Incomplete Regimen Research Articles

1568. Evaluating the Appropriateness of Antiretroviral Therapy in the Critical Care Setting

Abstract Background The care of patients with HIV in the intensive care unit (ICU) can be complex as they may develop acute kidney injury and therefore necessitating continuous renal replacement therapy, need feeding tubes, and are prescribed new medications. Issues regarding drug-drug interactions, fluctuating renal & hepatic function, adverse effects, oral administration issues including crushing of tablets are challenges that may arise. The purpose of this study was to evaluate the appropriateness of antiretroviral (ARV) therapy in the ICU. Background - HIV and ICUs In 2018, almost half of Americans living with HIV were aged 50 and older. Co-morbidities associated with ICU admissions include cardiovascular, renal, hepatic, and pulmonary disease. Medication errors are defined as: incorrect/incomplete regimen, incorrect dose, incorrect renal adjustment, incorrect administration, and major drug-drug interaction. Methods This was a retrospective, observational, quality improvement project that reviewed charts from January 2018 to August 2022. Adult patients that were admitted to the the ICU at Long Island Jewish Medical Center and receiving ART for HIV were included. Patients receiving ARV for indications other than HIV were excluded. Using the medical record system, data was collected: demographics, renal and hepatic dysfunction, ARV ordered (e.g., tablet formulation, combination/single tablet), completeness of treatment regimen, drug-drug interactions, feeding placement, and concomitant medications. Descriptive statistics were utilized. Results Of the 68 patients screened, 43 were included in the study. The mean age was 57 ± 13 years, 60.5% males, and majority of patients were admitted to the medical ICU (55.8%). The median CD4 count was 250 cells/μL and 37.2% of the patients had undetectable viral loads. A total of 18 patients (41.9%) required a gastric tube during their ICU stay. ID was consulted in 41.9% of the cases. Inappropriate ART was found in 46.5% of patients with drug-drug interactions, inappropriate tablet crushing, and renal dose adjustment needed being the most prevalent reasons for inappropriateness. 27 patients (62.8%) had opportunities for interventions. which included failure to re-initiate ARV sooner (n = 8), inappropriate ARV crushing (n = 8), ARV use contraindicated at time prescribed (n = 6), ARV not reconciled once stable (n = 5), and drug-drug interactions (n = 4). An intervention could have been made 5 days sooner on average. 20 patients identified with an inappropriate ART regimen and patients could have had more than one reason for inappropriateness so total 26 identified reasons for inappropriate ART Most reasons for inappropriateness were related to patient’s renal function, ART administration, and drug-drug interactions followed by incomplete regimen. The other reason for inappropriateness was that patient was not re-initiated on ART during ICU stay when it was appropriate to do so. 27 patients identified with one or more areas for improvement– these were interventions that could have been made. Most areas for improvement included earlier ARV re-initiation either to the same regimen from home PTA or a more appropriate regimen (such as a kidney or liver-sparring regimen) Other areas identified included inappropriate formulation/administration of ART, contraindications such as AKI were present at the time ART was ordered, addressing drug-drug interactions, Other = address drug-drug interactions (4), earlier initiation of new ARV regimen (patient was tx-naïve) (1), earlier initiation of adjusted ARV regimen (1), incomplete regimen (1) Conclusion The study demonstrates that there are opportunities for improvement in the care of HIV in the ICU setting. Daily assessments of ART for re-initiation, dose adjustment, appropriate administration is crucial. Disclosures All Authors: No reported disclosures

ART-related medication errors in hospitalized people with HIV in the INSTI-era: analysis from 2 health systems in South Georgia, U.S.

ABSTRACT ART-related medication errors occur at high rates in hospitalized people with HIV (PWH), but few studies included modern regimens. As such, we evaluated ART-related medication errors in hospitalized PWH in an era where use of INSTI-based regimens dominate. This multi-center, retrospective cohort included PWH at least 18 years hospitalized in South Georgia, U.S. between March 2016 and March 2018. Of those eligible for inclusion, 400 were randomly selected and included. Three hundred sixty-three inpatient ART-related medication errors occurred in 203 patients during the study period due to incorrect scheduling (44%), an incorrect or incomplete regimen (27%), and drug–drug interactions (27%). Approximately 25% of errors persisted to discharge. Medication errors were more likely to occur in patients receiving NNRTI- or PI-containing multi-tablet regimens, whereas those receiving INSTI-containing multi-tablet regimens were less likely to experience a medication error. ART-related medication errors are less likely in patients receiving INSTI-containing multi-tablet regimens. Ensuring appropriate transition of ART throughout hospitalization remains an area in need of significant improvement.

Impact of a standardized order set and medication-use process on medication error rates in sexual assault patients presenting to the emergency department for HIV nonoccupational postexposure prophylaxis.

To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP). In November 2019, a multidisciplinary group collaborated on an initiative to improve the nPEP medication-use process for SA patients presenting to the EDs within a large integrated health system. Electronic medical records of patients 13 years of age or older who presented for SA examination and were prescribed nPEP during the pre- (February 2018-August 2019) and poststandardization (February 2020-August 2021) periods were included. The primary objective was to compare the proportion of patients experiencing a medication error before and after SA/nPEP process standardization. Data regarding the following medication errors were evaluated: incomplete regimen; inappropriate/duplicative regimen; dosing, frequency, or quantity prescribed error; and initiation of nPEP without an HIV test. Two hundred six patients met criteria for inclusion. A higher proportion of patients experienced medication errors in the prestandardization group relative to the poststandardization group (46.5% vs 11.9%, P < 0.001). Fifty-five errors were observed in the prestandardization group, compared to 16 errors in the poststandardization group. The majority of errors in the prestandardization group were directly related to antiretroviral regimens, while the majority of errors in the poststandardization group involved initiation of nPEP without an HIV test. The standardization of the SA/nPEP process was associated with significantly lower medication error rates. Optimization of medication-use technology is an effective strategy in reducing medication errors.

Incomplete cisplatin regimens in chemoradiation and its effect on outcomes for locally advanced cervical cancer

ObjectiveTo identify factors associated with receipt of incomplete cisplatin during chemoradiation for locally advanced cervical cancer and its impact on outcomes.MethodsPatients with locally advanced cervical cancer treated with chemoradiation at...

Ineligible and Incomplete Cisplatin Regimens in Chemoradiation Treatment for Patients With Locally Advanced Cervical Cancer: A Population for Survival Improvement

For patients with locally advanced cervical cancer (LACC), concurrent chemoradiation (CRT) improves outcomes. However, not all patients are medically eligible and others may not undergo the prescribed number of cycles due to toxicity or noncompliance. The purpose of this study was to identify factors associated with ineligible or incomplete cisplatin regimens during CRT for LACC and its impact on outcomes.Patients with LACC treated with CRT at our institution between 2015-2020 were retrospectively identified. Patients who received no cisplatin or ≤ 4 cycles were identified as the 'incomplete' cohort and those who received 5 or 6 cycles as the 'complete' cohort. Multivariable logistic regression was conducted to examine factors associated with receipt of incomplete chemotherapy. Secondary endpoints of locoregional failure (LRF), overall survival (OS), and distant failure (DF) were evaluated in multivariable Cox and Fine-Gray models.145 patients with LACC underwent CRT with 23 (15.9%) patients in the incomplete treatment cohort (9 with no cisplatin, 14 with ≤ 4 cycles) and 122 (84.1%) patients in the complete treatment cohort. None of our cohort received any substitute chemotherapy agent instead of cisplatin. The most common reasons for receiving incomplete cisplatin treatment were comorbidities/infections (39.1%), low cell counts (26.1%), and cisplatin intolerance (13.0%). In multivariable logistic regression on receipt of incomplete chemotherapy, only ECOG 2-4 was a significant predictor as these patients were 53.6 times more likely to receive incomplete chemotherapy (OR 95% CI 5.37-534.9, P = 0.0007). Median follow-up time was 18.0 months. 2-year OS was 88.0% (95% CI 79.4-93.1%) and 2-year disease free survival was 74.5% (95% CI 64.9-81.9%). Multivariable analysis demonstrated that the incomplete treatment cohort had inferior recurrence outcomes - LRF HR 17.59 (95% CI 4.37-70.88, P < 0.0001) and DF HR 5.49 (95% CI 1.81-16.60, P = 0.01). Similarly, the incomplete treatment cohort had inferior OS (HR 7.00, 95% CI 1.56-31.41, P = 0.01).At our high-volume cancer center, approximately 1 in 6 patients with locally advanced cervical cancer who underwent definitive intent chemoradiation were cisplatin ineligible or did not receive a complete cisplatin regimen. The only factor associated with receiving an incomplete regimen was poor performance status. Furthermore, an incomplete cisplatin regimen was independently associated with markedly inferior recurrence and survival outcomes. Given that a notable proportion of patients are deemed ineligible for cisplatin chemotherapy or do not complete a standard of care regimen, this population may be a potential target for immunotherapy or novel targeted agents with more favorable toxicity profiles in order to improve survival outcomes.N.V. Kotha: None. C.W. Williamson: None. M. McHale: None. L.K. Mell: Research Grant; Merck, Astra-Zeneca. Consultant; Bayer. J.S. Mayadev: Consultant; Astra Zeneca, NRG Oncology, GOG Foundation, Varian Medical Systems; NRG Oncology Cervix Co-Chair, GOG Foundation Board.

The Bendamustine Plus Rituximab Regimen Is Active and Safe in Previously Untreated Patients with Waldenström Macroglobulinemia, a Study on Behalf of the French Innovative Leukemia Organization (FILO)

BackgroundWaldenström macroglobulinemia (WM) is a rare low-grade B-cell malignancy characterized by the infiltration of IgM-secreting lymphoplasmacytic cells in the bone marrow. There is no standard therapy for WM, but several drugs have been shown to be effective either alone or in combination. Bendamustine (B)-Rituximab (R) has been found to be effective in salvage (Tedeschi , Leukemia Lymphoma 2015) or first setting in MW (Treon, ASH2016).BR- regimen has however reported to be associated with an increase in secondary cancer and the development of secondary myelodysplastic syndrome (MDS) or acute myeloblastic leukemia (AML) in patients with previously treated non-Hodgkin lymphoma. Prolonged neutropenia after R-chemotherapy treatment of lymphoma or CLL has also been associated with an increase of MDS/AML, and a shorter interval between the occurrence of the two malignancies. However, this has not been evaluated in previously untreated WM, nor the possible relationship with secondary cytopenia to WM treatment.MethodsForty-four symptomatic previously untreated patients with WM based on the second WM Workshop recommendations for diagnostic criteria were enrolled in this retrospective multi-center study between January 2012 and January 2017 in ten French centers. MYD88L265P and CXCR4 mutations were searched using q PCR and or next generation sequencing. Del (17) p and/ or TP53 mutation were investigated for 22 patients. All patients received a BR regimen consisting of 375 mg/m2 of rituximab on day 1 and 90 mg/m2 of bendamustine on days 1 and 2, repeated every 4 weeks, with a maximum of 6 cycles. Long-term complications of BR, 6 months or more after treatment discontinuation were analyzed. PFS and OS were plotted using the log rank test and Kaplan-Meier comparison.ResultsThe median age at WM diagnosis was 69 years old (range 45-88) and the median age at initiation of therapy was 70 years old (range 46-89). The MYD88L265Pmutation was present in 24/30 (80%) of the cases. CXCR4 mutations were observed in 2/14 cases, alteration of TP53 in 1/22 cases.The median time from diagnosis to therapy was 2 months (range 0-123 months). The median serum IgM level was 3,870mg/dl (range 650-12000). The criteria for initiating BR treatment were: anemia (54%), B-symptoms (45%), hyper viscosity (25%), adenopathy and/or splenomegaly (18%), thrombocytopenia (16%), neuropathy (11%), and amyloidosis (4%). According to the IPSSMW score, 22% of patients were low risk, 35% intermediate risk, and 43% high risk. Overall 82% of patients completed the planned 6 courses.Using consensus response criteria, the ORR was 95% (CR15%, VGPR 40% PR38% MR 2%) and the major response rate (CR+VGPR+PR) 93%.Toxicities attributed to BR led to dose reduction and/ or incomplete regimen of intended therapy in 18% of patients. Their median age was 78 years old. Toxicities were related to excessive or prolonged myelosuppression in 5 patients and infection in 3.Most of the adverse events were hematological and infectious toxic effects. Grade 3-4 neutropenia occurred in 4 (11%) cases and grade 3-4 thrombocytopenia in one (3%). Minor infections developed in eight cases: three cutaneous infections, two herpes zosters, one upper respiratory tract infection, one sinusitis, and one oral-herpes. Grade 3-4 pneumonia was observed in two cases and sepsis in one.Among 38 evaluable patients for toxicities after BR therapy, 16(42%) developed one or more long-lasting cytopenias: neutropenia (34%), anemia (10%), and thrombocytopenia (8%), all grade I and II.The median duration for prolonged neutropenia, anemia, and thrombocytopenia were 6 months (range: 6-24 months), 7.5 months (range: 6-9 months) and 12 months (6-30 months), respectively.After a median observation time of 27 months (range 5-51 months) after BR-regimen, the PFS and OS were 92% and 100%, respectively. Two patients relapsed at 24 and 45 months. One patient with a history of breast cancer prior to WM treatment relapsed from this solid tumor at 23 months. None of the patients developed aggressive lymphoma or secondary MDS/AML at the last follow-up.ConclusionThe BR regimen is efficient in patients with previously untreated WM. In elderly patients, the dose of bendamustine needs to be lowered. Long-lasting cytopenia occurred in half of patients and resolved in most cases within one year after the end of treatment. Longer follow-up is needed to assess the long-term risks of BR treatment. DisclosuresLaribi:MUNDIPHARMA: Research Funding; NOVARTIS: Honoraria, Research Funding; ROCHE: Research Funding; TEVA: Research Funding; HOSPIRA: Research Funding; AMGEN: Honoraria; TAKEDA: Honoraria, Research Funding. Leblond:SERVIER: Honoraria, Membership on an entity's Board of Directors or advisory committees; GILEAD: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; JANSSEN: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Honoraria; ABBVIE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; ROCHE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; NOVARTIS: Honoraria, Membership on an entity's Board of Directors or advisory committees.

1306. Evaluation and Predictors of Antiretroviral (ART)-Related Medication Errors in Hospitalized People Living with HIV (PWLH)

BackgroundAs HIV has become a chronic condition, management of the disease and preventing resistance is paramount to improving patient outcomes. Medication errors can lead to suboptimal therapy and potential development of resistance. The purpose of this study was to identify the rate of antiretroviral (ART)-related medication errors in hospitalized people living with HIV (PWLH).MethodsThis was a multi-center, retrospective cohort study of patients diagnosed with HIV and/or AIDS based on International Classification of Diseases codes. Patients were included if they were at least 18 years old and hospitalized between March 2016 and March 2018. Patients were excluded if they were pregnant and only received intravenous zidovudine during their hospitalization. Of the patients eligible for inclusion, 400 were randomly selected and included in this study. The primary objective was to determine the rate of inpatient ART-related medication errors. Secondary objectives included the type of errors and rate of error resolution prior to discharge.ResultsA total of 203 ART-related medication errors occurred during the study period (mean 0.9 ± 1.2 errors per patient). Incorrect schedule was the most common type of error followed by incorrect or incomplete regimen. More errors occurred in male patients (P = 0.01), those known to be infected with HIV on admission (P < 0.05), and in patients with an undetectable viral load (P = 0.01). Approximately 30% of ART-related medication errors were resolved prior to discharge, of which pharmacists were responsible for 25%. Incorrect schedule, incorrect or incomplete regimen, and clinically significant drug-drug interaction (DDI) were the most common medication errors that persisted at discharge. Among resolved errors, resolution of clinically significantly DDI or incorrect/incomplete ART were the most common interventions.ConclusionART-related medication errors continue to occur in hospitalized PLWH and frequently persist at discharge. Interventions should be developed to reduce rates of ART-related medication errors on admission. Antimicrobial stewardship programs serve as an ideal platform to incorporate ART stewardship into routine activities to help minimize errors while inpatient and during transitions of care.Disclosures All authors: No reported disclosures.

Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey.

BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.

Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: an extended case-control study.

SummaryBackgroundNo study of long-term protection following killed oral cholera vaccination has been done outside of the historically cholera-endemic areas of south Asia, or has examined protection after a single-dose vaccination regimen. To address this, we examined the duration of protection of the standard two-dose regimen and an incomplete regimen of one dose up to 4 years after vaccination in Haiti.MethodsIn the setting of two-dose vaccination campaigns with a killed, bivalent, whole-cell oral cholera vaccination, we did a case-control study from October, 2012 through November, 2016. Eligible participants were required to be resident in the vaccine catchment area (Artibonite Department or Central Department) where they were recruited at the start of the study; and be eligible for the vaccination campaign (ie, aged ≥12 months, not pregnant, and living in the region at the time of the vaccine campaign). Patients with cholera had a positive stool culture and were recruited from cholera treatment centres. Community controls were matched to people with cholera by age group, time, and neighbourhood. We did adjusted matched regression analyses to calculate vaccine effectiveness and examine heterogeneity in effectiveness over time. The primary outcome was the effectiveness of one and two oral cholera doses as compared with zero doses from 2 months to 48 months after vaccination, measured by self reporting.FindingsAmong 178 people assigned to the case group and 706 people assigned to the control group, we found no evidence that two-dose effectiveness decreased during follow-up. In adjusted analyses, the average cumulative 4 year effectiveness for two doses was 76% (95% CI 59–86). In contrast, single-dose effectiveness decreased over time in a log-linear fashion, with a predicted vaccine effectiveness of 79% at the end of 12 months (95% CI 43–93), which declined to zero before the end of the second year.InterpretationIn a setting of epidemic and newly endemic cholera in Haiti, single-dose vaccination with killed, bivalent, whole-cell oral cholera vaccination provided short-term protection; however, vaccination with two doses was required for long-term protection, which lasted up to 4 years after vaccination. These results add to the evidence in support of the use of killed, bivalent, whole-cell oral cholera vaccination as part of comprehensive cholera control plans.FundingUS National Institute of Allergy and Infectious Diseases of the National Institutes of Health and the Bill & Melinda Gates Foundation.

14: ANIMAL BITE EPIDEMIOLOGY AND SURVEILLANCE FOR RABIES POST EXPOSURE PROPHYLAXIS, IRAN

Background and aims:Animal bites are a significant threat to human health because of fatality of subsequent infections such as rabies. The aim of this study was to determine the epidemiology...

Animal bite incidence in the County of Shush, Iran

ObjectiveTo determine the epidemiology of animal bites during a five-year period (2004–2008) in Shush County, Khuzestan province, southwestern Iran. MethodsIn a descriptive cross sectional study, all cases of animal bites referred to the health centers in Shush County were investigated during 2004–2008. The necessary data were recorded on the special questionnaire that contains questions about bite animal, age, sex, occupation, treatment, the bite site on the body and so forth. ResultsOut of a total of 2 283 cases that underwent the animal bites during the mentioned five years, 1 771 people (77.6%) were male and 511 (22.4%) were female. Most cases were related to age groups 10–20 (33.4%) and 20–30 (22%) years. The average incidence rate of animal bite during these years was determined as 2.82 cases per 1 000 people. The highest incidence rate was related to the year 2007 with 3 cases per 1 000 people. Animal bites in the winter (29.3%) and fall (29%) were more common. Almost 86.5% and 13.5% of the cases occurred in rural areas and urban areas, respectively. Nearly 30% and 20.4% of cases were students and farmers, respectively. A total of 2 155 (94.4%) and 86 (3.8%) bites occurred by the dog and cat, respectively. The greatest bite place on the body was in the feet (81.4%) and in the hands (13%(. During the study period, 2 162 cases (94.7%) were treated with an incomplete regimen, and 120 cases (5.3%) were treated with a complete regimen. ConclusionsBecause the cost of prevention after biting for the health system is high, so, preventive programs must be concentrated on public health instruction, particularly in villagers, students, farmers and the owners of the domestic animals.

Antiretroviral medication errors remain high but are quickly corrected among hospitalized HIV-infected adults.

Antiretroviral therapy (ART) medication errors can lead to drug resistance, treatment failure, and death. Prior research suggests that ART medication errors are on the rise in US hospitals. This analysis provides a current estimate of inpatient antiretroviral prescribing errors. Retrospective review of medication orders during the first 48 hours of hospitalization for patients with human immunodeficiency virus (HIV) infection admitted to the Johns Hopkins Hospital between 1 January and 31 December 2009. Errors were classified as (1) incomplete regimen, (2) incorrect dosage, (3) incorrect schedule, and (4) nonrecommended drug-drug combinations. Multivariable regression was used to identify factors associated with errors. A total of 702 admissions occurred in 2009. Of these, 380 had ART medications prescribed on the first day and 308 on the second day of hospitalization. A total of 145 ART medication errors in 110 admissions were identified on the first day (29%), and 22 errors were identified in 21 admissions on the second day (7%). The most common errors were incomplete regimen and incorrect dosage or schedule. Protease inhibitors accounted for the majority of dosing and scheduling errors (71%-73%). Compared with patients admitted to the HIV/AIDS service, those admitted to surgical services were at increased risk of errors (adjusted odds ratio, 3.10; 95% confidence interval, 1.18-8.18). ART medication errors are common among hospitalized HIV-infected patients on the first day of admission, but most are corrected within 48 hours. Interventions are needed to safeguard patients and prevent serious complications of ART medication errors especially during the first 24 hours of hospitalization.

Efficacy of the pentavalent rotavirus vaccine, RotaTeq® (RV5), between doses of a 3-dose series and with less than 3 doses (incomplete regimen)

Post-hoc analyses of the Rotavirus Efficacy and Safety Trial (REST) were conducted to determine whether the pentavalent rotavirus vaccine (RV5) confers early protection against rotavirus gastroenteritis (RVGE) before completion of the 3-dose regimen. To evaluate the efficacy of RV5 between doses in reducing the rates of RVGE-related hospitalizations and emergency department (ED) visits in infants who ultimately received all 3 doses of RV5/placebo, events occurring from 2 weeks after the first and second doses to receipt of the subsequent dose (Analysis A) and events occurring from 2 weeks after the first and second doses to 2 weeks after the subsequent dose (Analysis B) were analyzed. In Analysis A, RV5 reduced the rates of combined hospitalizations and ED visits for G1–G4 RVGE or RVGE regardless of serotype between doses 1 and 2 by 100% (95% confidence interval [CI]: 72–100%) or 82% (95% CI: 39–97%), respectively, and between doses 2 and 3, RV5 reduced the rates of combined hospitalizations and ED visits for G1–G4 RVGE or RVGE regardless of serotype by 91% (95% CI: 63–99%) or 84% (95% CI: 54–96%), respectively. Similar rate reductions were observed in Analysis B. These data suggest that RV5 provides a high level of protection between doses against hospitalizations and ED visits for RVGE starting as early as 14 days after the first dose.

Pattern of antibiotic usage by adult populations in the city of Benin, Nigeria

Inappropriate use of antibiotics may play a major role in the development and spread of antibiotics resistant bacteria. Against this background, questionnaires were administered for utilization of antibiotic usage among some Nigerians in Benin. There were 3435 respondents made up of 743 (21.6%) housewives, 467 (13.6%) taxi drivers, 892 (26.0%) students, 288 (8.4%) teachers, 85 (2.5%) lawyers, 741 (21.5%) traders and 219 (6.4%) others. The questionnaires revealed that 43.1% and 56.9% of the populace took full and incomplete regimens, respectively. The commonly prescribed antibiotics were ampicillin, chloramphenicol, streptomycin, and tetracycline. The least prescribed were cefotaxime, pefloxacin and ciprofloxacin while methicillin and vancomycin were not prescribed at all. There was no significant difference (p>0.05) between the mean prevalently used antibiotics. It was also found that lawyers, teachers, students took antibiotics without prescription even for unspecified ailments, which contradicts the WHO guidelines on the usage of antibiotics. Key words: Antibiotics usage, Nigerian populace.

Effect of a clinical pharmacist’s interventions on duration of antiretroviral-related errors in hospitalized patients

The effect of a clinical pharmacist's interventions on the duration of antiretroviral-related errors in hospitalized patients was studied. Between August 4, 2005, and February 4, 2006, all patients at least 18 years of age who were admitted to a 651-bed tertiary care teaching hospital and prescribed highly active antiretroviral therapy (HAART) were identified by one clinical pharmacist. If a HAART error was suspected, the pharmacist intervened with the house staff or outpatient physician to discuss and resolve the problem. The pharmacist also retrospectively identified potential HAART errors among patients with human immunodeficiency virus (HIV) admitted between January 2 and June 30, 2005. HAART errors included the following: incomplete regimen, incorrect dosage, incorrect schedule, medication-disease interaction, incorrect formulation, incorrect antiretroviral, duplication of therapy, and drug-drug interaction. The duration of each error was measured from the time of the initial incorrect order until a correct order was placed or until the patient was discharged. A total of 199 admissions for patients with an order for HAART were identified during the study periods. A total of 73 HAART errors were confirmed in 41 patients. The most common type of error was incomplete regimen. There was no significant difference in the frequency or type of prescribing when comparing the preintervention and intervention phases. The median length of time until an error was corrected, however, was significantly shorter during the intervention phase (15.5 hours) than the preintervention phase (84 hours) (p < 0.0001). The duration of prescribing errors was decreased when a clinical pharmacist monitoring patients receiving HAART intervened to resolve errors.

Reflections on current issues concerning the stability of parenteral nutrition mixtures

Reflections on current issues concerning the stability of parenteral nutrition mixtures

Self-reported zidovudine adherence among pregnant women with human immunodeficiency virus infection in four US states

Objective: Our purpose was to identify clinical and psychosocial factors associated with rates of prenatal zidovudine use and adherence among human immunodeficiency virus–infected pregnant women. Study Design: Two hundred sixty-four women completed 2 interviews between October 1996 and November 1998 at prenatal clinics in Miami, Florida; Brooklyn, New York; Connecticut; and North Carolina. Interviews took place after 24 weeks’ gestation and then between 32 weeks and delivery. Results: Prenatal zidovudine had been prescribed for 94% of the women, 37% of whom received monotherapy. Among women taking zidovudine, 20% reported incomplete adherence. In multivariate analyses having missed zidovudine doses was positively associated with prenatal illicit drug use (odds ratio, 3.49; 95% confidence interval, 1.30-9.42; P < .05) and missing prenatal vitamins (odds ratio, 2.71; 95% confidence interval, 1.30-5.67; P < .01). Conclusions: Zidovudine therapies have been successfully implemented in prenatal care settings in the United States. The success of these therapies may be limited among some patients by incomplete regimen adherence, particularly among illicit drug users. (Am J Obstet Gynecol 2001;184:1235-40.)