Empty Drug Research Articles

Design and Development of a Self-nanoemulsifying Drug Delivery System for Co-delivery of Curcumin and Naringin for Improved Wound Healing Activity in an Animal Model.

The present study endeavored to design and develop a self-nanoemulsifying drug delivery system to improve the solubility and dermatological absorption of curcumin and naringin. Curcumin and naringin-loaded self-nanoemulsifying drug delivery system formulations were developed using aqueous phase titration. Phase diagrams were used to pinpoint the self-nanoemulsifying drug delivery system zones. Tween 80 and Labrasol (surfactants), Transcutol (cosurfactant), and cinnamon oil were chosen from a large pool of surfactants, cosurfactants, and oils based on their solubility and greatest nano-emulsion region. Fourier transform infrared spectroscopy, zeta sizer, and atomic force microscopy were used to characterize the optimized formulations and test for dilution and thermodynamic stability. The optimized curcumin-naringin-self-nanoemulsifying drug delivery system demonstrated the following characteristics: polydispersity index (0.412 ± 0.03), % transmittance (97%), particle size (212.5 ± 05 nm), zeta potential (- 25.7 ± 1.80 mV) and having a smooth and spherical droplet shape, as shown by atomic force microscopy. The ability of their combined formulation to cure wounds was tested in comparison to pure curcumin suspension, empty self-nanoemulsifying drug delivery system, and standard fusidic acid. Upon topical administration, the optimized curcumin-naringin-self-nanoemulsifying drug delivery system demonstrated significant wound healing activity in comparison with a pure curcumin suspension, empty self-nanoemulsifying drug delivery system, and standard fusidic acid. Based upon this result, we assume that skin penetration was increased by using the optimized curcumin-naringin-self-nanoemulsifying drug delivery system with enhanced solubility.

Comparison of two methods for collecting antimicrobial usage in large dairy farms in Ohio and California

Quantification of on-farm antimicrobial use (AMU) is critical to correlate with patterns of antimicrobial resistance, surveil­lance programs and formulate interventions to optimize its use. Prior studies have used the empty drug container (EDC) method to quantify AMU; however, the method is labor-intensive and time-consuming. Therefore, this study aimed to compare it against farm treatment records (FTR) as a reliable method to collect on-farm AMU. We hypothesized a low level of agreement in on-farm treatment incidence (TI) obtained between these 2 different collection methods.

Roots Cause of the Drug Shortage and Expired Drug Problem at Hospital X

Good drug management in the Hospital Pharmacy Installation is the key to the smooth running of pharmaceutical services. The availability of the necessary drugs at the right time and place affects patient safety and satisfaction. Empty drugs and expired drugs are problems in drug management, mainly Hospital X. Empty drugs result in the replacement of drugs in prescriptions, thus increasing the burden on pharmaceutical services and creating risks for patient safety. Expired drugs cause hospital losses. This study aims to describe the root cause of drug shortages and expired drugs in Hospital X. The research used a qualitative approach to dig deeper into these complex problems—elicitation of data using semi-structured interviews supported by secondary data from the hospital. Data were analyzed using a Fishbone diagram to get a systematic overview of the root causes of problems based on specific domains. The root causes of expired drug problems and empty drug substitution in Hospital X are materials/inputs, methods, people, machinery/equipment, measurement (process evaluation), and the pharmacy facility environment domains.

P18 You can’t prescribe what you don’t have: the limitations of addressing the management of symptomatic sexually transmitted infections in a rural Zambian health post

Abstract Background Management of sexually transmitted infections (STIs) remains a significant global issue, with more than one million cases acquired each day worldwide.1 Growing antimicrobial resistance poses a significant threat to addressing this global burden of disease. While STIs are a recognized public health problem in Zambia,2 resistance remains largely an unknown entity.3 This is particularly true of rural areas where there is no local resistance data available and very few microbiology labs. In this setting, the WHO syndromic approach to STI management is recommended.4 Objectives To reduce inappropriate antimicrobial prescribing for genital presentations in a rural health post in Zambia by the provision of educational resources and collaborative teaching based on the WHO syndromic approach to STIs. Volunteers for a non-governmental organization designed and implemented a clinical audit to improve diagnosis and management of genital symptoms in a rural Zambian health post as part of an ongoing antimicrobial stewardship programme.5 Methods Antibiotic use was measured at two intervals over a 1 year period (April to June 2022 and January to March 2023). Patient records were reviewed against an inclusion criterion of a relevant genitourinary diagnosis. The data was analysed for diagnostic accuracy and for the appropriateness of antimicrobial prescribing using the appropriate prescribing ratio (APR).6,7 National guidelines and WHO recommended alternatives were used as the standard. Data collection and analysis was approved by the Zambian Ministry of Health. The WHO granted permission to use and adapt its materials (ID:202300108). The intervention consisted of collaborative teaching structured around the implementation of simple flow charts based on the WHO syndromic approach and national Zambian guidelines. One-to-one mentoring was delivered over a period of three weeks. Results The proportion of plausible differentials increased from 52.5% (n=40) to 80.5% (n=41). APR increased from 5% to 9.8%. The proportion of inadequate and unnecessary prescriptions reduced, falling from 85% to 73.2% and 10% to 2.4%, respectively. Suboptimal prescriptions increased, rising from 0% to 14.6%. Conclusions This audit supports the use of guidelines and education based around the WHO syndromic approach to improve the diagnosis of genital infections in low resource settings. The limited improvement in prescribing was most likely influenced by the severe antibiotic shortages reported by local healthcare workers.5 This highlights the significance of addressing supply chains and ordering processes, particularly to rural areas. It is likely that improvements in appropriate prescribing rates will depend on parallel improvements in local antimicrobial availability. No educational intervention can overcome an empty drug cupboard, but education can be used to conserve the limited stock through more selective use. Improved access to either laboratories or point of care testing would make the decision to prescribe easier. However, in their absence, increasing adherence to the WHO syndromic approach has the potential to limit unnecessary prescriptions in low-resource rural settings, improving resource conservation and antimicrobial stewardship.

Analisis Sediaan Farmasi Di Indonesia Dalam Menunjang Sistem Kesehatan Nasional: A Systematic Review

Pharmaceutical preparations is a term that covers all forms of pharmaceutical preparations ranging from drugs, medicinal ingredients, traditional medicines to cosmetics. This term has been regulated in Government Regulation of the Republic of Indonesia Number 51 of 2009 concerning Pharmaceutical Work. Management of pharmaceutical preparations is a cycle of activities starting from the selection, scheduling needs, receiving, storage, distribution, destruction and withdrawal, control, which is necessary for pharmaceutical service activities. The method used in this study is a Systematic Literature Review (SLR) of ten national journals which were obtained using online database facilities via the Google Scholar, Refseek, and Sciencegate pages. Journals were selected based on publications published between 2018 and 2023. There were obstacles in the implementation of pharmaceutical preparations, including planning that was still conservative, from delays in drug procurement in demand and distribution, resulting in empty drug supplies. However, not all aspects are problematic. There are many other aspects of the mechanism of pharmaceutical preparation that are carefully programmed and procedurally appropriate. This matter needs to be done routinely and continuously, and with written commitments for pharmaceutical preparations in Indonesia in supporting SKN it can be categorized as quite good.

Monitoring of antimicrobial usage among adult bovines in dairy herds of Punjab, India: A quantitative analysis of pattern and frequency.

The present study aimed to evaluate the antimicrobial usage (AMU) pattern in dairy herds of Punjab, India. The on-farm quantification of AMU in adult bovine animals by the manual collection of empty drug containers ("bin method") along with the records of the treatment was carried out in 38 dairy farms involving 1010 adult bovines for 1 year from July 2020 to June 2021. The farm owners were asked to record the antibiotic treatments as well as to deposit empty antibiotic packaging/vials into the provided bins placed at the farms. A total of 14 different antibiotic agents in 265 commercial antibiotic products were administered to the dairy herds during the study. A total of 179 (67.55%) administered products contained antimicrobials of "critical importance" as per the World Health Organization (WHO). Mastitis (54.72%), followed by the treatment of fever (19.62%), reproductive problems (15.47%), and diarrhea (3.40%) accounted for the majority of drugs administered in the herds during the study period. The most commonly used antibiotics were enrofloxacin (89.47% herds; 21.51% products), followed by ceftriaxone (50% herds; 12.83% products), amoxicillin (50% herds; 12.83% products), oxytetracycline (55.26% herds; 11.70% products), and procaine penicillin (47.37% herds; 12.83% products). The highest quantity of AMU [in terms of antimicrobial drug use rate (ADUR)] was observed for ceftiofur, followed by ceftriaxone, procaine benzyl penicillin ceftizoxime, enrofloxacin, cefoperazone, amoxicillin and ampicillin. A total of 125 (47.17%) products contained "highest priority critically important antimicrobials" (HPCIA) and 54 (20.37%) products contained "high priority critically important antimicrobials". In terms of overall number of animal daily doses (nADD), the highest priority critically important antimicrobials (HPCIA) of the WHO such as third-generation cephalosporins and quinolones, respectively accounted for 44.64 and 22.35% of the total antibiotic use in the herds. The bin method offers an alternative to monitoring AMU as a more accessible approach for recording the actual consumption of antimicrobials. The present study, to the best of our knowledge, is the first of its kind to provide an overview of the qualitative and quantitative estimate of AMU among adult bovines from India.

SISTEM INFORMASI INVENTORY OBAT BERBASIS WEB DENGAN FRAMEWORK CODEIGNITER DI APOTEK PUSPITA FARMA SEMARANG

Technological developments within a company are needed in the execution and evaluation of all existing jobs so that the work becomes fast, precise, and accurate. Puspita Farma Pharmacy is one of the community service businesses engaged in the sale of medicines. The high level of service to the community causes errors in processing and making reports which are still done manually.
 The process of recording goods report data using two kinds of record books, namely a daily goods order book, a daily goods sales recap book, and a record book for each purchase of goods. The use of this manual system found many obstacles that caused the work process to be ineffective and efficient, including errors in recording incoming and outgoing drug data, resulting in empty or excessive drug supplies and the discovery of expired drugs.
 As a solution to the problems currently experienced by the Puspita Farma Pharmacy, it is necessary to create a drug inventory information system at the Puspita Farma Pharmacy. This information system was created using the PHP programming language, Mysql for databases and the Codeigniter framework for data processing.

Compounds from the Medicines for Malaria Venture Box Inhibit In Vitro Growth of Babesia divergens, a Blood-Borne Parasite of Veterinary and Zoonotic Importance.

Babesiosis is an infectious disease with an empty drug pipeline. A search inside chemical libraries for novel potent antibabesial candidates may help fill such an empty drug pipeline. A total of 400 compounds (200 drug-like and 200 probe-like) from the Malaria Box were evaluated in the current study against the in vitro growth of Babesia divergens (B. divergens), a parasite of veterinary and zoonotic importance. Novel and more effective anti-B. divergens drugs than the traditionally used ones were identified. Seven compounds (four drug-like and three probe-like) revealed a highly inhibitory effect against the in vitro growth of B. divergens, with IC50s ≤ 10 nanomolar. Among these hits, MMV006913 exhibited an IC50 value of 1 nM IC50 and the highest selectivity index of 32,000. The atom pair fingerprint (APfp) analysis revealed that MMV006913 and MMV019124 showed maximum structural similarity (MSS) with atovaquone and diminazene aceturate (DA), and with DA and imidocarb dipropionate (ID), respectively. MMV665807 and MMV665850 showed MMS with each other and with ID. Of note, a high concentration (0.75 IC50) of MMV006913 caused additive inhibition of B. divergens growth when combined with DA at 0.75 or 0.50 IC50. The Medicines for Malaria Venture box is a treasure trove of anti-B. divergens candidates according to the obtained results.

Overview of Distribution of Medicines and Consumable Medical Materials (Bmhp) from Pharmacy Warehouse Pharmacy Depot to Inpatient Installations of Diseases in General Hospital in South Tangerang City in 2021

The problem in distributing pharmaceutical preparations that often occur in hospitals is when medicines arrive late at the hospital pharmacy depot/satellite. Not only employees who feel loss but patients who need medicines are even more harmed because they have to wait for the medicine that comes too late. The type of research used in this study is descriptive qualitative research using case study design. Primary data is obtained from direct observations and in-depth interviews and document studies. This research was conducted in South Tangerang City Hospital from May to June 2021. Based on the results of research obtained for input obtained human resources results in pharmaceutical warehouses are not adequate, infrastructure to distribute medicines and medical materials consumables to the room has not been up to standard. In the process obtained results that have been done by the distribution flow of drugs and medical materials consumables. In the output obtained results there is still a void of drugs. Conclusion In the input of human resources in the Pharmacy Warehouse is not adequate, the infrastructure in distributing medicines and medical materials consumables to the room has not been up to standard. The distribution process has been carried out by the standards of operational procedures in force. At the output is still the discovery of empty drug stocks. Suggest the head of the warehouse to be able to supervise the SOP that the distribution of drugs and BMHP. The need to hold a special trolley addition in the Pharmacy Warehouse to facilitate the distribution of drugs and medical materials consumables.

Rectal perforation caused by a self-inserted foreign body: a case report

Rectal foreign bodies have a storied history as a part of anorectal trauma. Objects encountered are most commonly household objects consisting of bottles and glasses. Other objects include tooth brushes, deodorant bottles, food articles, knives, sports equipment, cell phones, flash lights, wooden rods, broom sticks, sex toys including dildos and vibrators, light bulbs, nails, or other construction tools, christmas ornaments, aerosol canisters, cocaine packets, and many more. The reasons for insertion in decreasing order of frequency are autoeroticism, concealment, attention-seeking behavior, accidental, assault and to alleviate constipation. Here we presented a case of 32 years old presented to the ER with complaints of pain in lower abdomen and anal region for 12 hours. He complained of severe pain when he tried to defecate. He gave history of self-insertion of an empty drug vial into his rectum. Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The important factors in dealing with these patients are careful history and physical examination. Patients are often embarrassed about this condition and may conceal the truth. So, a high index of suspicion is required to accurately diagnose.

Pegylated bis-indolyl polyurethane dendrimer: Empty drug carrier with prominent anticancer activity

Blocked isocyanate-terminated, bioactive bis-indole based polyurethane dendrimers of generation G0 – G3 were subjected to urethane interchange reaction with poly(ethylene glycol) monomethyl ether; the reactions yielded corresponding PEGylated dendrimers. The structures of the PEGylated dendrimers were confirmed using spectroscopic and SEC-MALS techniques. The PDI of the polymers were found between 1.24 and 1.49 and these values were on par with 1.46 of poly(ethylene glycol) monomethyl ether used. All the PEGylated dendrimers were found to have a prominent cytotoxicity in human breast (MDA MB-231) and lung (A549) cancer cells. Based on the MTT, AO/EtBr staining and ROS assay results, PEGylated G2 and G3 dendrimers were further subjected to determination of apoptosis using protein markers; the pro-apoptotic markers BaX and caspase-3 were found up regulated and the anti-apoptotic marker Bcl-2 was down regulated. The results confirmed that the PEGylated bis-indolyl G3 polyurethane dendrimer – an empty drug carrier – itself had strong tendency to activate apoptosis type cell death in human cancer cells.

Analysis of Silicone Oil in Prefilled Syringes and Biopharmaceutical Drug Products Using High-Performance Liquid Chromatography.

As the packaging of choice for many therapeutic proteins, prefilled syringes have been widely used in biopharmaceutical industry as primary containers, where silicone oil is applied to ensure their proper functionality. Adequate lubrication from sufficient amount of silicone oil and its appropriate distribution across syringe barrels is crucial for successful administration of drug product (DP) from the prefilled syringes; however, silicone oil is also susceptible to leaching from the syringe surface into the formulation with the potential to interact with therapeutic proteins, which could lead to the formation of visible and sub-visible aggregates and/or particles that are potentially immunogenic. Accurate determination and careful control of silicone oil levels in both empty syringes and protein drug products are therefore critical in process development to ensure syringe functionality, drug product quality, and patient safety. On the other hand, analysis of silicone oil can be challenging especially when the analysis is performed on formulated protein drug products, where matrix effects could be significant. It is demonstrated in this study that silicone oil in empty syringes or formulated drug products can be extracted effectively using organic solvents and quantitatively determined using high-performance liquid chromatography (HPLC) coupled with a universal detector. It was also shown that direct extraction of silicone oil from formulated protein drug products can be very challenging, but pretreatment of the protein drug products with pepsin enzymatic digestion facilitated the extraction process, which enabled the analysis of silicone oil in the drug product at low ppm levels.

An observational cohort study on antimicrobial usage on dairy farms in Quebec, Canada

Quantification of antimicrobial usage (AMU) is crucial to measure the effect of intervention programs, to determine associations between usage and resistance, to compare populations, and for benchmarking purposes. The primary objective of the study was to describe quantitatively the AMU on Quebec dairy farms over 1 yr: (1) the total AMU, (2) the AMU per administration route (intramammary, injectable, oral, intrauterine), and (3) the AMU per antimicrobial class and according to the categorizations of Health Canada and the World Health Organization. The secondary objective was to assess the effect of several characteristics (herd size, level of milk production, and incidence rate of common infectious diseases) on AMU rate. The AMU data were obtained for 101 dairy farms randomly selected in 3 important Quebec dairy regions by collecting and recording all empty drug packaging and invoices for medicated feed (spring 2017 to spring 2018). The AMU rate was reported in number of Canadian defined course doses for cattle per 100 cow-years. The average herd size was 67 cows per farm, and 2/101 farms were certified organic. Overall, an estimated mean of 537 Canadian defined course doses for cattle/100 cow-years was observed. The intramammary route during lactation was the most frequently observed, followed, in decreasing order of usage, by oral route in the feed, intramammary route at drying-off, and injectable route. Oral (other than in animal feed) and intrauterine formulations were infrequently collected from the garbage cans. The 5 most frequently observed antimicrobial classes were, by decreasing order of usage, ionophores, penicillins, aminocoumarins, aminoglycosides, and polymyxins. Highest priority critically important antimicrobials as defined by the World Health Organization were mainly collected from intramammary formulations during lactation followed by injectable and drying-off intramammary formulations. The herd size was positively associated with the total AMU rate but not with the usage rate of highest priority critically important antimicrobials. Incidence of diseases along with preventive use of antimicrobials (drying-off and medicated feed with antimicrobials) explained 48% of the variance in total AMU rate.

Antimicrobial Resistance Patterns in Organic and Conventional Dairy Herds in Sweden.

Monitoring antimicrobial resistance (AMR) and use (AMU) is important for control. We used Escherichia coli from healthy young calves as an indicator to evaluate whether AMR patterns differ between Swedish organic and conventional dairy herds and whether the patterns could be related to AMU data. Samples were taken twice, in 30 organic and 30 conventional dairy herds. Selective culturing for Escherichia coli, without antibiotics and with nalidixic acid or tetracycline, was used to estimate the proportions of resistant isolates. Microdilution was used to determine the minimum inhibitory concentrations (MICs) for thirteen antimicrobial substances. AMU data were based on collection of empty drug packages. Less than 8% of the bacterial growth on non-selective plates was also found on selective plates with tetracycline, and 1% on plates with nalidixic acid. Despite some MIC variations, resistance patterns were largely similar in both periods, and between organic and conventional herds. For most substances, only a few isolates were classified as resistant. The most common resistances were against ampicillin, streptomycin, sulfamethoxazole, and tetracycline. No clear association with AMU could be found. The lack of difference between organic and conventional herds is likely due to a generally good animal health status and consequent low AMU in both categories.

Antibiotic Use in Organic and Non-organic Swedish Dairy Farms: A Comparison of Three Recording Methods.

Biases of antimicrobial use (AMU) reporting systems pose a challenge to monitoring of AMU. Our study aimed to cross-compare three data sources of AMU in Swedish dairy herds to provide an account of the validity of AMU reports. We studied AMU differences between two production systems, to investigate how the reporting system affected this comparison. On-farm quantification of AMU via a manual collection of empty drug containers (BIN) took place in organic (n = 30) and conventional (n = 30) dairy herds during two periods between February 2016 and March 2017. A data extract mirroring these periods was obtained from two linked datasets that contain AMU data as reported by the prescribing veterinarians. These included data from the Swedish Board of Agriculture system (SBA) and Växa milk recording system (VXA). Using the European Medicines Agency technical units, the total number of defined daily doses (DDDvet), and defined course doses (DCDvet) per animal/year were calculated for each herd/period/dataset. Descriptive statistics and Bland–Altman plots were used to evaluate the agreement and systematic bias between the datasets. Mixed models for repeated measures were used to assess AMU differences between production systems. We found consistent numerical differences for the calculated AMU metrics, with BIN presenting higher usage compared to the SBA and VXA. This was driven by a disparity in intramammary tubes (IMt) which appear to be underreported in the national datasets. A statistically significant interaction (BIN dataset) between the production system and drug administration form was found, where AMU for injectable and lactating cow IMt drug forms differed by the production system, but no difference was found for dry-cow IMt. We conclude that calculating AMU using DDDvet and DCDvet metrics at a herd level based on Swedish national datasets is useful, with the caveat of IMt potentially being misrepresented. The BIN method offers an alternative to monitoring AMU, but scaling up requires considerations. The lower disease caseload in organic herds partly explains the lower AMU in particular drug forms. The fact that organic and conventional herds' had equally low AMU for dry-cow IMt, coupled with mismatches in IMt report across herds indicated an area of further research.

In vitro toxicity evaluation of lomefloxacin-loaded MCM-41 mesoporous silica nanoparticles

Lomefloxacin (LF) is interesting as a model molecule from a safety point of view because of its high potential for serious adverse drug effects (i.e. phototoxic reactions). In this study, MCM-41 mesoporous silica nanoparticles (MCM-41) were loaded with lomefloxacin, aiming to overcome the drug’s intrinsic cytotoxicity. The good biocompatibility of the empty drug carrier (0.1–1.0 mg/ml) was established by the absence of red blood cell lysis (hemolysis assay). The cytotoxicity of empty MCM-41 and lomefloxacin-loaded MCM-41 (LF-MCM-41) was evaluated by using a battery of in vitro cytotoxicity assays: Alamar blue, lactate dehydrogenase release and reactive oxygen species formation by dichlorofluorescein assay. Three cell cultures models: hepatoma HepG2, fibroblasts L929 and endothelial EA.hy926 cells were used to compare the cytotoxicity and reactive oxygen species formation by free drug, empty MCM-41, and LF-MCM-41. The findings from the study indicated that empty MCM-41 (0.1–1.0 mg/ml) showed a low cytotoxic potential in HepG2, followed by L929 and EA.hy926 cells. Lomefloxacin loading in MCM-41 mesoporous silica nanocarrier reduced the cytotoxicity of the free lomefloxacin, especially in the high concentration (1.0 mg/ml MCM-41, containing 120 µg/ml LF). L929 and EA.hy926 cells were more sensitive to the protective effects of LF-MCM-41, compared to HepG2 cells. The results indicate that an improvement in lomefloxacin safety might be expected after incorporation in an appropriate drug delivery system.

Zika Outbreak Aftermath: Status, Progress, Concerns and New Insights

Zika, a neurotrophic virus belonging to Flaviviridae family of viruses and transmitted by vector mosquitoes of Aedes species, took the world by storm during its recent outbreak. Its spread to newer territories, unprecedented pace of transmission, lack of existing therapeutic agents and vaccines and an empty drug pipeline raised an alarm. Uncertainty about full spectrum of diseases and its long-term consequences, newly discovered modes of transmission and controversies over vector status of mosquito species like Culex quinquefasciatus led to layers of complexity and presented new hurdles and challenges in Zika virus research. This review summarizes the progress and updates of efforts, concerns, financial burden and available resources in light of newly acquired knowledge in Zika virus research.

Antimicrobial resistance in non-aureus staphylococci isolated from milk is associated with systemic but not intramammary administration of antimicrobials in dairy cattle

Non-aureus staphylococci (NAS) are the bacteria most frequently isolated from bovine milk. Objectives of this study were to determine herd-level associations between antimicrobial use (AMU) and prevalence of antimicrobial resistance (AMR) and antimicrobial resistance genes in NAS according to antimicrobials and routes of administration. The AMR profile was determined using a micro-broth dilution method against a panel of 23 antimicrobials for 1,702 NAS isolates obtained from 89 herds. A subset of these isolates (n = 405) was submitted to whole-genome sequencing, and the presence of AMR genes was determined using data from 4 databases. Antimicrobial use was determined for all herds using an inventory of empty drug containers and quantified for each antimicrobial as the number of antimicrobial daily doses administered. Generalized linear models were used to estimate antimicrobial and route-specific associations between AMR in NAS and AMU. Prevalence of multidrug resistance in NAS was associated with systemic use of antimicrobials. Estimated relative risk associated with a 1-unit increase in antimicrobial daily doses per cow-year administered systemically was 1.28. No association was present with either intramammary or intrauterine use. Three drug classes, all of high or very high importance for human medicine, were associated with drug-specific AMR when administered systemically: penicillins, third-generation cephalosporins, and macrolides. Prevalence of tet, erm, and blaARL genes in NAS was higher in herds that used more tetracyclines, macrolides, and third-generation cephalosporins, respectively. No association between drug-specific AMU and prevalence of blaZ, mphC, and msrA was identified, irrespective of route of administration. The either weak or nonexistent association between AMR and antimicrobials administered intramammarily suggest that a decrease in AMR of NAS following implementation of selective dry cow therapy would be minimal in comparison to reduced use of systemic antimicrobials.

Preparing Your Pediatric Patients and Their Families for the Operating Room: Reducing Fear of the Unknown.

1. Adam C. Adler, MS, MD*,‡ 2. Stephanie Leung, BS, CCLS† 3. Benjamin H. Lee, MD*,‡ 4. Scott R. Dubow, MD§ 1. *Department of Anesthesiology, Perioperative and Pain Medicine and 2. †Department of Child Life, Texas Children’s Hospital, Houston, TX 3. ‡Baylor College of Medicine, Houston, TX 4. §Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA * Abbreviations: BiPAP: : bilevel positive airway pressure CLS: : child life specialist CPAP: : continuous positive airway pressure DEA: : Drug Enforcement Administration IV: : intravenous MRI: : magnetic resonance imaging OSA: : obstructive sleep apnea Clinicians should: identify the resources available to patients and families to allow for a smooth perioperative experience; understand the long-term effects and potential maladaptive changes associated with an anxiety-provoking perioperative period; understand the most common parental and patient concerns and misconceptions regarding surgery; understand the most common and up-to-date perioperative anesthesia practices; understand the indication for referral to the preoperative anesthesia clinic for patient evaluation to avoid unnecessary cancellation. Pediatricians are often tasked with preparing children and their families for the preoperative period and dealing with questions related to postoperative issues and concerns. Instruction based on current practice and new research and techniques may help patients and families cope with the stressors of surgery. Determining which patients may benefit from a medical or child life preoperative visit is of crucial importance. After completing this article, the reader should be able to: 1. Describe common preoperative anesthesia practice. 2. Recognize the role of a child life specialist in preparing children for surgery. 3. Differentiate children who would benefit from a preoperative anesthesia and/or child life evaluation. 4. Instruct patients and families on issues related to the perioperative period. 5. Address a wide array of parental concerns regarding surgery, anesthesia, and postoperative pain management. The period of time surrounding a planned surgical procedure can be tumultuous and anxiety provoking for both pediatric patients and their parents. The “mysterious place” that is the operating room often remains a mystery to many health care providers, including those tasked with caring for patients both before and after a procedure. As the health care provider most familiar to patients and their families, the pediatrician is in a …

Comparison of treatment records and inventory of empty drug containers to quantify antimicrobial usage in dairy herds

Assessment of antimicrobial use (AMU) is vital for interpreting the origin of changes in antimicrobial resistance (AMR). The objectives of the present study were to estimate the association between AMU determined using on-farm treatment records (TR) and inventory of empty drug containers (INV). Herds were selected to represent Canadian dairy farms. Producers were asked to record animal health events and treatments on a standard General Health Event form. For inventory data, 40-L receptacles were placed at various locations considered convenient to deposit all empty drug containers. Antimicrobial defined-daily dosages (ADD) were calculated for 51 Canadian herds using the 2 methods. Estimation of AMU was 31,840 ADD using the INV and 14,487 ADD using the TR, indicating that for every TR entry, 2.20 times more treatments were observed using the INV. Mastitis, reproductive conditions, and dry cow therapy were the most frequent reasons for antimicrobial therapy when assessing TR. For all antimicrobials evaluated, mean ADD was higher using the INV versus TR. Regardless, a strong positive correlation (0.80) was observed between the 2 methods, indicating that herds with increased number of ADD recorded using the INV also had increased number of ADD recorded using TR. Furthermore, a positive association was observed for the 6 most commonly used antimicrobials. In comparison to methods used in surveillance programs on AMU in livestock that assume a constant use in all herds (i.e., sales data), INV provided a herd-level specific quantity of AMU positively correlated with AMU recorded at the animal level in general. The INV was easy to implement and provided a measure of total AMU in the herd. Availability of such information would be valuable for interpreting changes in AMR at the herd level and enabling evaluation of interventions for decreasing AMR.