychiatric field, i.e., a neurologist or psychiatrist (OR: 6.85 [6.77; 6.92]). A diagnosis of ID frequently appears in outpatient billing data. Future analyses should be devoted to the specific care of people with intellectual disability, who constitute an especially multimorbid and vulnerable patient group.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Abstract 3348: Impact of comedications on pCR rates and relapse in breast cancer. Analysis of the Saint-Louis observational cohort

Abstract Context: There is a growing interest in drug repurposing and pathological complete response (pCR) that may influence the progression and treatment of breast cancer (BC). However, few studies focus on the influence of comedications, i.e., non-anticancerous drugs taken for coexisting conditions in cancer patients on neoadjuvant chemotherapy (NAC), and even less regarding the impact of response to treatment and relapse in breast cancer. Objectives: To assess whether the use of comedications modifies pCR and patient relapse probability in BC. Methods: We retrospectively analyzed data from Saint-Louis Hospital (Paris, France). Characteristics from 664 patients with neoadjuvant chemotherapy. Response to chemotherapy was assessed by pathological complete response (pCR). We analyzed comedication according to levels 1 and 2 of the Anatomical Therapeutic Chemical Classification System (ATC). A chronic comedication was defined by a comedication declared at diagnosis, excluding local and/or non-continuous administration. To estimate the average causal effect of comedication on pCR, we employed Inverse Probability Weighting (IPW) and Super Learner strategy to pick the best regression model. We used a Cox multivariate regression model to analyze the average causal effect of comedications on relapse probability. Results: 664 patients were included in this study. The median age at inclusion was 51.4 years. Of 664 patients, 194 patients (29.2%) had at least one comedication (433 total comedications). The repartition of comedications, according to the 1st level of ATC, was as follows: Cardiovascular system (C): 40.2% (n=174), Nervous system (N): 23.8% (n=103) and Alimentary tract and metabolism (A): 15.2% (n=66). Among the population with collected pCR, 112 tumors achieved pCR (18.6%). After IPW adjusted for clinical, pathological, and treatment variables, C03 (Diuretics) was associated with an increased likelihood of positive pCR (C03 versus no C03, OR = 5.0, CI95% [1.25-12.2]). By contrast, N06 (Psychoanaleptics) was associated with a decrease in pCR rates (OR= 0.3, CI95% [0.1-0.6]). The multivariate survival analysis showed a significant effect on the relapse probability of Selective Serotonin reuptake inhibitors (SSRIs, NO6) (OR = 2.3 CI95% [1.2-4.4], p = 0.01). Discussion: In this observational analysis, the use of chronic cardiovascular diuretics (C03) during NAC was associated with improvement of pCR rates. On the contrary, Psychoanaleptics (N06) were significantly associated with lower pCR rates and a higher probability of relapse. This finding prompts for further research on the interactions between chemotherapy, nervous system drugs such as SSRIs, and pathological complete response. Citation Format: Anne-Sophie Hamy, Amyn Kassara, Hamid Hocini, Clementine Garin, Luis Teixeira, Caroline Cuvier, Paul Gougis, Elise Dumas, Fabien Reyal, Beatriz Grandal, Nadir Sella, Eric Daoud, Aurélien Latouche, Thierry Dubois, Annabelle Ballesta, Samar Alsafadi, Elaine Del Nery, Élodie Anthony, Benjamin Marande, Cedric de Bazelaire, Anne de Roquancourt, Catherine Michel, Sylvie Giacchetti, Marc Espie. Impact of comedications on pCR rates and relapse in breast cancer. Analysis of the Saint-Louis observational cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3348.

AVAILABILITY ANALYSIS OF ORAL ANTIPLATELETS IN THE RUSSIAN FEDERATION

Abstract The Aim. Pharmacoeconomic assessment of the oral antiplatelet availability of various drug manufacturers and dosage forms based on the analysis of price characteristics. Materials and methods. The analysis included drugs from the group of platelet aggregation inhibitors (excluding heparin) (ATC code B01AC): clopidogrel, clopidogrel + acetylsalicylic acid (ASA), ASA and dipyridamole in various dosages and number of tablets per package. The cost values were estimated by the resources of large resources "Apteka.ru", "009.rf" with the average value calculations in the eight federal district’s capitals of the country. Results. The cost of drugs in the analyzed group varied depending on the drug manufacturer. The highest amount of the cost variation was in the ASA tablet form (100 mg) – 407.47%, followed by the tablet form of clopidogrel (75 mg) – 311.16%, ASA (50 mg) – 172.20%, dipyridamole (75 mg) – 117.36% and the lowest values for the tablet forms of dipyridamole (25 mg) – 68.19% and the combination of ASA with clopidogrel (100mg + 75mg) – 59.13%. The highest Ca.s values were in ticagrelor (90 mg) – 24.92% and prasugrel (10 mg) – 7.87%, the lowest in ASA (50 mg) – 0.1%. According to the linear index of distribution, the drugs ASA (100 mg) – 89%, clopidogrel (75 mg) – 70%, and less accessible ticagrelor (60 mg) – 18% and prasugrel (10 mg) – 14% had a higher physical availability. Conclusion. Based on the calculated values a high availability of such antiplatelet drugs as ASA (50 mg and 100 mg), clopidogrel (75 mg) was revealed. According to the results of the study, the antiplatelet drugs ticagrelor (60 mg and 90 mg) and prasugrel (10 mg) have the least level of availability.

COMBINED ABC/OTC-ANALYSIS OF A RANGE OF MEDICINAL PREPARATIONS IN HOME FIRST AID KITS OF GERIATRIC PATIENTS

Geriatric patients are the most frequent visitors to the pharmacy, which makes it necessary to analyze their needs, in particular, assortment analysis of home first aid kits. The aim of the study was to conduct a combined ABC-OTS analysis of the range of medicines (M) in the home first-aid kits of geriatric patients to identify the most expensive groups allowed to leave pharmacies without a doctor’s prescription. Materials and methods: The objects of the study were home first aid kits of geriatric patients over 65 years old (106); instructions for the medical use of medicines; data on prices for medicines from the reference service “003” of the State Unitary Enterprise “Medical Equipment and Pharmacy of Tatarstan”. The method of combined ABC/OTS analysis is used in the work. Statistical processing of the obtained results was performed using MicrosoftOfficeExcel 2010. Results. A combined ABC/OTC analysis of home first aid kits of geriatric patients was carried out. The OTC analysis revealed the pre- dominance of over-the-counter drugs in the home medicine cabinets of the elderly (59.93%). As part of the ABC analysis, group A (79.90%) included 198 names of M, group B (15.05%) - 146 names, group C (5.05%) - 157 names. The most expensive drugs according to the ATC classification in all three groups were the groups “Drugs for the treatment of diseases of the cardiovascular system” and “Digestive tract and metabolism”. In the groups, M was determined by the frequency of occurrence in first aid kits: group A – parac- etamol (25.25%), pancreatin (24.24%), ibuprofen (21.72%), acetylsalicylic acid (17.17%), group B – hydrogen peroxide (11.11%), iodine (8.59%), loperamide (8.22%), ibuprofen (1.37%), group C – motherwort tincture (4.46%), marshmallow medicinal herb ex- tract (3.82%), loratadine (3.18%), chlorhexidine (3.18%). The average cost of M by ABC analysis groups indicates a higher cost of M of group A (525.96 rubles), in comparison with groups B (143.15 rubles) and C (46.77 rubles). Conclusion. As a result of the combined ABC/OTC analysis of the range of drugs in the home first aid kits of geriatric patients, the predominance of OTC drugs was revealed (59.93%). The distribution of medicines in the most expensive group A is: medicines sold to the population from pharmacies by prescription - 44.95% of items (the share of costs is 42.15%, the average cost of 1 package is 527.43 rubles), OTC drugs - 55.05% (the share of costs is 57.85%, the average cost of 1 package is 491.73 rubles). Group A is dominat- ed by M ATX-groups “Drugs for the treatment of diseases of the cardiovascular system”, “Digestive tract and metabolism” In groups B and C, OTC drugs predominate both in terms of the number of names (62.33% and 63.69%, respectively) and in terms of costs (61.57% and 63.48%, respectively). In group B, the cost of M is comparable: 143.15 rubles - dispensed from pharmacies by pre- scription and 143.01 rubles - OTC drugs. In group C, the average package price is higher for prescription drugs: 47.04 rubles compared with 45.93 rubles in the case of OTC drugs. The most expensive OTC drugs in home medicine cabinets according to the ATX classification belong to the groups “Other nonsteroi- dal anti-inflammatory drugs”, “Bioflavonoids”, “Other immunostimulants”, “Other drugs for the treatment of diseases of the muscu- loskeletal system”, “Other nonsteroidal anti-inflammatory drugs”, “Combination of drugs for the treatment of liver and biliary tract diseases”. The predominance of OTC drugs in home first-aid kits, both in terms of the number of names and the financial costs of their acquisi- tion, indicates an increasing role of pharmaceutical workers in the rational pharmacotherapy of geriatric patients.

Drug shortages in low- and middle-income countries: Colombia as a case study

BackgroundDrug shortages are a global problem. Analyzing shortages worldwide is important to identify possible relationships between drug shortages across countries, determine strategies that reduce drug shortages, and reduce the inequality in access to medicines between countries. In contrast to well-documented shortages in high-income countries, there are few studies that consider low- and middle-income economies. We evaluate drug shortages in one middle-income country, Colombia.MethodsWe collected data from INVIMA, the institution responsible for managing medicine shortage alerts in Colombia. We classified the data using the Anatomical Therapeutic Chemical (ATC) classification system and analyzed them using descriptive statistics. We considered a study period from 2015 to 2021 (vital medicines) and from 2010 to 2020 (non-vital medicines).ResultsIn total, 173 unique ATC codes were in shortage. These included antidotes, alimentary tract and metabolism products, anesthetics, cardiac stimulants and antithrombotic agents. The major causes were manufacturing problems and few suppliers. Drug shortages substantially increased from 2020 to May 2021 due to the COVID-19 pandemic. Among resolved shortages, the average duration was 1.6 years with a standard deviation of 1.9 years. The longest, naloxone tablets, were in shortage for almost 10 years.ConclusionsDrug shortages are a persistent problem in Colombia. Government institutions have made progress in implementing systems and procedures to report them. However, the approaches implemented need to be maintained and refined. This study lays the groundwork for the analysis of drug shortages in other LMICs. We highlight the necessity of addressing drug shortages in their global context and reducing the inequality in access to medicines between countries.

Rational Use of Antibiotics: An Area of Concern

Published on:June 2022Journal of Young Pharmacists, 2022; 14(2):165-168Review Article | doi:10.5530/jyp.2022.14.31 Authors: Sougata Sarkar,1 Vartika Srivastava,2,*Shambo Samrat Samajhdar,1 Chaitali Pattanayak,2 Santanu Tripathi3 1Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, INDIA. 2Department of Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha INDIA.3Department of Pharmacology, Netaji Subhas Medical College and Hospital, Patna, Bihar, INDIA. Abstract: Most of the IPD (Inpatient department) and OPD (Outpatient department) patients receive a course of antibiotics either for treatment or prevention of infection or during discharge. The therapeutic outcome with an antibiotic depends mostly on choice of appropriate agent. The selection of antibiotic depends on causative agent, patient factors, clinical pharmacology of antibiotics and its cost effectiveness. Antimicrobial resistance (AMR) occurs when microbes like bacteria, parasites, viruses and fungi become resistant to antimicrobial drugs that are used for treatment of various diseases leading to decreased effectiveness, difficulty in treatment of disease and hence requiring multiple therapeutic options. Antimicrobial stewardship is a coordinated intervention, designed to improve and measure the appropriate use of antimicrobial agents, by promoting the selection of optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration. To strengthen the implementation of rational antibiotic use and reduction of antimicrobial resistance, WHO (World Health Organisation) in 2019 introduced “AWaRe” classification of antibiotics that includes details of 180 antibiotics classified as Access, Watch or Reserve, their pharmacological classes, Anatomical Therapeutic Chemical (ATC) codes and WHO Essential Medicines List status. One health approach is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and environment. Recently, WHO issued new guidelines regarding the use of antimicrobials in animals producing food, recommending the restricted use of such medicines in growth promotion or prevention of disease in healthy animals. Hence rational use of antibiotics is important for successful treatment outcome and prevention of emerging drug resistance for broader community.Key words: Antibiotics, Antibiotic resistance, Antibiotic stewardship, AWaRe Classification, One health approach.

Characterising the use of varenicline: an analysis of the Australian dispensing claims data.

Background and aimsIn Australia, patterns of use of smoking cessation medications and factors associated with their dispensing are currently not known. This study aimed to measure the demographic and clinical factors associated with varenicline dispensing compared with nicotine replacement therapy (NRT) and bupropion among first‐time users of Pharmaceutical Benefits Scheme (PBS) subsidised smoking cessation medicines in Australia and to characterise those who discontinued varenicline treatment prematurely.DesignRetrospective, population‐based study. Logistic regression was used to identify factors associated with varenicline dispensing compared with NRT and bupropion. Sensitivity analyses estimated the proportion of individuals who completed the recommended 12 weeks of varenicline treatment.Setting and participantsFirst‐time users of PBS subsidised smoking cessation medicines in Australia. Individuals first dispensed a smoking cessation medicine between 2011 and 2019 were identified from a 10% random sample of the national dispensing claims data.MeasurementsThe outcome for the regression analysis was the dispensing of varenicline compared with NRT and bupropion. The dispensing of a smoking cessation medicine was identified using the World Health Organization Anatomical Therapeutic Chemical Classification System and PBS item codes. Independent variables included demographic and clinical characteristics such as sex, age, concessional status, year of treatment initiation and comorbidities identified using the Rx‐Risk index. The proportion of people who discontinued varenicline treatment after the initiation pack was determined using prescription refill data.FindingsA total of 94 532 people had their first PBS subsidised smoking cessation medicine. Of these, 62 367 (66.0%) were dispensed varenicline, 29 949 (31.7%) NRT and 2216 (2.3%) bupropion. The odds of varenicline dispensing were higher in males (OR, 1.18; 95% CI, 1.14–1.21), but lower in older adults (0.86 [0.82–0.90] in above 30 years to 0.49 [0.47–0.52] in 61 years and above), among concession beneficiaries (0.44; 0.43–0.46), and those with congestive heart failure (0.60; 0.53–0.68), depression (0.61; 0.54–0.69), anxiety (0.70; 0.66–0.73), psychotic illness (0.39; 0.37–0.42), and chronic obstructive pulmonary disease (0.87; 0.82–0.92). The majority (37 670; 60.4%) of those dispensed varenicline discontinued treatment after the initiation pack. Anxiety and psychotic illnesses were significantly more prevalent in those who discontinued treatment. Only 2804 (4.5%) of those dispensed varenicline completed 12 weeks of treatment.ConclusionIndividuals dispensed varenicline in Australia appear to be healthier compared with those who are dispensed nicotine replacement therapy or bupropion.

Utilization of Gonadotropin-Releasing Hormone Agonists in the Treatment of Metastatic and Locally Advanced Prostate Cancer - Comparisons of Practices from Three European Countries

Abstract Introduction: Prostate cancer is one of the most common health threats for men in the developed world. With the advent of prostate cancer screening using serum prostate-specific antigen (PSA) tests, prostate cancer mortality has declined at the expense of substantial disease overtreatment. Modern prostate cancer therapy is performed according to certain guidelines. Antiandrogens are compounds that inhibit the action of androgens in prostate cancer cells by blocking receptors and preventing the binding of hormones to them. Aim: The aim of this research is to analyze the use of registered forms of LHRH agonists used in the treatment of locally advanced and metastatic prostate cancer in the last five years to examine trends in prescribing this group of drugs in Serbia whose patients gravitate towards the Urology Clinic at the UCC Kragujevac. Material and method: Using the ATC/DDD methodology, the use of LHRH agonists at the Urology Clinic of the UCC Kragujevac. A retrospective study of the use of this group of drugs according to the ATC classification was performed on the basis of data obtained from the hospital pharmacy for the period from year 2016 to year 2021, and the results are expressed by the number of DDD per 1000 inhabitants per day (1000/inhabitants/day). In the observed period, 1361 patients with a diagnosis of C61 (malignant prostate tumor) were treated at the Clinic of Urology. Results: In the observed period, a preparation containing triptorelin in a dose sufficient for one month of therapy was most often used. The total consumption of gonadorelin was lower compared to the rest of Serbia and EU countries, which was expected due to the protocol and the number of patients who gravitated towards the UCC Kragujevac. Conclusion: Despite certain limitations, this evaluation represents the first attempt to summarize the available evidence on the prescribing of LHRH agonists in Serbia. It was found that the consumption in UCCKG is lower compared to the consumption of these drugs in Serbia, Croatia and Italy at the same time intervals, for the same observed diagnosis.

DACPGTN: Drug ATC Code Prediction Method Based on Graph Transformer Network for Drug Discovery.

The Anatomical Therapeutic Chemical (ATC) classification system is a drug classification scheme proposed by the World Health Organization, which is widely used for drug screening, repositioning, and similarity research. The ATC system assigns different ATC codes to drugs based on their anatomy, pharmacological, therapeutics and chemical properties. Predicting the ATC code of a given drug helps to understand the indication and potential toxicity of the drug, thus promoting its use in the therapeutic phase and accelerating its development. In this article, we propose an end-to-end model DACPGTN to predict the ATC code for the given drug. DACPGTN constructs composite features of drugs, diseases and targets by applying diverse biomedical information. Inspired by the application of Graph Transformer Network, we learn potential novel interactions among drugs diseases and targets from the known interactions to construct drug-target-disease heterogeneous networks containing comprehensive interaction information. Based on the constructed composite features and learned heterogeneous networks, we employ graph convolution network to generate the embedding of drug nodes, which are further used for the multi-label learning tasks in drug discovery. Experiments on the benchmark datasets demonstrate that the proposed DACPGTN model can achieve better prediction performance than the existing methods. The source codes of our method are available at https://github.com/Szhgege/DACPGTN.

Morniflumate in the treatment of upper airways affections in adults: a review and meta-analysis.

We compared, by a meta-analytic process, the antipyretic and symptomatic activity, and the safety profile of morniflumate (ATC code: M01AX22) with those of other commonly used non-steroidal anti-inflammatory drugs (NSAIDs) in acute ear, nose and throat (ENT) diseases. Our search strategy was performed in various database, included Google Scholar, PubMed and Embase, the key word was "morniflumate". Interventional studies in adults with ENT or lower airway inflammatory diseases were compared in a meta-analysis for the number of symptom-free and fever-free patients at day 3 of therapy, and of drug interruptions due to adverse events (AEs). For symptoms, we included only studies on ENT inflammatory diseases; for fever and AEs, we also considered studies on lower airway inflammatory diseases. Of 33 studies retrieved, 8 (24.2%) met the inclusion criteria and compared morniflumate to placebo, nimesulide, paracetamol and other NSAIDs. On day 3, the number of symptom-free patients was significantly higher with morniflumate vs placebo and nimesulide (+20% and +30%, respectively) and similar to the other comparators. The number of fever-free patients significantly increased (up to 70%) with morniflumate vs all comparators except paracetamol (similar). No difference was found in the number of AE-related interruptions. morniflumate showed good antipyretic and symptomatic activity and a short-term safety profile at least comparable to that of other NSAIDs.

Opioid Exposure and the Risk of Dementia: A National Cohort Study

To examine the association between prescription opioid use and the risk of dementia in old-age, since existing studies of the association are few, and the evidence is inconsistent. Prospective national cohort study (N=91,307, aged 60 years and over), without a dementia diagnosis for ten years, followed-up for incident dementia from January 2013 to October 2017. Opioid exposure was based on opioid purchases classified from Anatomical Therapeutic Chemical Classification system codes (N02A), and classified as exposed if the purchase period covered at least 60 days within a 120-day interval; otherwise, unexposed. Healthcare maintenance organization in Israel. During follow-up, 2,849 (3.1%) persons were opioid exposed (mean age 73.94 ± 6.71 years), and 5,298 (5.8 %) persons developed dementia (mean age 78.07 ± 6.54 years). Cox regression models were fitted to quantify the risk of incident dementia with Hazard Ratios (HR) and their associated 95% Confidence Intervals (CI). The opioid exposed group aged 75+ to 80 years were at an increased risk of incident dementia (Adjusted HR=1.39, 95% CI=1.01, 1.92, Z-statistic=2.02, p <0.05) compared to the unexposed. The point-precision estimates were generally similar to the primary analysis across fourteen sensitivity analyses. Policymakers, caregivers, patients, and clinicians may wish to consider that opioid exposure aged 75-80 is linked with an increased dementia risk to balance the potential benefits and adverse side effects of opioid use in old age.