Inappropriate Drug Use Research Articles

Study on the Influence of Pharmaceutical Management on Rational Drug Use under Chinese Health Strategy

In order to better promote the implementation of the healthy China strategy and the innovation of public hospital system management, we can explore a modern public hospital management system that can meet the needs of the people in the new era from the aspects of medical service supply mode, collaborative governance design of public hospitals and internal management system of public hospitals. In this paper, 300 prescriptions in our hospital before and after May, 2020 were selected as research objects, and were randomly divided into two groups, one group was the control group (300 cases) without pharmaceutical management, and the other group was the observation group (300 cases) with pharmaceutical management. Then, the drug satisfaction, irrational drug use and inappropriate drug use of the two groups were compared. The results showed that the satisfaction of medication in the observation group was significantly better than that in the control group, and the irrational and inappropriate medication was lower than that in the control group, with statistical differences (P <0.05). It shows that the implementation of pharmaceutical management measures under the strategy of Healthy China can effectively improve patients' satisfaction with medication and prevent irrational medication.

Enhancing the Rational Use of Albumin and Intra-venous Pantoprazole in Hospitals by Implementing Pharmaceutical Guidelines in Hospitals: A Quasi-experimental study

Background: Irrational use of drugs is a serious global problem, especially in developing countries. Scientific evidence has announced albumin and intravenous pantoprazole as expensive drugs, i.e., relatively irrationally applied in hospitals without following the guidelines. Objectives: Considering health cost management policy in Iran, this study aimed to evaluate the effects of implementing pharmaceutical guidelines to rationalize and reduce the use of albumin and intravenous pantoprazole and the related inappropriate costs. Methods: This quasi-experimental study was conducted from January 2016 to October 2018 in two teaching Hospitals in Jahrom City, Iran. Pharmaceutical guidelines were implemented throughout the physical training as well as a pharmacist-led intervention and supervising. All inpatient prescriptions of the studied medicines were evaluated. Results: Before conducting the intervention (June 2016), an average of 357 albumin vials were monthly used; after performing the interventions, 166 and 167 vials were used in 2017 and 2018, respectively. Reduced albumin use rate equaled 48%, i.e., significant (P=0.002). Annual cost-saving was estimated to be 25000 USD. In comparison to the previous year, there were 46% and 70% reductions in the mean number of pantoprazole vials prescribed in 2017 and 2018, respectively (P=0.005).Consuming pantoprazole was measured to be 1457 vials per month in 2017 and 795 in 2018, i.e., significant (P=0.002). Cost-Saving in intravenous pantoprazole was estimated to be 16000 USD in 2017 and 25000 USD in 2018. Conclusion: Prescription strategies, such as pharmaceutical guidelines with educational measures, pharmacist-led intervention, monitoring the prescribing drug, and feedback to prescribers can significantly decrease the inappropriate use of expensive drugs and their costs.

Inappropriate drug use rates of geriatric patients attending to a university hospital cardiology policlinic.

The interest in risks related to inappropriate drug use (IDU) and polypharmacy among the elderly has increased in recent years. We aimed to determine the frequency of IDU and multiple drug use in elderly patients in the cardiology outpatient clinic. : In this prospective, cross-sectional study, a total of 513 patients aged 65 years and above who were admitted to the Cardiology Policlinic between December 2017 and January 2018 were included. To determine the prevalence of IDU, we investigated the suitability of the drugs used by the patients (according to the criteria of Beers 2015 and Screening Tool of Older People's Prescriptions [STOPP] version 2), the number of violated criteria in both the guidelines and which criterion was violated by the inappropriate drugs. : The 513 patients (mean age: 73.18 ± 5.99) in this study included females (n = 235; 45.8%) and males (n = 278; 54.2%). A total of 2,910 drugs were used by the 513 patients (mean per patient: 5.67 ± 2.51); 52.8% of the patients were using more than five drugs. The Beers criteria revealed that 304 IDUs were detected among the drugs and showed that 38.6% (n = 198) of the patients had IDU. According to the STOPP criteria, 366 IDUs were identified among the drugs used, and 45.6% (n = 234) of the patients had IDU. IDU frequencies of the elderly patients are similar to the world literature in our study. As the number of chronic illnesses the patients had increases, the frequency of IDU increases according to Beers and STOPP criteria in our study.

Microbial Co-infections in Covid Patients: A Mini Review

In this review, we highlight the complications of COVID-19 affected patients due to microbial infections, which increase the severity of the disease. Nearly 50% of COVID-19 affected patients among non-survivors were either co-infected with bacterial, fungal, or viral pathogens. During ongoing COVID-19 pandemic, it has been a challenge for developing and under developing countries to identify co-infections in patients due to limited healthcare facilities and high cost for the diagnostic tests. Since several microbial co-infections are associated with COVID-19, there is need to diagnose such co-infections in early stage so that required control measures would be taken to avoid the further health risks. People with severe COVID-19, COVID-19 patients in intensive care units (ICU), are susceptible to bacterial and fungal infections. Bacterial pathogens, representing less than 14% of patients with reported infections include Mycoplasma pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa while fungal sps include Aspergillus, Candida auris, black fungus etc that invade the brain or cause patients to lose vision. The unregulated and inappropriate use of antibiotics, antimicrobial drugs and alcohol based hand sanitizers may enhance the evolution of AMR phenotypes among infectious pathogens.

Modern facilities of pharmacological correction of hyperuricemia in rheumatic diseases: management of difficult clinical cases

The article presents clinical cases of management of patients with low compliance with treatment, suffering from rheumatic diseases and disorders of purine metabolism.Cases report 1. The first patient with advanced gout, after taking 100 mg of allopurinol, developed undesirable effects: sore throat, change in voice, cough, and therefore treatment was discontinued. After six months without therapy, the condition worsened and, in self-medication, the patient resumed taking allopurinol at a dose of 300 mg per day, which, as expected, resulted in a resumption of the allergic reaction and a serious exacerbation of gouty arthritis. In order to stop continuous relapses of arthritis, it became necessary to prescribe glucocorticoids. After stabilization of the state, constant administration of febucostat with positive clinical and laboratory dynamics was recommended.Cases report 2. The second patient with rheumatoid arthritis (RA) developed analgesic nephropathy, secondary hyperuricemia, and typical gouty attacks in the background of high activity of the underlying disease, existing kidney pathology and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs). Frequent exacerbations of arthritis prompted the patient to finally see a rheumatologist. The adjusted therapy made it possible to reduce RA activity, reach the recommended level of uric acid, and reduce the drug load on the kidneys with almost complete withdrawal of NSAIDs. Thus, in modern conditions, rheumatologists have in reserve all the necessary means for the pharmacological correction of hyperuricemia, even in difficult clinical cases. Febucostat is the drug of choice for correcting uric acid levels in case of intolerance to allopurinol, as well as in the development of secondary gout against the background of renal failure. In addition, it should be noted that the effectiveness of the treatment of rheumatic diseases largely depends on the patient’s compliance. To increase adherence to therapy, regular patient schools are recommended.

An Overview of Knowledge of Traditional Medicine for Self-medication in the Community in the Era of the COVID-19 Pandemic

Self-medication is usually used by the community to treat minor illnesses, especially during the COVID-19 pandemic, such as fever, dizziness, cough, flu, pain, ulcers, diarrhea, and others. Most self-medication leads to inappropriate drug use. Self-medicated knowledge is the key to prevent unwanted events, one of the example is by providing education about traditional medicine for self-medication. In addition, making a plantation pharmacy is also a solution to make it easier for people to obtain traditional medicines. The method of implementing this community service activity is to provide counseling on using traditional medicine for self-medication and planting pharmacy plantation. An overview of knowledge of traditional medicine for self-medication in the community in the era of the COVID-19 pandemic is descriptive research by looking at primary data (from questionnaires) taken in a cross-sectional manner. Based on the data obtained, it can be concluded that most people have a sufficient level of knowledge (59.09%). The community has a positive attitude towards traditional medicine self-medication as evidenced by the number of respondents who answered agree from these statements. Therefore, research can be carried out as well as counseling, education and health promotion to society with a larger sample.

Risks vs. benefits of switching therapy in patients with postmenopausal osteoporosis

ABSTRACT Introduction: Osteoporosis is characterized by the fragility of bones, leading to fractures and, consequently, the deterioration of functional capacity and quality of life. Postmenopausal women, in particular, are prone to osteoporosis and often require anti-osteoporosis treatment. In the last few decades, various anti-osteoporosis drugs have been approved for clinical use. In an aging society, osteoporosis cannot be treated using a single agent; therefore, switching therapy is an important treatment strategy. Areas covered: This review covers switching therapy in patients with postmenopausal osteoporosis. It’s extremely important to understand the characteristics of each drug including; limitations on the duration of use, side effects due to long-term use (such as atypical femur fracture and osteonecrosis of the jaw) or discontinuation (such as rebound phenomenon), compliance, and ability to prevent fractures. We review and summarize the risks and benefits of switching therapy. Expert opinion: When switching therapy, the order of drug administration is important. Routine monitoring should be continued after switching treatments. We recommend first using osteoanabolic agents in postmenopausal women with severe osteoporosis. In addition, identifying predictors of the efficacy and side effects of treatment may help prevent the inappropriate use of drugs for the treatment of osteoporosis.

Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital. Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018. Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52). Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.

Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia

BackgroundResearch suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach.MethodsWe used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators.ResultsThe intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations.ConclusionsBarriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.

Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden.

Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting. Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised). The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16-1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71-0.87 and OR 0.52, CI 0.45-0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42-0.67). Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.

Controversial link between proton pump inhibitors and anticancer agents: review of the literature.

Drug-drug interactions represent a topic of great interest, not only due to the risk of unexpected adverse events but also due to the possibility of altering the effectiveness of a specific treatment. Inappropriate or concomitant use of drugs can often lead to changes in the bioavailability of various compounds, resulting in pharmacokinetic alterations. A recent example is the concomitant administration of proton pump inhibitors (PPIs) and anticancer agents. PPIs are overused beyond their classic indications, resulting in a high risk of interactions with other drugs, such as anticancer agents, both PO and intravenous. However, the real clinical impact of concomitant acid suppression therapy and anticancer therapies remains controversial and is not yet fully understood. Certainly, the gut microbiota plays a key role in regulating the response of the immune system, and PPIs can significantly alter the gut microbiome, resulting in gut dysbiosis. Indeed, while the link sometimes appears to lead to negative outcomes, as in the case of immunotherapy, oral capecitabine, or tyrosine kinase inhibitors, in other cases, it seems to enhance the effectiveness of intravenous chemotherapy. In this review, I analyse the possible drug interactions between PPIs and the main classes of anticancer drugs.

Implementation of Pharmacist-Driven Antifungal Stewardship Program in a Tertiary Care Hospital.

Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. This study included three periods, consisting of observation, feedback/education, and daily AFS activities. In the observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In the second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In the final period, a clinical pharmacist participated in daily ward rounds to evaluate the appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Four hundred eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mold infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, and 46.3%; P = 0.046) and treatment of fungal diseases (27.8%, 32.4%, and 71.9%; P < 0.001) between the first, second, and third periods, respectively. The 30-day mortality was not significantly changed between the three periods (19%, 15.6%, and 27.5%; P = 0.050). Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

Antimicrobial Resistance in Pasteurellaceae Isolates from Pyrenean Chamois (Rupicapra pyrenaica) and Domestic Sheep in an Alpine Ecosystem.

Simple SummaryAntimicrobial resistance (AMR) is a public health concern. Increasing resistance has arisen due to the inappropriate use of antimicrobial drugs in both, human and veterinary medicine. Although AMR is mainly linked to direct and indirect human activities, little is known about the presence and impact that AMR has on wild animals, especially for those bound to habitats subjected to little human pressure. Our study analyzed the AMR profiles of different Pasteurellaceae species obtained from the infected lungs of Pyrenean chamois (Rupicapra pyrenaica) and domestic sheep found in a National Hunting Reserve from Spain. We have found evidence of the presence of AMR in both animal species. Furthermore, some isolates were resistant to cephalosporins and fluoroquinolones, which are antimicrobials of critical importance in human medicine. Further research is needed to discern pathways of AMR dissemination within natural environments and assess its persistence in wildlife in order to prevent further AMR spreading at a global scale.Antimicrobial resistance (AMR) has spread worldwide due to the inappropriate use of antimicrobial drugs in human and veterinary medicine, becoming a public health problem. However, little is known about its occurrence and maintenance in wild animals, and very few studies have been carried out in ecosystems subjected to low human pressure. In our study, nasal and lung swabs were collected from hunted Pyrenean chamois (Rupicapra pyrenaica), and nasal swabs from sympatric domestic sheep were also collected. The swabs were cultured in agar plates to obtain bacterial isolates from the Pasteurellaceae family. The presence of AMR was assessed in a total of 28 Pasteurellaceae isolates from 45 Pyrenean chamois, and 9 isolates from sympatric domestic sheep found in the National Hunting Reserve of Freser-Setcases (Northeastern Pyrenees, Spain). The isolates belonged to one of the following three species: Pasteurella multocida, Mannheimia haemolytica and Bibersteinia trehalosi. Some P. multocida and M. haemolytica isolates tested positive for AMR. The statistical analysis revealed no differences between the AMR levels from chamois and domestic sheep isolates. However, one P. multocida of chamois origin presented resistance to cephalosporins and fluoroquinolones, which are antibiotics of critical importance for human health. Further studies are required to elucidate potential routes of dissemination of AMR genes in natural environments and assess any significant persistence in wildlife to design risk mitigation actions.

Pharmacist and Prescriber Responsibilities for Avoiding Prescription Drug Misuse.

Pharmacists have the same duty as prescribers to prevent inappropriate use of dangerous drugs. Loperamide, for example, is an over-the-counter medication that has been reported to be potentially misused for euphoric effects. Pharmacists and prescribers alike face challenges in providing optimal care for patients and protecting communities from drug misuse. These challenges include cognitive bias, underdeveloped safety culture, and differing expectations of responsibilities of the other party in ensuring safe prescribing. This commentary explores legal, ethical, and practical considerations for pharmacists and prescribers working together to address uncertainty in drug prescribing.

Relational continuity of care in community pharmacy: A systematic review.

Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle-Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.

P634 Trajectories of oral budesonide use in Crohn’s disease cohort of Tuscan patients

Abstract Background Crohn’s disease (CD) is an immune-mediated inflammatory chronic disorder of the gastrointestinal tract. The therapeutic approach includes firstly oral budesonide (OB), followed by immunomodulatory drugs and biologics. The aim of the present study was to identify and characterize adherence trajectories of OB in CD patients and related patterns. Methods In this retrospective cohort study, data was retrieved from administrative healthcare databases in Tuscany, an Italian region. Patients were included if they had a first record of a diagnosis of ICD-9 or disease exemption or a first record of dispensation of OB as CD patient, in the period from 6/1/2011 to 6/30/2016 (index date, ID). Patients &amp;lt; 18 years old at ID or with history of data before ID &amp;lt; 5 years or follow-up of data after ID &amp;lt; 3 years were excluded. Patients with autoimmune hepatitis, cancer and no dispensation of OB were excluded from CD cohort. We considered as covariates sex, age, and number of concomitant drugs during the month before ID. We estimated adherence to OB monthly through the Medication Possession Ratio and computed trajectory of adherence treatment with a procedure consists into 3 steps: 1) computation of 24 statistical measures; 2) factor analysis; 3) cluster analysis. We described the adherence in the clusters. Results 3333 patients were included CD cohort, among them 1262 were excluded for no dispensation of OB. 2071 were patients included the computation of trajectory of OB use. Trajectories’ curves showed three difference clusters of adherences to OB, which identify two main subgroups of OB users: 925, 603 and 543 were the patients in each cluster. Cluster 1 is represented by a curve of adherence that rapidly decreased to 20–30% of adherence within 5 months. Instead, cluster 2 and 3 described patterns of a short therapy timing, with discontinuation within about 4 months, likely referring to an acute treatment of CD, typical treatment approach used in mild to moderate CD. Statistically significance differences were evidenced between covariates across the clusters. Conclusion Trajectories’ curves showed three difference clusters of adherences, which identify two main subgroups of OB users. Further analyses need to characterize the identified clusters in order to evaluate possible inappropriate use of drug (cluster 1) and potential switch to other therapies (cluster 2 and 3). Finally, these results could clarify drug use in patients with CD and provide new insights in order to improve management of patients by clinicians.

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study.

ObjectiveExplicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to report the results of the international Delphi validation study for the Turkish Inappropriate Medication use in the Elderly (TIME) criteria set, which aims to detect inappropriate prescribing in older adults in Eastern Europe.MethodsThe study was conducted between June 2019 and March 2020. Delphi rounds were conducted by the TIME international working group, which included 11 internationally recognized experts in geriatric pharmacotherapy as Delphi panelists. They were asked to indicate to what extent they agreed or disagreed with each TIME criterion, taking into account both the available evidence and their own experience. We used a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) and an online software program (SurveyMonkey®) to grade the level of agreement. Criteria with a median value of 1 or 2 and a 75th centile value of 1 or 2 were accepted, and criteria with a median value > 2 were rejected. Those with a median value of 1 or 2 but a 75th centile value > 2 were retained, to be assessed in the following round. The initial list of Delphi criteria comprised 153 TIME items.ResultsAfter three Delphi rounds, 134 criteria were accepted and seven criteria were rejected, while 12 criteria did not achieve consensus, and so were not included in the final validated set of TIME criteria.ConclusionWe developed the internationally validated TIME criteria set based on a Delphi process involving international experts. The validation study suggests that the TIME criteria set can be applied in both central and Eastern European settings. Further studies are needed to assess the utility and benefit of the TIME criteria in reducing inappropriate drug use and improving clinical outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-021-00855-5.

Appropriateness and Pattern of Antibiotic Prescription in Pediatric Patients at Adigart General Hospital, Tigray, Ethiopia.

Background Inappropriate and unnecessary use of antibiotics can increase morbidity, mortality, medical expenses or patient cost, and microbial antibiotic resistance. However, in developing countries like Ethiopia, information regarding appropriateness of antibiotic prescribing pattern to guide improvement strategies is scant. Objective The aim of this study was to assess appropriateness and pattern of antibiotic prescription in pediatric patients at pediatric ward of Adigrat General Hospital. Methods Hospital-based retrospective cross-sectional study was conducted to assess the antibiotic prescribing pattern in pediatric inpatient and outpatient ward of Adigrat General Hospital from December 1, 2018 to April 30, 2019. Data was collected by using structured data collection checklist, and the systematic random sampling technique was employed to enroll the required sample size during the study period. Appropriateness of drug use in pediatrics was evaluated using Ethiopian Standard Treatment guideline and WHO pediatric guideline. Result A total of 692 pediatric patients' medical charts were reviewed. The median age of patients on antibiotics was 3.26 years (IQR: 2-4). Majority (49.13%) of the patients were hospitalized for 5-9 days. SCAP (195), tonsillitis (114), and cellulitis (99) were most frequently encountered pediatric diseases. Penicillins (37.86%) followed by cephalosporins (31.79%) antibiotics were the most prescribed antibiotics in pediatric wards. This study also showed that ceftriaxone and ceftriaxone+amoxicillin were the most frequently used single and combination antibiotics, respectively. The prescribing practices were not stick to WHO core indicators and standards. Inappropriate prescription of antibiotics was observed in 28.3% of patients. Advanced age of children, children aged between 6 to 10 years (AOR = 3.225; CI = 1.080 − 9.630; P = .036) and 11-18 years (AOR = 18.691; CI = 5.156 − 67.756; P = .000), was the independent determinant of inappropriate drug use. Conclusion Inappropriate antibiotic prescribing was encountered in 28.3% of children. The rate of generic prescription was not in line with WHO recommendation. Advanced age of children was the independent factor for inappropriate use of antibiotics.

A Study of Self- Medication Uses without a Prescription among Iraqi Patients in Baghdad City

Background: Medicines are those chemical compounds which consist of a single substance or more and areobtained through natural (plant or animal), as well as industrial methods, by chemical reactions that utilizedin the treatment of diseases that can infect human and animals or alleviate illness, prevention or diagnosing.Self-medication is the unwanted medical use of prescription and / or over-the-counter drugs. These practiceshave become an encouraging global form of self-care when it comes to minor ailments. Well it is not limitedto over-the-counter medicines. This also includes the use of prescription medications such as antibiotics.Objective: This study explores the extent of a widespread phenomenon of medicines usage without a doctorprescription, and studied the self-medication practices reasons among patients in the city of Baghdad.Methods: A cross-sectional descriptive study was conducted by questionnaires were distributed randomlyto 300 adults in different age group, sex and level of education at PHC in Baghdad city.Result: In this study, findings depict that the (34.3%) of study male participants are aged (30-39) years old.In regarding with education, thirty-four percent are primary school graduated and work a housewife residentin rural areas. Also, the (53 %), (12.3%) respectively take drugs in the last months for flu. The (64.7%) ofdrugs was prescribed by physician and (35.3%) of drug take without prescription because (16.3%) of themnot have access to physician care. The source of drugs supplies, the (31.7%) take it from others source and(38.3%) of information on the use of these drugs was obtained from physicians. The most common types ofdrugs used without prescription the result indicated that (39.0) was antibiotics and (53.3%) of sample notcommitment by dose, Reading instructions &amp; advertence with complication. Also the (73%) of sample don’tuses or depending upon herbs.Conclusion &amp; Recommendations: The continued use of medications without a prescription is an alarmingproblem in the country of Iraq. The prevalence of self-medication management is high in Middle Easterncountries and is often associated with inappropriate drug use. Therefore, it is necessary to understand therelationship between the various factors that favor the management of self-medication and to evaluate theevolving trends to help us develop strategies to reduce the health risks associated with drugs among thepeople of the Middle East.The recommendations included the imposition of regulatory measures that restrict access to prescriptionmedications only in countries where antibiotics are available over the counter. Another recommendation,which has emerged in several studies, is to improve the use of media campaigns to effectively guide publiceducation programs.

Comparison of Five Lists to Identify Potentially Inappropriate Use of Non-Steroidal Anti-Inflammatory Drugs in Older Adults.

To compare the prevalence of potentially inappropriate non-steroidal anti-inflammatory drugs (NSAIDs) among NSAIDs users defined with frequently used potentially inappropriate medication (PIM) lists and to identify the determinants of their use. Cross-sectional survey among community-dwelling older adults from Germany. N = 284 NSAIDs users aged 65-89 years. All currently regularly or as-needed used drugs were recorded during a home visit. Multivariate logistic regression models were applied to assess the potential determinants of potentially inappropriate NSAIDs use. Prevalence of potentially inappropriate NSAIDs use was 54.2%, 45.4%, 29.9%, 20.4%, and 3.5% when applying the STOPP, 2019 Beers, EU(7)-PIM, FORTA, and PRISCUS list, respectively. No study participant was identified as a potentially inappropriate NSAIDs user by all five lists simultaneously. The majority (68%) were identified only by one or two lists. Merely the STOPP and Beers criteria had a moderate inter-instrument agreement. Lower pain severity, gout, peptic ulcer (PU), cardiovascular disease (CVD), and chronic kidney disease (CKD) were statistically significantly associated with potentially inappropriate NSAIDs use defined by the STOPP criteria and the latter three conditions also with the 2019 Beers criteria. The STOPP and Beers criteria may be superior to the other lists because they more frequently identify potentially inappropriate NSAIDs use in conditions implying a high risk for NSAIDs' adverse events (i.e., PUD, CKD and CVD). We developed a harmonized, country-independent PIM list for NSAIDs with the same advantages as observed for the STOOP and 2019 Beers criteria and recommended its use.