Prescribed Class Of Drugs Research Articles

A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship.

BackgroundICUs are settings of high antifungal consumption. There are few data on prescribing practices in ICUs to guide antifungal stewardship implementation in this setting.MethodsAn antifungal therapy (AFT) service evaluation (15 May–19 November 2019) across ICUs at three London hospitals, evaluating consumption, prescribing rationale, post-prescription review, de-escalation and final invasive fungal infection (IFI) diagnostic classification.ResultsOverall, 6.4% of ICU admissions (305/4781) received AFT, accounting for 11.41 days of therapy/100 occupied bed days (DOT/100 OBD). The dominant prescribing mode was empirical (41% of consumption), followed by targeted (22%), prophylaxis (18%), pre-emptive (12%) and non-invasive (7%). Echinocandins were the most commonly prescribed drug class (4.59 DOT/100 OBD). In total, 217 patients received AFT for suspected or confirmed IFI; 12%, 10% and 23% were classified as possible, probable or proven IFI, respectively. Hence, in 55%, IFI was unlikely. Proven IFI (n = 50) was mostly invasive candidiasis (92%), of which 48% had been initiated on AFT empirically before yeast identification. Where on-site (1 → 3)-β-d-glucan (BDG) testing was available (1 day turnaround), in those with suspected but unproven invasive candidiasis, median (IQR) AFT duration was 10 (7–15) days with a positive BDG (≥80 pg/mL) versus 8 (5–9) days with a negative BDG (<80 pg/mL). Post-prescription review occurred in 79% of prescribing episodes (median time to review 1 [0–3] day). Where suspected IFI was not confirmed, 38% episodes were stopped and 4% de-escalated within 5 days.ConclusionsAchieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.

The Chemical Relationship Among Beta-Lactam Antibiotics and Potential Impacts on Reactivity and Decomposition.

Beta-lactam antibiotics remain one of the most commonly prescribed drug classes, but they are limited by their propensity to cause hypersensitivity reactions (e.g., from allergy to anaphylaxis) as well as by the emergence of bacteria with a myriad of resistance mechanisms such as β-lactamases. While development efforts continue to focus on overcoming resistance, there are ongoing concerns regarding cross-contamination of β-lactams during manufacturing and compounding of these drugs. Additionally, there is a need to reduce levels of drugs such as β-lactam antibiotics in waste-water to mitigate the risk of environmental exposure. To help address future development of effective remediation chemistries and processes, it is desired to better understand the structural relationship among the most common β-lactams. This study includes the creation of a class-wide structural ordering of the entire β-lactam series, including both United States Food and Drug Association (US-FDA)-approved drugs and experimental therapies. The result is a structural relational map: the “Lactamome,” which positions each substance according to architecture and chemical end-group. We utilized a novel method to compare the structural relationships of β-lactam antibiotics among the radial cladogram and describe the positioning with respect to efficacy, resistance to hydrolysis, reported hypersensitivity, and Woodward height. The resulting classification scheme may help with the development of broad-spectrum treatments that reduce the risk of occupational exposure and negative environmental impacts, assist practitioners with avoiding adverse patient reactions, and help direct future drug research.

Forecasting the Incremental Value to Society Created by a Class of New Prescription Drugs: A Proposed Methodology and Its Application to Treating Chronic Hepatitis C in India.

For low- and middle-income countries, the forecasted incremental value to society created by a class of new prescription drugs would be a useful criterion to prioritize the licensing, subsidization, and provision of new drugs. We provide a methodology to forecast the value of a new class of drugs, defined as the incremental value obtained in the scenario in which the new class of drugs is available along with existing drugs compared with the scenario of existing drugs only. We forecasted the value created by direct-acting antiviral drugs to treat chronic hepatitis C in India. We conducted a physician survey together with an aggregate multinomial logit model to forecast for each patient type the fraction of physicians who would prescribe the new drug under different scenarios. Value was determined by the monetary equivalent of increased life expectancy, reduced disability, and decreased future infection of others, minus drug cost, all treatment-related costs, and the cost of side effects. We forecasted that the introduction of direct-acting antiviral drugs is likely to create USD11.5 billion of value in India over a 5-year period, based on a 'realistic' assumption about the growth rate of India's per capita GDP. Under 'pessimistic' and 'optimistic' assumptions about the growth rate, the value changes to USD6.5 and 22.5 billion, respectively. There is major value likely to be created by the new direct-acting antiviral drugs in treating hepatitis C in India; this is consistent with the Indian Government's decision to provide the drugs free of cost.

Preprocedural features of patients under antihypertensive drugs may help identify responders to renal denervation: a hypothesis-generating study.

Renal denervation (RDN) is effective to lower systolic blood pressure (SBP) in essential hypertension. However, patient selection under medications remains an important unmet clinical need. This multicenter study aimed at observing whether preprocedural features associated with increased renin-angiotensin-aldosterone activity influence RDN response. This study enrolled the patients who underwent RDN for uncontrolled hypertension. Medical records were reviewd and patients were divided into 2 groups depending by meeting any of the following conditions prior to RDN: (1) >10 mmHg of office SBP reduction after aldosterone inhibition, (2) aldosterone-renin ratio >30 or (3) slow flow on the renal angiogram. RDN responders were defined by a reduction in 24-hour mean ≥6 mmHg or by ≥1 class of antihypertensive drug withdraw. A total of 46 patients were enrolled, of which 27 (59%) were in control group A and 19 (41%) in group B. The baseline age, gender, office and 24-hour SBP (mean 140.0 ± 12.8 mmHg vs. 144.0 ± 16.5 mmHg, p = 0.577) were comparable, while the number of prescribed drug classes was fewer in group A (4.0 ± 1.3 vs. 4.9 ± 0.9, p = 0.014). The proportion patients with prescribed aldosterone antagonist or high aldosterone-renin ratios were higher in group B. At 12 months post RDN, the results were significantly better in group B in terms of mean change in office SBP (12.4 ± 23.5 mmHg vs. 29.9 ± 25.5 mmHg, p = 0.046) and the proportion of RDN responders (51.9% vs. 89.5%, p < 0.001). RDN was more effective in patients with any of 3 clinical indices.

Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study.

To consider antidepressant prescribing on a population level with a focus on regional prescribing patterns in Germany. Based on data from about 70 million individuals covered by all statutory health insurance funds in Germany in 2010, the prevalence of antidepressant use (overall, for drug classes and individual drugs) was calculated stratified by age and sex. Regional analyses were performed on a state and also on a district level. The study population comprised 68 427 464 (female: 53.0%) persons, of which 5 052 293 (7.4%) were prescribed at least one antidepressant. The most frequently prescribed drug class was tricyclic antidepressants whereas on a substance level citalopram was most commonly used. Antidepressant prescribing was lowest in children and adolescents (0.2%) and most common in persons aged 70 years and older (13.4%). Women more often received antidepressants than men (9.7% vs. 4.8%). Prevalence of antidepressant use varied between 8.7% (Saarland) and 6.3% (Saxony-Anhalt) and was generally highest in the southwestern and lowest in the eastern states. Accordingly, districts with the highest prevalence were located in the southwestern states. Antidepressant use in Germany varied considerably by age and sex and also on a state and district level.

Assessment of Drug Utilization Pattern and Rational Use of Antihypertensive Therapy in Geriatric Patients: A Prospective Observational Study

Background: Hypertension is one of the most frequently occurring noncommunicable diseases, and it causes a variety of cardiovascular complications and mortality. Diagnosis and treatment in elderly patients are very difficult due to their changes in physiology and physiological responses to the therapy. Drug utilization studies are plausible instrument in the evaluation in health care practice. Objective: To assess drug utilization pattern and rational use of antihypertensive therapy in geriatric patients. Materials and methods: This is a prospective observational study that took place in 200 inpatients over the course of six months. The study includes subjects with age group of 65 years and above with all comorbidities. The collected data was statistically evaluated by appropriate descriptive statistical analysis. Here the prescription pattern and rationality were analysed. Results: In this study out of 200 patients, 53% of prescriptions contain combination therapy and remaining 47% contains mono therapy. Most commonly prescribed class as mono therapy was Calcium channel blockers 79. 00% (Amlodipine). Among two drug regimen Calcium channel blockers + Diuretics and the three-drug regimen Calcium channel blockers + Angiotensin Receptor Blocker + Diuretic combination are generally prescribed. Here the overall rate of adherence to JNC 8 is 95%. Conclusion: In this study by analysing prescription pattern, we concluded that most commonly prescribed drug class was Calcium channel blockers (Amlodipine). The present study results demonstrate that, most of the physicians are adherent to the JNC 8 recommendations.&#x0D; Keywords: Antihypertensive drugs, Adherence to JNC 8, Rational use, Prescription patterns.

Assessment of quality of life and drug prescription pattern in acute coronary syndrome

Objectives: To assess the health-related quality of life (QOL) in patients with acute coronary syndrome (ACS) and predict those patients who may have worsened QOL 6 months later and also observe the prescribing patterns of drugs given in their treatment. Materials and Methods: A prospective observational study was conducted at the cardiology department in a tertiary care hospital. The data were collected in both inpatient and outpatient cardiology departments based on our inclusion and exclusion criteria for a period of 6 months. A total of 240 patients were analyzed with a data collection form by interviewing the patients about their sociodemographic details, laboratory parameters, and diagnostic reports. The MacNew Heart Disease Questionnaire, Medical Research Council Breathlessness Scale, and New York Heart Association (NYHA) Functional Scale were used for assessing the QOL in patients with ACS. We calculated Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients for identifying the mortality risk. Results: Urban people were more prone to ACS than rural people, according to our data. According to the NYHA Functional Classification, ability to do physical activity was more considerably affected in NSTEMI patients than STEMI and angina. Most of the patients had Grade 2 shortness of breath. 35% of the patients had a high mortality risk. Based on the MacNew Questionnaire data, 23% of the patients with ACS were doing emotionally poor, 45% of the patients had shown physically impaired symptoms, 28% of the patients were socially dependent, 8% of the patients showed poor gastric condition. 49% of the patients were given reperfusion therapy with either percutaneous coronary intervention (PCI) or coronary artery bypass graft, 25% of the patients were managed with dual-anticoagulant therapy, and 6% of the patients were treated with single-anticoagulant therapy. Commonly prescribed drug classes were statins (90%), antiplatelets (86%), anticoagulants (75%), antianginal (55%), beta-blockers (50%), diuretics (35%), angiotensin-converting enzyme inhibitors (18%), and angiotensin receptor blockers (16%). Conclusion: QOL was significantly affected in ACS patients. Most of the patients had risk factors for ACS. Patients explained impairments in all the four domains used in the questionnaire such as emotional, physical, social, and gastric impairments. QOL was more affected in STEMI patients and they had a high mortality risk. Most of the patients had NSTEMI. Low-risk patients were given single-anticoagulant therapy and medium-risk patients were treated with dual-anticoagulant therapy. PCI was preferred in almost all the patients.

TRENDS IN PRESCRIPTION PATTERN IN MEDICAL INDIAN ICU AND IT’S IMPACT ON PATIENT OUTCOME

Objective: The objective of this study is to evaluate the trends in prescribing pattern in medical ICU concerning patient age, gender, past, and current illness along with comorbidities for the evasion of polypharmacy and to improve patient outcomes. Methods: A prospective analysis of the case records of patients admitted to the ICU of Yashoda hospital in India was carried out. Results: 120 patients were evaluated, consisting of 77% male patients. The mean±SD of age is 53.81±14.63. The majority of the study subjects belonged to the age group of 50-67 y (32%) Most common causes for admission to the ICU were Respiratory diseases and Stroke. Diabetes mellitus and Hypertension are the most common co-morbidities identified. The total number of drugs used were 1502 during this study period. The average number of drugs per prescription is 12. The range is between 2-30. The average number of antibiotics per prescription is 3. Commonly prescribed drug classes were the GI agents in 100% of patients, followed by antimicrobial agents (AMAs) in 95.8% of patients. About 42.5% of patients received 3 antibiotics per day. 55 potential drug-drug interactions were interpreted in 46 patients. 30(55%) were moderate interactions 25(45%) were major interactions, which were addressed. De-escalation of antibiotics was seen in 29% of patients while escalation in 13%. The death rate is only 5% in our ICU setting. Conclusion: This prescription pattern study can provide a framework for continuous prescription audit in the ICU

Motivations for Prescription Drug Misuse Related to Mental Health Problems in Adults

Background Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. Objectives This project investigates the connections between PDM motivations and mental health to inform intervention efforts. Methods Using nationally representative adult data from the 2016–2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. Results Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to “relax or relieve tension” were more likely to have all categories of mental health problems. Those that misused prescription stimulants to “help study” had lower odds of all mental health problems. Conclusions While there were differences based on prescription drug class, a range of motivations increased adults’ likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.

Study on drug use pattern in the management of the cardiovascular diseases and with comorbidities

Background: Cardiovascular drugs are the number one cause of death globally; more people die annually from CVDs then from any other cause CVD. The purpose of this study to identify the rationality of drug prescribed for cardiovascular diseases with its comorbidities. Along with medication adherence and cost analysis. To assess the drug use pattern and to observe the drug related complications in patients with cardiovascular diseases.Methods: A hospital based prospective observational study was conducted at department of medicine in RMMCH. A total of 79 patients were enrolled based on inclusion criteria and the data was collected using designed data collection form.Results: Data of 79 patients were collected over 6 months mean age of patients with 19.95-60.5. Male to female ratio was 1.43:1. In cardiovascular diseases, most common disease conditions are systemic hypertension and acute coronary syndrome seen in our study population. Average drugs prescribed per patient was 4-9. Most frequently prescribed drug classes were beta blocker, antiplatelet, hypolipidemic agent. In these few minor drug interactions have been found. Study has no adverse drug reaction. The average cost of drugs was prescribed for 2500-3200 IND. Before patient counseling medication adherence and outcomes were less after counseling, medication adherence and outcomes are increased from 5% to 65%.Conclusions: The study concludes that most of the drugs were prescribed rationally according to world health organization/ESC guidelines. As behalf of this study, we could provide the information about the risk factor, leading commodities. Importance of medication adherence and cost of medications to cardiovascular drugs.

Benzodiazepines: Uses, Dangers, and Clinical Considerations.

Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood–brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.

Sleep difficulties and use of prescription and non-prescription sleep aids in Portuguese higher education students

The present study aims to characterize the prevalence, the pattern of medically prescribed and over-the-counter medication/supplements in Higher Education students, as well as to relate the consumption of sleeping medication with insomnia severity, sleep effort, sleep locus of control, anxiety, and depression. Data was collected from a sample of 2029 Portuguese Higher Education students, aged ≥18 years old, being approximately 75% women and 25% men. Thirty-one percent of the sample considered suffering from insomnia, 6% consumed sleeping medication prescribed by a physician, 4% consumed OTC (over-the-counter) medication/supplements, and 2% undergone psychotherapy. Among the Higher Education students with insomnia, 19% reported consuming sleep medication prescribed by a physician, benzodiazepines were the most prescribed drug class, and the General Practitioner the physician who prescribed most frequently. Twelve percent of students with insomnia consumed OTC medication/supplements, with Valerian being the most consumed substance. Among students with insomnia, only 8% undergone psychotherapy.

Antibiotic Prescribing Pattern in Primary Care Practice in Federal Territory Kuala Lumpur and Putrajaya, Malaysia

Introduction: The emerging of antibiotic resistance has become a challenge to global health and there is a strong association between antibiotic consumption and incidence of resistance. One of the tools to monitor and identify antibiotic prescribing pattern is Point Prevalence Survey (PPS). Objectives: To determine the pattern of antibiotic prescribing in Primary Health Clinics (PHC) in Federal Territory Kuala Lumpur and Putrajaya (FTKLP). Methods: A cross-sectional study was conducted at 17 PHCs in FTKLP using universal sampling. Data from prescriptions received were recorded in PPS-PC data collection form. The compliance of the antibiotics prescribed were determined via cross-referencing with the Malaysian National Antibiotic Guideline (NAG) 2014 and/or Clinical Pathway for Antimicrobial Stewardship Program in PHCs (CP) 2019. Results: A total of 338 prescriptions with antibiotics were received and the prescribing rate of antibiotics at the PHCs in FTKLP 2019 was 5.94%.Only 128 (37.9%) prescriptions with antibiotics prescribed were compliant with either the NAG or the CP while 33 (9.8%) prescriptions were found non-compliant with either guideline. Compliance of the remaining 177 prescriptions could not be determined due to non-specific diagnoses. The most commonly prescribed drug class was penicillin (n=198, 58.4%), followed by cephalosporins (n=80, 23.6%) and macrolides (n=41, 12%). Conclusion: This PPS study showed a low compliance of antibiotic prescribing to guidelines compared to recent studies and indicate the need for further action to be taken in order to improve antimicrobial prescribing in PHCs. KEYWORDS: Point prevalence survey, antibiotic, primary care

PHENOME-WIDE GENETIC CORRELATION AND CAUSALITY OF COVID-19 SEVERITY HIGHLIGHTS OVERLAP WITH SUBSTANCE-USE TRAITS

Nearly 10% of U.S. 12th graders report high-intensity drinking (10+ or 15+ drinks in a row), but the extent to which these drinkers also engage in nonmedical use of prescription drugs (NMUPD) is largely unknown. This study examined the associations between different thresholds of past two-week high-intensity drinking and past-month NMUPD among U.S. 12th graders.The sample consisted of eleven nationally representative cross-sections of 12th graders in the Monitoring the Future study (2005–2015) who answered questions on past two-week drinking behaviors and past-month nonmedical use of prescription opioids, sedative, stimulants, and tranquilizers (N = 26,502 respondents).High-intensity drinking during the past two-weeks was associated with an increased risk of past-month NMUPD. The odds of NMUPD were four times larger among 12th graders who indicated drinking 15 or more drinks on at least one occasion (AOR = 4.43, 95% CI = 3.18, 5.01) relative to those who had 0–4 drinks during the past two-weeks, after adjusting for relevant covariates. These associations were similar across different classes of prescription drugs and tended to be stronger among non-white respondents. A sub-analysis revealed simultaneous co-ingestion of alcohol and NMUPD was more prevalent among high-intensity drinkers.More than 1 in every 4 U.S 12th graders who engage in high-intensity drinking (15+ drinks in a row) also report NMUPD. Given the greater likelihood of simultaneous co-ingestion of alcohol and prescription drugs among high-intensity drinkers, adolescent substance use interventions need to address the risks associated with mixing alcohol and prescription drugs.

An Observational Study on Drug Utilization Pattern in Asthma and Chronic Obstructive Pulmonary Disease in Tertiary Care Teaching Hospital

Background: Obstructive airway diseases such as asthma and COPD are defined as a decreased capacity to get air through the conducting airways and out of the lungs.&#x0D; Objective: To study the drug utilization pattern in asthma and chronic obstructive pulmonary disease, determine irrationally (does not comply with prescription) drug usage, and whether they were prescribed following the standard treatment guidelines.&#x0D; Methodology: A total of 150 patients of either sex aged 18 years and above having asthma and/or COPD were included in the study. The medical records of patients were checked and information was recorded. The prescriptions were analyzed for drug utilization patterns. The newly diagnosed patients were followed up and medication adherence was determined after 1 month.&#x0D; Results: Out of all 150 patients there were 103 male and 47 female patients. 54 patients were having asthma, 89 patients COPD, and 7 patients asthma COPD overlap. The majority of the patient were prescribed 1 to 3 drugs per prescription. Inhaled corticosteroids were the highest prescribed drug class. The most commonly prescribed drug combination was budesonide + formoterol. The majority of the patients have poorly adhered to the treatment.&#x0D; Conclusion: Study data highlights that very few drug interactions were identified between prescribed medications. The drugs and their combinations were prescribed according to the standard guidelines GOLD (Global Initiative for Chronic Obstructive Lung Disease) and GINA (Global Initiative for Asthma).

Off-label and unlicensed drug treatments in Neonatal Intensive Care Units: a systematic review

Newborns are particularly susceptible to off-label and unlicensed (OLUL) drug treatments, especially in the intensive care setting, inferring from dosing regimens and indications supported in older populations and built on non-neonatal pathophysiology. This use leads to unpredictable drug effectiveness and safety and, therefore, an increased probability of medication errors and adverse drug reactions. An extensive literature search was conducted in MEDLINE, Scopus, and Web of Science for papers published from 2011 to 2020 considering OLUL drug use in Neonatal Intensive Care Units (NICUs). Of the 902 studies retrieved, 618 after duplicates were removed, 74 full texts were carefully assessed for eligibility and, in the end, 23 published studies were included, representing a total of 6,762 patients in 80 NICUs worldwide. Considering overall prescriptions, 43.5% were OL and 11.1% were UL. Most studies found that more than 50% of the newborns were exposed to at least 1 OLUL drug and 10 of them reported a rate higher than 90%. Most prescribed drug classes in an OL manner were anti-infectives for systemic use drugs, including ampicillin and gentamicin, followed by nervous system drugs such as fentanyl. The most prescribed drug class in a UL manner was nervous system drugs, being caffeine the most prescribed one. The main reasons for OL prescribing included age and dose, and for UL prescribing, modifications of licensed drugs, extemporaneous preparations, or changes in the pharmaceutical forms. Very preterm, lower birth weight, disease severity, and longer length of stay in the NICU were associated with higher OLUL prescribing. These findings show that despite recent attempts by international regulatory authorities to develop more clinical trials in the pediatric population, OLUL drug use is still widespread, particularly among newborns in NICUs. More efforts must be made by these regulatory entities to ensure the development of safer drugs for the neonatal period.

Prevalence of Polypharmacy and Inappropriate Medication in Adults With Intellectual Disabilities in a Hospital Setting in Switzerland.

Background: Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors.Aim: The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID.Methods: A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions.Results: Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization.Conclusions: This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.

Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017

Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program “Drug Safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001–2003) with the last time period (2015–2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12–1.19), especially mirtazapine (RR 1.16; 95% CI 1.12–1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35–1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03–1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83–0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86–0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81–0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015–2017 than in 2001–2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.

Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project.

Background Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg). Results A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients. Conclusion With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study.

A cross-sectional study on current prescription trends and errors in outpatient department of a Bangladeshi secondary care district hospital.

Context:The rational prescription leads to a healthy and good-quality life of a patient. Irrational, inappropriate, and unnecessary prescriptions are major therapeutic issues in Bangladesh, which can cause severe consequences.Aim:This cross-sectional study was conducted to evaluate the prescription patterns and errors as well as to review the most frequently prescribed drug classes among outpatients at a secondary hospital in Pabna, a district of Bangladesh.Methods:A total of 400 prescriptions were reviewed from March 2019 to May 2019. In this study, statistical data analysis was implemented by IBM SPSS Statistics V22 and data revealed in frequencies, mean, and percentage. Spearman's rank correlation coefficient was calculated to show the correlation between bivariate coded variables.Results:The results revealed that majority of the prescription were prescribed for females (73.5%) where proton-pump inhibitors (PPIs), analgesics, vitamins, and single antibiotics were most frequently prescribed medicine for the female patients compared to male patients. Almost half of the collected prescription contained four medicines (47%). Maximum number of prescriptions contained two (30.5%) essential drugs and among 1402 medicines of 400 prescriptions, antiulcerants were most frequently prescribed medicine (23.32%) where esomeprazole was highly prescribed generic drug (44.75%). Moreover, Spearman's rank correlation coefficient suggested that PPIs and analgesics were frequently prescribed medicines at a time for the patients (0.182). According to the age group, the study also got some significant variations in prescribing pattern. However, most common prescription errors were prescriber's name not mentioned (100%), diagnosis not mentioned (96.75%), dose not indicated (15.41%), and wrong drug name (0.36%).Conclusion:Findings of the current study represent the existing prescribing trends of different therapeutic classes of drugs and common prescription errors in a secondary health facility of Bangladesh. From this study, it is observed that physicians prescribed rationally in some cases but need to ensure rationality in all prescriptions. Continuous monitoring of drug use, development of prescribing guidelines, and training are recommended to ensure and implement good-quality prescribing practices for promoting the rational and cost-effective use of drugs.