Defined Daily Doses Research Articles

Use of Antidepressant and Anxiolytic Drugs in Scandinavian Countries between 2006 and 2021: A Prescription Database Study

Introduction. The use of antidepressant and anxiolytic drugs has changed in Scandinavian countries over recent decades, with notable national variations. Objective. To describe and compare antidepressant and anxiolytic drug use in Norway, Sweden, and Denmark. Methods. Data included each country’s prescription registers from 2006 to 2021. The measures were period (1-year) prevalence (users per 1000 inhabitants) and therapeutic intensity (TI; daily defined dose (DDD) per 1000 inhabitants per day), overall, by drug classes and age groups. Results. The prevalence of antidepressant use increased from 2006 to 2021 and was highest in Sweden (78 to 107 users per 1000 inhabitants) and lowest in Norway (61 to 69 users per 1000 inhabitants). The prevalence of anxiolytic use decreased, most steeply in Denmark (50 to 18 users per 1000 inhabitants). The TI of antidepressants increased consistently in Norway and Sweden, but more variably in Denmark. Sweden had the highest increase in TI of antidepressants (56%). The TI of anxiolytics declined most markedly in Denmark (by 75%). The prevalence of antidepressant and anxiolytic use was highest among adults ≥65 years. The prevalence of antidepressant use increased across age groups in Sweden and young people (5-19 years) in Norway, but not in Denmark. Conclusions. The use of antidepressants increased in Scandinavia in 2006-2021, but decreased for anxiolytics, with country variations in the number of users and the amount used. Future research should target factors underlying high antidepressant and anxiolytic use in older adults across countries and increasing antidepressant use in Sweden and among young Norwegians.

Trends in antihypertensive use among privately insured hypertensive clients in Ghana.

The objective of the study was to describe the patterns of antihypertensive medicines (AHM) in a selected national population in Ghana. The claims data for all privately insured patients in Ghana over three years to 2018 were analysed. The classes of medicines used, the dose by time, gender and age, and generic status were examined. In addition, the use in Defined Daily Dose (DDD) per 1000 population per day was estimated. Classes of AHM prescribed were CCB, ARB, ACEI, diuretics, and BB. Amlodipine, nifedipine, losartan, lisinopril, and bendroflumethiazide accounted for 74% of all use. The most widely used single CCB was amlodipine 3.92 DDD/1,000 population/day in 2016, 3.92 DDD/1,000 population/day in 2017, and 4.92 DDD/1,000 population/day in 2018. In those aged 51-60 years, use of CCB in women (74.0 DDD/1,000 population/day) was almost twice that of men (38.3 DDD/1,000 population/day). The top ten medicines accounted for 93% of all single medicine products in 2018. Most single medicine products was generic (76.5% in 2016; 79.9% in 2017 and 83.1% in 2018) whiles most fixed combination products were branded (73.0% in 2016; 89.7% in 2017 and 91.3% in 2018). The patterns of AHM use are clinically expected although the Ghana Standard Treatment guidelines are not directive about lines of treatment.

Antimicrobial surveillance in South Australian prisons: a pilot study.

ObjectivesThis study aimed to determine the feasibility of capturing antimicrobial usage data from prisons for inclusion in the Antimicrobial Use and Resistance in Australia (AURA) surveillance system and to analyse 2021 and 2022 South Australian (SA) usage data for notable trends.MethodsMonthly antimicrobial supply data for eight SA prisons were collected. Antimicrobial volume was converted into the World Health Organization metric, defined daily doses (DDD). Usage rates were calculated relative to prison occupied bed days (OBD).ResultsAnnual usage of systemic antimicrobials across eight SA prisons totalled 26,448 DDD and 23,526 DDD in 2021 and 2022 respectively. Antibacterials accounted for 80.6% of all antimicrobials dispensed during the study period. The average antibacterial usage rate in female prisons was higher on average than in male prisons. The state-wide systemic antibacterial usage rate in SA prisons declined by 11.3% from 23.8 DDDs/1000 OBD in 2021 to 21.1 DDDs/1000 OBD. Doxycycline, amoxicillin, flucloxacillin, amoxicillin-clavulanic acid, and cefalexin accounted for 72% of the total systemic antibacterial usage rate. Variation in the oral and topical antifungal agents used and the rate of use was observed between prisons.ConclusionsThis SA pilot study demonstrates the feasibility of including prisons in routine national antimicrobial surveillance using similar methodology to hospital surveillance. The contributing facilities comprised 6.1% of all Australian prison beds, and extrapolation of the results suggests that the identified gap in surveillance may equate to over 400,000 DDD per annum in prisons nationwide, equating to approximately 5% of hospital inpatient antimicrobial usage.

A point prevalence survey and monitoring indicator research on the second batch of national key monitoring and rational use drugs.

With the remarkable effect of controlling the increase in drug costs by the first batch of National Key Monitoring and Rational Use Drugs (first NKMRUDs), the National Health Commission of the People's Republic of China releases the second NKMRUDs to further strengthen the reasonable use of drugs. Unfortunately, the second NKMRUDs include some drugs of National Volume-based Procurement and National Essential Medicines, which challenges the management of pharmaceutical affairs on the three kinds of drugs. The main objective of this study was to investigate the prevalence of the second NKMRUDs and explore their monitoring indicators. An adapted WHO methodology for point prevalence surveys was conducted for the second NKMRUDs. For the monitoring indicators, we sought to explore whether the defined daily dose (DDD) and days of therapy (DOT) can be suitable for the second NKMRUDs through comparing differences between DDD and DOT with the prescribed daily dose (PDD). Among the 935 included patients, 29.20% of the patients received at least one of the second NKMRUDs. A total of 273 patients were administered with 487 times of the second NKMRUDs. Among them, 162 , 62 , and 49 patients were receiving one, two, and three or more agents, respectively. The most commonly prescribed second NKMRUDs were compound amino acids, budesonide, and ceftazidime. The total DDDs and DOTs of the second NKMRUDs were 3360.68 and 1819.80, respectively, with the PDDs of 1865.26. The deviations (80.17%) of DDDs from PDDs were significantly greater than those (-2.44%) of DOTs. The prevalence of the second NKMRUDs was obtained by using the adapted PPS methodology at a tertiary university hospital. The DOT indicator is found to more accurately reflect actual consumption than the DDD indicator for second NKMRUDs. It is recommended to use the DOT indicator to monitor second NKMRUDs.

Use of Tocolytic Agents in Preterm Labor: A Cross‐Sectional Analysis from a Chinese Real‐World Study from 2016 to 2021

What Is Known and Objective. Tocolytic agents are used to prolong gestational age and prevent immediate preterm birth (PTB). This study aims to provide an overview of the use of tocolytics among patients with PTB in China through retrospectively analyzing trends in application, influencing factors, and inappropriate prescriptions. Methods. The prescription data of five tocolytic agents from 2016 to 2021 were extracted from the database of the Hospital Prescription Analysis Cooperation Project. Drug consumption was expressed as number of prescriptions, cost of prescriptions, and DDDs (defined daily doses). Pearson correlation analysis was used to examine the association between DDDs and DDC (defined daily cost). The appropriateness of prescriptions was analyzed in terms of drug dosage form, administration, clinical diagnosis, and combined medication. Results. The total number of tocolytic prescriptions and the total cost of tocolytic agents increased by 6.12% and 387.58%, respectively, over the six‐year duration of the study. From 2016 to 2021, the ranking of the number of prescriptions and DDDs of tocolytic agents was magnesium sulfate > ritodrine > nifedipine > indomethacin > atosiban. During the study period, the cost of tocolytic agents increased significantly, which was mainly related to the increased costs of magnesium sulfate in 2017 and atosiban in 2018 and 2019. The ranking of DDCs was atosiban > ritodrine > magnesium sulfate > nifedipine = indomethacin from 2016 to 2021. For atosiban, the DDC was negatively correlated with the DDDs. Inappropriate prescription, which accounted for 14.84% of all prescriptions, was mainly manifested in the inappropriate selection of nifedipine dosage form, low frequency of nifedipine and indomethacin, and overdosing of ritodrine. Furthermore, 22.87% of tocolytic prescriptions remained active after 34 weeks of gestation, and 7.24% of the prescriptions authorized the use of combination drugs, with magnesium sulfate and nifedipine being the most commonly prescribed combination. What Is New and Conclusion. Magnesium sulfate, ritodrine, and nifedipine were the top three tocolytic agents. As the inappropriate use of tocolytic agents continues to persist, it is important to intensify efforts to ensure the safety and the appropriateness of maternal medication.

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

Polypharmacy in Older Adults: The Hazard of Hospitalization and Mortality is Mediated by Potentially Inappropriate Prescriptions, Findings From the Moli-sani Study.

We evaluated the impact of polypharmacy on the health of community-dwelling older adults. We prospectively analyzed 5,631 individuals from the Moli-sani study (51% men, aged ≥65years, recruitment 2005-2010, follow-up 2005-2020). Exposure was categorized as chronic polypharmacy therapy (C-PT; ≥5 therapeutic groups and >2 defined daily doses (DDDs)) or non-chronic polypharmacy therapy (NC-PT; polypharmacy but ≤2 DDDs). Hospitalization and mortality were the main outcomes. The mediating role of potentially inappropriate prescriptions (PIP) was examined. Compared to individuals not on polypharmacy, those in NC-PT and C-PT had higher hazards of mortality [21% (95% CI 7%-37%) and 30% (16%-46%), respectively] and hospitalization [39% (28%-51%) and 61% (49%-75%), respectively]. Similar results were found for cardiovascular outcomes. PIP mediated the association between polypharmacy and outcomes, with mediation effects ranging from 13.6% for mortality to 6.0% for hospitalization. Older adults without multimorbidity experienced the same harm from multiple medications as those with multimorbidity. Polypharmacy is associated with a higher hazard of mortality and hospitalization, with PIP playing an important role. Addressing "medication without harm" requires assessing the appropriateness of drug prescriptions and monitoring for adverse effects.

Patterns of Antidepressant and Anxiolytic Use and Spending in 14 European Countries (2012-2021): A Comprehensive Time Series Analysis.

The assessment of antidepressant and anxiolytic consumption and expenditures represents a reliable barometer of the burden of such mental health disorders and the effectiveness of relative healthcare services. The current analysis aims to evaluate trajectories of consumption and expenditures of antidepressant and anxiolytic drugs to define patterns of usage and spending across 14 European countries between 2012 and 2021. A retrospective longitudinal study was performed based on pooled time series secondary data analysis over 2012/2021. Defined Daily Doses (DDD) per 1000 inhabitants and health expenditure per capita were analysed. Linear and quadratic trends were computed to determine relationships between the variables of interest. Only 2 patterns of consumption/expenditure of antidepressants can be identified: consumption and expenditure both grow; consumption grows, and spending decreases. Consumption and expenditures registered 2 main patterns, decreasing in most European countries and increasing only in 2 cases. Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. The variation in consumption of such drugs during this timeframe is attributable to several reasons, such as the epidemiological characteristics of mental disease, for instance, the prevalence and incidence of disorders, the accessibility of drugs and alternative treatments, like psychotherapy, different clinical practices and national guidelines. However, such analyses deserve attention for targeted policies and strategies for promoting mental health.

Real-world pharmacological treatment of pregnant patients with rheumatic diseases from China: a retrospective analysis from 2016 to 2021.

Introduction: We investigated trends in the use of therapeutic drugs for pregnant patients with rheumatic diseases in nine Chinese cities (Beijing, Chengdu, Guangzhou, Harbin, Hangzhou, Shanghai, Shenyang, Tianjin, and Zhengzhou) to provide a reference for drug use in clinic. Methods: Outpatient prescription data for pregnant patients diagnosed with rheumatic diseases in nine cities across China in 2016-2021 were extracted from the Hospital Prescription Cooperation Project of the Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association. A retrospective analysis was then performed, incorporating data on patient age, defined daily doses (DDDs), defined daily cost (DDC), and other metrics. Results: In 2016-2020, more than 70% of the pregnant patients diagnosed with rheumatic diseases in these nine cities were 25 to < 35years of age. The most common rheumatic diseases during pregnancy were antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus (SLE). In terms of the routine use of daily therapeutic drugs, the DDDs of low molecular weight heparins (LMWHs), glucocorticoids, and immunosuppressive agents dominated the top three. Intravenous immunoglobulin (IVIG) and tumor necrosis factor inhibitors (TNFi) have been used since 2019 and had been in the forefront of the DDC. Conclusion: The number and total cost of prescriptions for therapeutic drugs of pregnancy complicated by rheumatic diseases, have increased significantly over the study interval. Conventional therapeutic drugs, especially glucocorticoids, LMWHs, and hydroxychloroquine were the most widely used drugs in pregnant patients with rheumatic diseases. However, IVIG and TNFi, relatively high cost, have shown gradual increases in clinical use since 2019.

Evaluation of antibiotics in pediatrics using the defined daily doses method and the World Health Organization (WHO) access, watch, and reserve classification (AWaRe 2021): a cross-sectional study.

irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021). this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s "AWaRe" categorization: "Access," "Watch," and "Reserve." a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively. antibiotic use was high in the research setting. Over half of the antibiotic use was in the "Watch" group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.

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.

Different operational definitions of polypharmacy and their association with the risk of all-cause hospitalization: A conceptual framework using administrative databases

Background: As in all pharmacoepidemiology studies, also in the cardiovascular field it is essential to take into account the clinical complexity of patients, which is very frequently estimated with polypharmacy. We aimed at describing the current heterogeneity of polypharmacy definition, and assessing the association of polypharmacy with clinical outcomes. Methods: Using administrative databases of the local health unit of Bergamo (Lombardy), all subjects aged ≥40 years with at least one reimbursed drug prescription during the year 2017 were identified. We selected from literature relevant operational definitions of polypharmacy. First, we applied World Health Organization (WHO) definition (at least ≥5 different medications, ATC 4th level code). Second, we excluded drug prescriptions associated with short-term treatment. Third, we considered only the prescriptions of drugs with a total annual defined daily doses (DDDs) ≥60. All the approaches were evaluated within one year, one quarter, and one month. A multivariate logistic regression model was performed to estimate odds ratios (OR) and 95% confidence intervals [95% CI] for the association between polypharmacy and the risk of hospitalization for all-causes. Results: Overall, 431,620 subjects were included in our cohort. The DDD-based definition led to estimates with little variability depending on the time windows (range 20.47%-21.16%), while the WHO definition determined the greatest variability (range 39.98%-31.24%). The DDD-based definition identified an older (mean age [SD], 72.6 [10.9]) and more complex cohort of patients (average number [SD] of previous hospitalizations 1.2 [1.7], average number of dispensed drugs 9.7 [3.5]). A dose-dependent increase in risk was observed as the number of the dispensed drugs increases regardless of definitions. Conclusions: Different definitions of polypharmacy led to different prevalence estimates. All definitions showed a dose-dependent association with hospitalization risk, with the definition based on DDDs being the least heterogeneous. However, only a patient-by-patient approach can determine whether or not polypharmacy is appropriate.

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.

Direct Oral Anticoagulants’ Consumption and Expenditure in the COVID-19 Pandemic in Russia and Clinical Practice Guidelines for Their Use

Background: The coronavirus pandemic has led to the creation of clinical guidelines by a large number of professional medical communities. However, the quality and methodology of development of Russian clinical guidelines has been little studied. The continued relevance of studying the use of DOACs (Direct oral anticoagulants) in patients with COVID-19 was the basis for conducting this study. Aim: The objective of this study was to assess DOAC consumption and expenditure in the Russian Federation during the COVID-19 pandemic and to analyze whether it was supported by the domestic evidence base for the use of DOACs in COVID-19 patients through identifying all publicly available Russian-produced CPGs (Clinical practice guidelines) for the treatment of COVID-19 and assessing their quality as the source of recommendations for the use of oral anticoagulants for the prevention of thrombotic complications in COVID-19 patients. We searched Russian databases for CPGs, published between 2020 and 2023. We identified seven relevant documents that met our inclusion criteria. Three authors analyzed Russian clinical guidelines using an AGREE II questionnaire. We calculated DOAC DDD (defined daily dose) consumption according to Russian clinical guidelines and DDD consumption in patients with COVID-19 for the period 2020–2022. Results: Seven clinical CPGs were analyzed with the AGREE II tool. It was revealed that experts gave the highest scores for the sections on scope and purpose (from 62.98% to 100%), and clarity of presentation (from 96.30% to 100%). The lowest scores were given for the sections on stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). When comparing the total score, it was found that two clinical guidelines received the highest scores—ROPNIZ (Livzan), and ROPNIZ (Drapkina). The minimum score was registered with the NIIOZMM (Khripun) clinical guideline. No guideline received a total score of more than 70%. According to clinical recommendations, the consumption of apixaban and rivaroxaban is 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy). Consumption of apixaban in the Russian Federation in 2020 and 2021 corresponds to the indicators presented in clinical recommendations (in 2020—26.59 DDD per patient with COVID-19; in 2021—15.75 DDD per patient with COVID-19), and in 2022—10.67 DDD, which is below the recommended values. In 2020, consumption of rivaroxaban in the Russian Federation was 26.59 which corresponds to data from clinical recommendations; in 2021, consumption decreased to 7.87 DDD; in 2022 it decreased to 5.48 DDD, which is 2.74 times less than recommended. Conclusions: Analysis of seven clinical recommendations revealed that such sections of clinical recommendations as scope, purpose, and clarity of presentation had the highest degree of assessment in accordance with AGREE II. The lowest scores were given for the sections on stakeholder involvement, rigour of development, applicability, and editorial independence. When comparing the total score, it was found that two clinical guidelines received the highest scores—the Russian Society for the Prevention of Non-communicable Diseases (Livzan), and the Russian Society for the Prevention of Non-communicable Diseases (Drapkina). The minimum score was registered with the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department clinical guideline. No guideline received a total score of more than 70%. During the pandemic, the highest DDD consumption of DOACs was in 2020, which exceeded the DOACs’ recommended DDD by Russian clinical guidelines. DOAC consumption had decreased by 2022. There was a decrease in the consumption of rivaroxaban, with an increase in apixaban’s share in the structure of DOAC consumption during the coronavirus pandemic. Obtained data indicate that in 2021 the apixaban consumption in the Russian Federation corresponded to the recommended DDD in the national guidelines, which indicates the most correct use of apixaban according to Russian GPGs.

Quantity of antibiotic use and its association with clinical outcomes in COVID-19 patients: A snapshot from a provincial referral hospital in Indonesia.

Irrational antibiotic use in Indonesia is considered high, yet there are still lacks reliable information regarding the issue. The quantity of antibiotic use studies, in particular during coronavirus disease 2019 (COVID-19) pandemic, was not well reported. The aim of this study was to evaluate antibiotic use in COVID-19 patients at a province referral hospital in Aceh, Indonesia, Dr Zainoel Abidin Hospital, and to assess the association between antibiotic use and COVID-19 clinical outcomes. The defined daily dose (DDD) method was used and expressed in DDDs per 100 patient-days as in hospital setting. The data were obtained from inpatient confirmed COVID-19 patients between March 2020 and December 2021. A logistic regression was used to determine the association between patients' characteristics and antibiotic usage with clinical outcomes. A total of 361 treated COVID-19 patients were included using a random sampling technique and analyzed. Out of 361 patients, 89.2% of them were treated with antibiotic(s). All the antibiotics were given empirically except for cefazoline (5.5%) that was used as prophylaxis to obstetric patients who underwent the c-section. Azithromycin was the most prescribed antibiotic and levofloxacin had the highest DDD. Our data suggested that there was no association between antibiotic use and clinical outcomes of COVID-19 patients (p=0.128). Having sepsis and another pulmonary disease however were associated with mortality of COVID-19 patients with adjusted odds ratio (aOR) 14.14; 95%CI 2.94-67.90, p=0.001 and aOR 8.64; 95%CI 3.30-22.63, p<0.001, respectively. In addition, patients older than 60-year-old had a higher chance to an unfavorable outcome compared to those younger than 30-year-old, aOR: 7.61; 95%CI: 1.07-53.94. In conclusion, the use of antibiotics is prevalent among COVID-19 and it is not directly associated with clinical outcomes.

Rationalization of Empiric Antibiotics Therapy in Patients Hospital Acquired Pneumonia at the East OKU Regional General Hospital

The use of antibiotics requires special attention to improve the quality of therapeutic results and prevent antimicrobial resistance. Through judicious administration of antibiotics, it is hoped that there will be an impact on the quality of treatment and control of microbial resistance. The method used in this research is descriptive analysis with a cross-sectional and retrospective research design, collecting data from medical record at East OKU Hospital for the period of 2016-2022. The analysis of the rationalization of the use of empiric antibiotics therapy showed that 65 % fell into the rational category, 35 % were irrational and had a total defined daily dose (DDD) value of 70.96 DDD/100 days of hospitalization.

Antimicrobial consumption in an acute NHS Trust during the COVID-19 pandemic: intervention time series analysis.

To determine the impact of the COVID-19 pandemic on antimicrobial consumption and trends of therapeutic drugs for COVID-19 treatments, including corticosteroids, remdesivir and monoclonal antibodies (tocilizumab) from April 2017 to September 2022 in a secondary care NHS Trust in England. A retrospective intervention time series analysis was conducted for April 2017 to September 2022 at the Mid Yorkshire Teaching NHS Trust. Data were retrieved from the pharmacy dispensing system as defined daily doses (DDDs) monthly and reported per 1000 occupied bed days (OBDs). Antimicrobial consumption and COVID-19 treatment options were measured. DDDs were calculated according to the classification of antimicrobials for systemic use (J01) and for other drugs classification. Trends for antimicrobial consumption and other therapeutic drugs for treating COVID-19 were also determined in each wave in England. During the pandemic: total antibiotic consumption decreased from 826.4 to 728.2 DDDs per 1000 OBDs (P = 0.0067); piperacillin/tazobactam use increased (P < 0.0001) and ciprofloxacin use decreased (P < 0.0001); there were no changes in Access, Watch, Reserve antibiotic use, and the proportion of antifungal consumption was consistent throughout the study. The use of total antibiotics (P = 0.024), levofloxacin (P = 0.0007), piperacillin/tazobactam (P = 0.0015) and co-amoxiclav (P = 0.0198) increased during wave one. Consumption of COVID-19 treatment drugs was highest during wave two, with 624.3 DDDs per 1000 OBDs for dexamethasone (P = 0.4441), 6.8 DDDs per 1000 OBDs for remdesivir (P < 0.0001) and 35.01 DDDs per 1000 OBDs for tocilizumab (P = 0.2544). This study determined the consumption of antimicrobials trends before and during the pandemic. The individual wave antimicrobial consumption indicates maximum consumption in the first wave, advocating for antimicrobial stewardship and preparedness for future pandemics.

Integrated care program for patients with dementia and behavioural disorders in the home setting.

Introduction: Behavioural symptoms involve suffering and functional worsening of people with dementia, overburden their caregivers and increase emergency department visits, hospitalizations and early institutionalizations.&#x0D; Objectives And Who It Is For: To evaluate the results of an interdisciplinary intervention to improve the control of behavioural symptoms in elderly people with dementia receiving chronic care at home.&#x0D; Who We Involved And Engaged With: Representatives of general practitioners, home care specialists, geriatricians, psychiatrists, healthcare managers, and patients and families voice through claims and suggestions. The first pilot was adapted considering patients’ needs and acceptance.&#x0D; Materials And Methods (What We Did): before-after quasi-experimental study with own individual as control. Inclusion criteria: admission to the Home Medicine section between 06/01/2021 and 09/30/2022, age older than 64 years; and major cognitive impairment with behavioural disorders of complex management for the attending physician; or need for adequacy of psychotropic drugs during the transition of care for having suffered an acute confusional syndrome during hospitalisation. Exclusion criteria: history of psychosis or life expectancy of less than six months.&#x0D; Intervention: Provision of care by a health care team coordinated by a geriatrician via telemedicine, the home follow-up physician and a health and social care counsellor (comprehensive gerontological assessment). The geriatrician agreed on tailored interventions together with the patient's relatives or caregivers.&#x0D; The main outcome variable was changes in the score of the behavioural disorders subscale of the NPIq questionnaire administered by the geriatrician. The consumption of psychotropic drugs, standardised by defined daily doses (DDD) according to WHO, was also analysed.&#x0D; Results: 81 persons were included (72% women), mean age 89.5 years. Seventy percent lived in a private home and the remainder in care homes. At baseline, they had the following mean (SD) symptom intensity scores of: delirium 1.1 (2.7), hallucinations 1.3 (2.6), agitation-aggression 2.6 (4.3), depression 0.9 (2.9), anxiety 1.1 (3.0), euphoria-denial 0.1 (1.0), apathy 0.6 (2.3), disinhibition 0.3 (1.7), irritability 1.0 (2.7), motor disturbances 0.9 (2.7), nocturnal behaviours 2.2 (3.8), appetite-ingestion 0.3 (1.6), total intensity 12.5 (13.7). At baseline, 42.0% were taking benzodiazepines, mean DDD 19.9/100 patients. &#x0D; After the intervention there was an average decrease of -7.6 points in the total NPIq scale (95%CI -10.0 to -5.1; p&lt;0.001) and 50% of those taking benzodiazepines had discontinuation or dose decrease. without significant changes in other psychotropic drugs (only an increase in donepezil and memantine).&#x0D; Learnings: The integrated management program of elderly with dementia and behavioural disorders improved behavioural symptoms with decreased doses of BZD after the intervention.&#x0D; Next Steps: For scientific purposes, to perform a randomised controlled clinical trial. For local managerial purposes, to scale up the initiative to all eligible persons.

Antibiotic utilization profile in surgical ward at secondary government hospital

Background: This study aimed to determine the profile of the antibiotic utilization in defined daily dose (DDD) units and DU 90% at surgical ward of secondary government hospital in Indonesia within six months period of study. Methods: A retrospective cross-sectional study was conducted over six months on surgical ward patients prescribed with at least one oral or parenteral antibiotic during hospitalization. Data were collected from pharmacy dispensing data and evaluated using World Health Organization (WHO) DDD. Antibiotics DDD were analysed using DU 90% segmentation in order to know the 90 percent cumulative of antibiotic consumption in surgical ward. WHO prescribing indicators were used to examine the antibiotic prescribing pattern in DU 90% segment. Results: Out of 319 antibiotic prescribed to surgical ward patients, 219 prescriptions were belonging to DU 90% segment including ceftriaxone (38.94%), moxifloxacin (16.41%), fosfomycin (14.06%), metronidazole (12.43%), and gentamicin (7.69%) in decreasing fashioned. Of the five groups of antibiotics belong to DU90%, ceftriaxone was the highest in DDD (272.5). The average number of antibiotic prescribed to patients were 1.64±0.92. The percentage of antibiotic prescribed by its generic name as well the prescribing of antibiotic from National list of essential medicines were 70.79% and 72.51%, respectively (optimal value 100%). Conclusions: Our findings on using drug utilization 90% and prescribing indicators are practical for assessing the most widely used antibiotics in ward or hospital setting and to evaluate the quality of prescribing pattern. The antibiotic utilization profile in this study can be used to provide comparative data between hospital and beneficial for future policy making to improve prescribing practice.

Statin use reduces radiation-induced stroke risk in advanced nasopharyngeal carcinoma patients

ObjectiveThis cohort study aimed to evaluate the impact of statin use on ischemic stroke risk in patients with advanced nasopharyngeal carcinoma (NPC) undergoing standard concurrent chemoradiotherapy (CCRT). MethodsUsing data from the Taiwan Cancer Registry Database, we conducted an inverse probability of treatment-weighted Cox regression analysis to examine the association between statin use during CCRT and ischemic stroke risk. ResultsThe adjusted hazard ratio (aHR) for ischemic stroke in the statin group compared to the non-statin group was 0.70 (95 % CI: 0.54–0.92; P < 0.0107). This protective effect was observed across different statin classes, with hydrophilic statins such as pravastatin showing an aHR of 0.37 (95 % CI: 0.17–0.85) and lipophilic statins including atorvastatin displaying an aHR of 0.32 (95 % CI: 0.21–0.50) compared to non-statin use. Analysis of cumulative defined daily doses (cDDD) revealed a dose–response relationship, with lower stroke risk observed in higher quartiles of cDDD. Additionally, patients with a daily defined dose (DDD) > 1 had a reduced risk of stroke with an aHR of 0.49 (95 % CI: 0.31–0.63), while those with DDD ≤ 1 showed an aHR of 0.59 (95 % CI: 0.40–0.84). ConclusionsOur study provides evidence supporting the beneficial effects of statin use during the CCRT period in reducing radiation-induced stroke risk among patients with advanced NPC undergoing definitive CCRT. Notably, pravastatin and atorvastatin demonstrated significant reductions in stroke occurrence. Furthermore, the findings suggest a dose–response relationship, where higher cumulative doses and greater daily dose intensity of statin use were associated with a lower risk of stroke.