Prevalence Of Prescriptions Research Articles

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

ObjectivesThere are limited data on factors influencing antibiotic prescription among insured patients. We assessed for correlates of an antibiotic prescription among insured patients.DesignA cross-sectional study.SettingThe study was conducted at the...

Utilization of Drugs with Pharmacogenetic Dosing Recommendations in Switzerland: A Descriptive Study Using the Helsana Database.

In Switzerland 167 drugs on the market contain information about pharmacogenetics in their drug label (PGx drug). Preemptive pharmacogenetic testing is reimbursed by health care insurance for only seven drugs (abacavir, carbamazepine, 6-mercaptopurine, azathioprine, 5-fluorouracil, capecitabine, and irinotecan) although, it is proposed to be a cost-effective approach to personalized medicine. The aim of this study was to describe the use of PGx drugs and their corresponding genes in Switzerland. We identified 90 drugs with dosing recommendations from the Pharmacogenetic Knowledgebase involving 24 genes. We assessed the utilization of those drugs between 2016 and 2020, using claims data from a large Swiss insurance company (Helsana). Of 841 491 persons with drug claims during the whole study period, 78.7% were exposed to PGx drugs. Ibuprofen, pantoprazole, and tramadol had the highest number of users. Seven genes (CYP2C19, CYP2C9, CYP2D6, SLCO1B1, HLA-B, MT-RNR1, and VKORC1) were responsible for over 95% of all potential drug-gene interactions. The prevalence of PGx drug prescriptions is high in the Swiss population. Therefore, intensified preemptive testing may be a useful option as a substantial amount of the Swiss population might benefit.

Evaluation of the Clinical Outcome and Cost Analysis of Antibiotics in the Treatment of Acute Respiratory Tract Infections in the Emergency Department in Saudi Arabia.

This study aims to assess the prevalence and antibiotic-treatment patterns of respiratory tract infections (RTIs), prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use among emergency department (ED) patients. A cross-sectional study was conducted at the ED in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patient characteristics (age, sex, weight, allergies, diagnostic tests (CX-Ray), cultures, microorganism types, and prescription characteristics) were studied. During the study, 3185 cases were diagnosed with RTIs: adults (>15 years) 55% and pediatrics (<15 years) 44%. The overall prevalence of RTIs was 21%, differentiated by upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI) (URTI 13.4%; LRTI 8.4%), of total visits. Three main antibiotics (ATB) categories were prescribed in both age groups: penicillin (pediatrics 43%; adults 26%), cephalosporin (pediatrics 29%; adults 19%), and macrolide (pediatrics 26%; adults 38%). The prevalence of inappropriate ATB prescriptions was 53% (pediatrics 35%; adults 67%). Errors in ATB included selection (3.3%), dosage (22%), frequency (3%), and duration (32%). There is a compelling need to create antimicrobial stewardship (AMS) programs to improve antibiotic use due to the high number of prescriptions in the ED deemed as inappropriate. This will help to prevent unwanted consequences on the patients and the community associated with antibiotic use.

Women of childbearing age: What antiseizure medications are they taking?

Women of childbearing age: What antiseizure medications are they taking?

Prevalence of Antimicrobial Prescribing in Long-Term Care Facilities in a Local Health Authority of Northern Italy.

Background: Almost half of antimicrobial prescriptions in long-term care facilities (LTCFs) is inappropriate. This broad use might represent a strong contributor to antimicrobial resistance in these facilities. This study aimed to assess antibiotic use patterns and potential associated factors with a survey of LTCFs in the local health authority (LHA) of Novara. Methods: A cross-sectional study was conducted in 25 LTCFs in the LHA of Novara following the healthcare-associated infection in LCTFs (HALT) protocol. Information on residents and facilities was assessed. Antibiotic usage and potential determinants were also estimated. Results: In total, 1137 patients were screened for antibiotic usage. Mean age was 84.58 years (SD 9.77), and the majority were female (76.52%). Twenty-six were antibiotic users (prevalence rate 2.29%, 95%CI 1.50–3.33). Antimicrobials were mainly prescribed orally (84.62%). Potential risk factors for antibiotic prescription were catheter use (central and peripheral venous, p-values 0.0475 and 0.0034, respectively, and urinary, p-value 0.0008), immobilization (p-value < 0.0001), and sex (p-value 0.0486). Conclusions: This study identified a low prevalence of antimicrobic consumption in LTCFs. Further surveillance studies are warranted to identify trends and changes in pathogen incidence and antimicrobial resistance and to inform public health authorities on the necessity of prudent use of antimicrobials in LCTFs.

Prescription appropriateness of anticoagulant drugs for prophylaxis of venous thromboembolism in hospitalized multimorbid older patients.

The aims were to assess: the prescription prevalence of anticoagulant drugs for thromboprophylaxis (TP) in hospitalized older patients; the appropriateness of their prescription or non-prescription; the in-hospital mortality in appropriately versus non-appropriately prescribed or not prescribed patients. 4836 patients aged 65 or older, admitted to the Italian internal medicine and geriatric wards participating to the REPOSI register from 2012 to 2019 were assessed for prescription of anticoagulant drugs for TP at admission and/or during hospital stay. The Padua Prediction Score (PPS) and the IMPROVE score were used to assess the thrombotic and bleeding risk. Patients were considered to be appropriately prescribed when had PPS ≥ 4 and IMPROVE < 7, and appropriately not prescribed when PPS < 4. Logistic regression model was used to assess whether appropriateness was associated with in-hospital mortality. Among 4836 patients included, anticoagulants were prescribed for TP in 1233 (25.5%). In all, 4461 patients were assessable for appropriateness: 3136 (70.3%) were appropriately prescribed or non-prescribed according to their thrombotic and bleeding risk. Among 1138 patients receiving prophylaxis, only 360 (31.7%) were appropriately prescribed, while among 3323 non-prescribed patients, 2776 (83.5%) were appropriately non-prescribed. The in-hospital mortality rate was lower in patients appropriately prescribed or non-prescribed than in those inappropriately prescribed or non-prescribed (OR: 0.63; 95% CI: 0.46-0.83). In conclusion, a high prevalence of multimorbid hospitalized patients were appropriately prescribed or non-prescribed for TP with anticoagulants, appropriate non-prescription being mainly driven by a high bleeding risk. The appropriateness of prescription or non-prescription was associated with lower in-hospital mortality.

Benzodiazepines and Related Drugs in Orthopaedics.

Benzodiazepines are among the most commonly prescribed drugs worldwide and are often used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants. The risk of dependence on and abuse of these medications has recently gained more attention in light of the current opioid epidemic. Benzodiazepines can increase the risk of prolonged opioid use and abuse. Given the prevalence of the use of benzodiazepines and related drugs, orthopaedic patients are often prescribed these medications. Orthopaedic surgeons need to be aware of the prevalence of benzodiazepine and related drug prescriptions in the general population, their current uses in orthopaedic surgery, and the risks and adverse effects of their use.

ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010-2019.

ContextADHD is the most common mental disorder in school-aged children. In France, methylphenidate is the only drug authorized for ADHD. Here, we describe the pattern of ADHD diagnosis and methylphenidate prescription to children and adolescents from 2010 to 2019.MethodsWe conducted a retrospective cohort study of all beneficiaries of the French general health insurance scheme (87% of the population, 58 million people). We extracted information for all children and adolescents aged 0–17 years who received: (1) A diagnosis of ADHD (34,153 patients). (2) At least one methylphenidate prescription (144,509 patients). We analyzed the clinical, demographic, institutional, and social parameters associated with ADHD diagnosis and methylphenidate consumption in France.ResultsThe ADHD diagnosis among children and adolescents increased by 96% between 2010 and 2019. ADHD diagnosis affects more boys than girls. About 50.6% of children hospitalized with a diagnosis of ADHD in 2017 also had another psychiatric diagnosis. The rate of children hospitalized with an ADHD diagnosis and treated with MPH varied between 56.4 and 60.1%. The median duration of MPH treatment for a 6-year-old ADHD child initiated in 2011 is 7.1 years. In 2018, 62% of ADHD children were receiving at least one psychotropic medication. Between 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription reached between 0.61 and 0.75% in 2019. Boys are predominantly medicated. The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. Diagnoses associated with methylphenidate prescription did not always correspond to the marketing authorization. Among children receiving the first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. A quarter of initiations and half of renewals were made outside governmental recommendations. Educational and psychotherapeutic follow-up decreased from 4.1% in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class were more likely to be diagnosed (55%) and prescribed methylphenidate (54%). Children from disadvantaged families had an increased risk of ADHD diagnosis (41.4% in 2019) and methylphenidate medication (25.7% in 2019).

Les psychotropes en pédopsychiatrie et leur prescription hors AMM : une étude transversale en population clinique tunisienne

ObjectiveAll drug prescriptions must comply with drug approval specifications. Nonetheless, off-label prescribing is often justifiable especially in pediatric patients. Our aim was to determine the rate of psychotropic prescriptions in child and adolescent psychiatry as well as the frequency of off-label prescribing and to evaluate the prescriptions’ abidance by the standards of good practice. Patients and methodA descriptive retrospective cross-sectional study on in-coming patients at the Department of Child and Adolescent Psychiatry at the teaching Mongi Slim Hospital in Tunis, during the year 2018 over twelve-month period, having been prescribed psychotropic medication. Sociodemographic and clinical data were collected from medical records. Conformity to drug approval specifications was assessed using the list of approved drugs provided by the Administration of Pharmacy and Medication of the Tunisian Ministry of Health. Results and discussionThe clinical sample included 106 patients having received psychotropic medication, representing a rate of psychotropic prescription of 13% among all new patients at the child and adolescent psychiatry department during the period between 1st January and 31 December 2018. Mean age was 11 [±3.7] years. Sex ratio was 1.3. Off-label prescribing rate was 60.6% due to non-abidance of standards of indication in 60% of cases, recommended dose in 35.4% of cases and recommended age in 13.7% of cases. Prevalence of off-label prescribing was significantly higher in adolescents than in children (P=0.001). The two most frequently off-label prescribed drugs were hydroxyzine and sertraline. ConclusionThe contrast between low psychotropic prescribing and high off-label prescribing rates highlights the need for conducting prospective studies in order to better evaluate the effectiveness and safety of drugs in child and adolescent psychiatry, and more importantly, to document off-label prescribing.

Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study.

Recent studies on the prescribing of hormone replacement therapy (HRT) medicines to treat symptoms of menopause are lacking. To describe the prescribing of HRT in a cohort of UK menopausal women. Population-based drug utilisation study using IQVIA Medical Research Database (IMRD-UK). Primary care data of women with recorded menopause and/or aged ≥50 years between January 2010 and November 2021 were extracted from the database. The incidence rate of women who received their first prescription for HRT was calculated annually using person-years-at-risk (PYAR) as the denominator. Incidence rates of HRT were estimated by type and route of administration. Relative changes in annual incidence rates were expressed as percentages and the average percentage change was assessed using linear regression. Annual prescribing prevalence per 100 women was calculated using mid-year menopausal population estimates. The incidence rate of prescribing of HRT increased from 5.01 in 2010 to 18.16 per 1000 PYAR in 2021, a relative increase of 13.64% (95% confidence interval [CI] = 6.97 to 20.30) per year. The incidence rate of fixed combinations of HRT increased from 3.33 to 12.23 per 1000 PYAR in 2010 and 2021, respectively. Transdermal formulations of HRT increased from 1.48 to 14.55 per 1000 PYAR in 2010 and 2021, respectively. The overall proportion of women in receipt of a prescription for HRT changed from 7.89% in 2010 to 6.86% in 2020. This study shows a steady increase in the number of women receiving their first prescription for HRT during the study period, which suggests regained acceptance of HRT medicines.

The Pattern of Antimicrobial Prescription at a Tertiary Health Center in Egypt: A Point Survey and Implications

The misuse of antimicrobials has major consequences, particularly antimicrobial resistance (AMR) and antimicrobials' related adverse effects. So, the WHO proposed antimicrobial surveillance to improve antimicrobials use. This point prevalence survey (PPS) was conducted to illustrate the prevalence of antimicrobial use at Mansoura University hospitals (MUH), Egypt. The survey process used was adapted from the European survey of antimicrobial resistance with modifications. The survey was conducted from 8 AM to 8 PM daily within 2 weeks. A total of 300 patients received antimicrobials and the prevalence rate of antimicrobial prescription was 79.15%. The major indications of antimicrobials were surgical prophylaxis followed by the treatment of community-acquired infection. The most commonly prescribed initial antimicrobial group was Aminopenicillin ± β-lactamase inhibitors. Although the purpose for antimicrobial administration was recorded in all cases, the stop/review history was recorded only in 19.6% and local guidelines were not available for 77.6% of antimicrobial prescriptions. The use of combined antimicrobials was common (46.6%), particularly in orthopedic and cardiothoracic surgery. The prevalence of antimicrobial prescription at MUH was high which requires serious actions including reviewing the antimicrobial indication, implementing local prescription guidelines, initiating an antimicrobial stewardship program (ASP), and optimizing infection control measures.

S842 Opioid Dependence and Over-Prescription of Opioids in Patients With Co-Existing IBD and IBS

Introduction: Opioids are commonly prescribed to control pain for patients with inflammatory bowel disease (IBD). However, the wide use of narcotics raised concerns for possible opioid dependence and related mortality. IBD patients with co-existing irritable bowel syndrome (IBS) are more likely to complain about abdominal pain. The goal of the study was to determine the prevalence of opioid prescription and opioid dependence in patients with coexisting IBD and IBS, and to compare with IBD patients without IBS. Methods: A retrospective cohort analysis was performed using IBM Explorys (1999-2022), which contained deidentified patient information from more than 300 hospitals in the US. We selected patients with a diagnosis with IBD and IBS (IBD+IBS). The control group consist of patients with IBD without IBS (IBD). We collected information regarding opioid prescriptions and diagnosis of opioid dependence. Categorical data was presented as number of patients and percentage. Odd ratios (OR) with 95% confidence interval were used to compare the cohorts. Results: We identified a total of 38,650 patients with co-existing IBD and IBS and 327,770 patients with IBD without IBS (Table). 83.2% of patients in the IBD+IBS group and 62.6% of patients in the control group have been prescribed opioids (OR [2.87-3.03], p< 0.0001). Opioids were more commonly prescribed in the IBD+IBS cohort including morphine (48.5 vs 29.1%), Hydromorphone (44.7 vs 24.8%), Oxycodone (46.0 vs 27.2%) and Hydrocodone (58.4 vs 35.7%). Opioid dependence was also more common in the IBD+IBS group (4.8% vs 1.6%, OR [2.99-3.33], p< 0.0001). Conclusion: Patients with overlapping IBD and IBS are prescribed opiates more often than patients with IBD alone, and the former are more likely to be diagnosed with opioid dependence. Appropriate use of therapies approved for IBS, in conjunction with treatment of IBD may help reduce opiate use in this population. Table 1. - Opioid prescription and opioid dependence in patients with IBD+IBS and IBD alone IBD+IBS (N=38650) % IBD alone (N=327770) % OR 95% CI P Opioid dependence 1840 4.8% 5110 1.6% 3.16 2.99-3.33 < 0.0001 Opiate 32140 83.2% 205290 62.6% 2.95 2.87-3.03 < 0.0001 Morphine 18760 48.5% 95410 29.1% 2.30 2.25-2.35 < 0.0001 Hydromorphone 17260 44.7% 81420 24.8% 2.44 2.39-2.49 < 0.0001 Oxycodone 17780 46.0% 89210 27.2% 2.28 2.23-2.33 < 0.0001 Hydrocodone 22590 58.4% 117110 35.7% 2.53 2.48-2.59 < 0.0001

Antidepressant use and off-label prescribing in primary care in Spain (2013–2018)

IntroductionRecent studies show an increase in the use of antidepressants in minors (younger than 18 years), although few antidepressants are indicated for this age group. The aim of our study was to calculate the annual prevalence of antidepressant use in children and adolescents and to review the adherence of prescription to current indications. MethodsStudy of the prevalence of antidepressant use in minors based on the records of the Electronic Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP) of Spain for the 2013–2018 period, considering at least one prescription per year for each patient. ResultsThe prevalence of antidepressant prescription in patients from the BIFAP cohort increased between 2013 (7.97 prescriptions per 1000 patients) and 2018 (8.87 prescriptions per 1000 patients), in most groups and in both sexes. In this period, female patients received the most prescriptions, surpassing prescriptions in male patients by up to 2.5 points in the overall rates. In patients younger than 13 years, this trend was inverted and antidepressant use was higher in male patients. The prevalence of prescription rose with increasing patient age, as did the proportion of off-label prescriptions. The use of off-label medication decreased over time. ConclusionsThere was a gradual increase in the prevalence of antidepressant prescription in minors younger than 18 years, with a predominance of the female sex. The high proportion of unapproved medication use in this age group calls for more thorough investigation of the risk-benefit balance of these treatments and of safer treatment alternatives.

Medicinal Treatment of Elderly Psoriasis Patients before and after Entering a Nursing Home

Psoriasis (PS) is a chronic inflammatory skin disease, and it increasingly appears also in the elderly population. There is a rising interest in drug therapy for PS, especially for people receiving care in nursing homes (NH). Which PS-related drugs are prescribed in the time before nursing home admission (NHA), and to what extent does the supply of drugs change after NHA? Which specialties prescribe PS-related drugs? Statutory health insurance data were examined for people with PS, aged ≥ 65 years, who were newly admitted to a NH in the period 2011–2014 and observed for one year before and after NHA. Changes in prescription prevalence (pre-post comparison) were examined for significant differences. Prescriptions of PS-relevant drugs were measured by defined daily dose and stratified according to the prescribing specialist group. The analysis included 718 insured persons with PS (76.2% female, mean age 83.3 years). Systemic therapeutics played a minor role (pre: 2.6% vs. post: 2.1%) in drug therapy. Topical steroids had a high share of about 40% in the pre–post comparison. Overall, the proportion of people with PS who received treatment remained at a comparable level before and after NHA. A structured assessment of the skin is crucial, specifically in people with cognitive impairment.

Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Multimorbidity, polypharmacy and inappropriate prescribing in elderly patients with atrial fibrillation: A report from the China Atrial Fibrillation Registry Study

BackgroundMultimorbidity, polypharmacy and inappropriate prescribing is common in elderly patients worldwide. We aimed to explore the current status of multimorbidity, polypharmacy and the appropriateness of pharmacological therapy among elderly patients with atrial fibrillation (AF) in China.Materials and methodsWe randomly selected 500 patients aged 65 years or older from the China AF Registry study. Multimorbidity was defined as ≥2 comorbidities and polypharmacy was defined as ≥5 long-term prescribed drugs. Appropriateness of prescribing was evaluated using the Screening Tool of Older People’s Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 2. Patients’ attitudes toward polypharmacy were evaluated by the Patients’ Attitudes Towards Deprescribing (PATD) questionnaire.ResultsAmong the 500 patients included (mean age 75.2 ± 6.7 years, 49.0% male), 98.0% had multimorbidity and 49.4% had polypharmacy. The prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was 43.6% (n = 218) and 71.6% (n = 358), respectively. Traditional Chinese medicine attributed largely to PIMs. Anticoagulants were the most common PPOs. Many clinical factors increased the risk of PIMs and PPOs. However, polypharmacy increased the risk of PIMs (OR 2.70, 95%CI 1.78–4.11; p < 0.0001), but not PPOs. In addition, 73.7% patients with polypharmacy were willing to have one or more of their medications prescribed if advised by their doctor.ConclusionMultimorbidity and polypharmacy were highly prevalent in elderly patients with AF in China. A high prevalence of inappropriate prescribing was also observed. Therefore, much more attention should be paid to the serious health problem in the elderly population.

Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda.

ObjectivesTo describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda.MethodsWe surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019–20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels.ResultsAntibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2–59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91–9.72) were significant contextual determinants of antibiotic prescribing.ConclusionsWe demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients.

Potentially inappropriate medications according to PRISCUS list and FORTA (Fit fOR The Aged) classification in geriatric psychiatry: a cross-sectional study

Adverse drug reactions (ADRs) constitute a frequent cause of hospitalization in older people. The risk of ADRs is increased by the prescription of potentially inappropriate medications for older people (PIMs). The PRISCUS list and the FORTA classification represent established tools to detect PIMs. The aim of the present study was to examine the prevalence and characteristics of PIM prescriptions on the gerontopsychiatric ward of a university hospital in Germany. To this aim, medication charts of 92 patients (mean age 75.9 ± 7.7 years; 66.3% female) were analyzed on a weekly basis until patient discharge by utilization of the PRISCUS list and the FORTA classification. Overall, 335 medication reviews comprising 2363 drug prescriptions were analyzed. 3.0% of the prescribed drugs were PIMs according to the PRISCUS list, with benzodiazepines and Z-drugs accounting for nearly half (49.3%) of all PIM prescriptions. 30.4% of the patients were prescribed at least one PRISCUS-PIM, while 43.5% of the study population took at least one FORTA class D drug. A considerable proportion of gerontopsychiatric patients were affected by PIMs; however, the overall number of PIM prescriptions in the study population was low. Further improvements in the quality of prescribing should target the use of sedating agents such as benzodiazepines and Z-drugs. Physicians should be aware of discrepancies between the PRISCUS list and the FORTA classification.

Use of antibiotics in patients who were attacked by animals that can transmit rabies.

Animal bites have a high probability of becoming infected. In high-risk wounds, the use of antibiotics that kill the associated microorganisms is recommended. The aim of this study was to determine the use of inappropriate antibiotics in patients in different regions of Colombia who were attacked in 2020 by animals that can transmit rabies. This was a retrospective follow-up study of a cohort of patients with wounds caused by animals; the patients were affiliated with the Colombian Health System. Sociodemographic, clinical and pharmacological data were collected. A total of 280 patients were analysed. The median age was 28.0 years, and 52.1% were men. The attacks were attributed to dogs (85.0%) and cats (15.0%), and 9.6% were classified as severe exposure. Antibiotics were used in 71.1% of cases for prophylaxis and in 4.3% of the cases for the treatment of superinfection; cephalexin (37.5%), amoxicillin/clavulanic acid (15.7%) and dicloxacillin (10.4%) were the predominant antibiotics used. A total of 72.0% of patients who received antibiotics received inadequate prescriptions, and 49.2% had no indication to receive prophylaxis. Being treated in the Caribbean region (OR: 4.09; 95% CI: 1.79-9.30) and receiving analgesics (OR: 3.15; 95% CI: 1.25-7.94) were associated with a greater probability of being prescribed antibiotics inadequately; attacks resulting in severe exposure were associated with a lower probability (OR: 0.40; 95% CI: 0.16-0.98). A significant proportion of patients had no indication for prophylactic antibiotics or was prescribed antibiotics not recommended by clinical practice guidelines. There was a low prevalence of prescriptions for amoxicillin/clavulanic acid, the most recommended antibiotic.

Anti-asthmatic prescriptions in children with and without congenital anomalies: a European data linkage study.

ObjectivesAsthma is the most common chronic disease in childhood, yet little is known about rates of asthma and wheezing in children with congenital anomalies. This study explored the prevalence and risk of receiving anti-asthmatic prescriptions in children with congenital anomalies compared to children without anomalies in six European regions/countries. ApproachThis was a EUROlinkCAT population-based linkage cohort study involving children from 0-9 years of age born between 2000-2014. Congenital anomaly data from six EUROCAT registries were linked to births data in national/vital statistics and to electronic prescription databases. Prescription/pharmacy dispensing records across regions were standardised to a Common Data Model. Anatomical Therapeutic Chemical classification codes beginning with R03 were used to identify anti-asthmatic prescriptions. Random-effects meta-analyses were performed to identify both the relative risk (RR) of receiving &gt;1 anti-asthmatic prescription in a year relative to the reference group, and the heterogeneity of prevalence rates across registries and age group. ResultsA total of 5.1% of children with congenital anomalies and 4.9% of reference children were dropped from the study as they were not linked. Children with congenital anomalies (n=60,662) had a higher prevalence of &gt;1 anti-asthmatic prescription and a significantly higher risk of being prescribed anti-asthmatics (RR=1.41, 95% CI 1.35-1.48) compared to reference children (n=1,722,912). The increased risk was consistent across all age groups. Children with congenital anomalies were more likely to be prescribed beta-2 agonists (RR=1.71, 95% CI 1.60-1.83) and inhaled corticosteroids (RR=1.74, 95% CI 1.61-1.87). Children with oesophageal atresia, diaphragmatic hernia, genetic syndromes and chromosomal anomalies had over twice the risk of being prescribed anti-asthmatics compared to reference children. Regional differences in prevalence and risk of anti-asthmatic prescriptions were identified. ConclusionChildren aged &lt;10 years with congenital anomalies consistently had higher prevalence and risk of receiving &gt;1 anti-asthmatic prescription across age group and across European regions. This study demonstrates that information on the prevalence of anti-asthmatic prescriptions issued/dispensed can be obtained through data linkage to monitor changes in prevalence over time.