Rational Drug Use Research Articles

Correlation between blood concentration of roxadustat and clinical efficacy in patients with anemia of chronic kidney disease.

Roxadustat has been associated with the efficacy and safety in patients with chronic kidney disease-related anemia. However, the relationship between roxadustat blood concentration and clinical efficacy is lacking. To explore of the correlation between clinical efficacy and blood concentration of roxadustat in patients with renal anemia of chronic kidney diseases, so as to provide reference for rational clinical drug use. A total of 46 patients were selected with a diagnosis of renal anemia who were prescribed roxadustat at the department of nephrology of the First Hospital of Hebei Medical University from December 2019 to March 2020. The roxadustat blood concentration was determined at 12 weeks of treatment, according to the cumulative response rate, patients were divided into the response group and the nonresponse group, and the relationship between roxadustat blood concentration and treatment effect was analyzed. We also explored the correlation between various factors and the blood concentration. The patients in the response group had higher roxadustat blood concentrations than the nonresponse group (P < .05), and there was no correlation between blood concentration and clinical characteristics such as age, gender, and dosage (P > .05). The blood concentration of roxadustat was correlated with clinical efficacy. The higher the blood concentration, the better the clinical efficacy, meaning it might be a predictor of efficacy.

Integrated analysis for treatment scheme of sodium–glucose cotransporter 2 inhibitors in patients with diabetic kidney disease: a real-world study

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for type 2 diabetes mellitus patients with impaired renal function, but the actual situation of SGLT2i using is unclear. Therefore, in this real-world study, we analyzed the treatment scheme and clinical characteristics of SGLT2i in patients with diabetic kidney disease (DKD). We included DKD patients hospitalized in the First Affiliated Hospital of Zhengzhou University from October 2017 to March 2020. The Apriori algorithm of association rules was used to analysis treatment scheme prescribing SGLT2i and other different combinations of hypoglycemic drugs. SGLT2i was used in 781 (12.3%) of 6336 DKD patients, both number and proportion of patients using SGLT2i increased from 2017 to 2020 (1.9% to 33%). Nighty-eight percent of all DKD patients using SGLT2i were combined with other glucose-lowering agents, and insulin, metformin and alpha-glucosidase inhibitors are most commonly used in combination with hypoglycemic drugs. Multivariate analysis showed that compared with non-SGLT2i group, patients using SGLT2i were associated with younger age, higher BMI, higher HbA1c, preserved kidney function, dyslipidemia and combined with ACEI/ARB and statins. In this real-world study, use of SGLT2i in DKD patients is still low. Most patients performed younger age and in the early stages of chronic kidney disease with poor glycemic control. Clinical inertia should be overcome to fully exert the cardiorenal protective effects of SGLT2 inhibitors, with attention to rational drug use.

Antibiotic resistance of Klebsiella pneumoniae and practical significance for veterinary medicine

For successful pharmacotherapy of animals, species identification of pathogens, analysis of antibiograms and interpretation of the results, and laboratory monitoring of the mechanisms of antibiotic resistance are important. This is necessary for veterinarians to rationally select antibacterial drugs and predict their clinical effectiveness. In veterinary clinics, antimicrobial therapy requires review of therapeutic efficacy more often than other treatments.Klebsiella are widely distributed in nature. These microorganisms are often etiological factors in septicemia in cattle, birds, horses, pigs, as well as in the development of infectious diarrhea in young farm animals.The purpose of the study is to study the antimicrobial resistance of Klebsiella pneumoniae isolated from dogs and its practical significance for veterinary medicine.Materials and methods. The microorganism K. pneumoniae was isolated from wound contents in a dachshund dog. The dog was observed in the intensive care unit in the veterinary clinic.The sensitivity to antibacterial drugs was assessed by the method of diffusion of antibiotics into agar.Research results. In the period from 2021 to 2022, a total of 100 isolates were isolated from dogs with purulentinflammatory processes, among which 18% are gram-negative and 82% are gram-positive microorganisms, and the case of Klebsiella pneumoniae isolation is 1%.The isolates of Klebsiella pneumonia were characterized by resistance to aminoglycosides (gentamicin, tobramycin, amikacin), III generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime), IV cephalosporins (cefepime), penicillins (Amoxicillin/clavulanic acid), carbapenems (imipenem, meropenem, doripenem, ertapenem). ), fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin), aminoglycosides (gentamicin, amikacin, tobramycin) and a number of other antimicrobial drugs (sulfamethoxazole trimethoprim). Klebsiella was highly sensitive only to fosfomycin.When analyzing this antibiogram of Klebsiella pneumoniae, it is necessary to conduct additional laboratory studies in order to establish the minimum inhibitory concentrations of antibiotics and to study the mechanisms of resistance.Conclusion. Among strains of Klebsiella pneumoniae isolated from wound exudate in dogs, there is a spread of resistance to most antibiotics, as well as an increase in resistance to cephalosporins and carbapenems. It is necessary to carry out laboratory control of antibiotic resistance for further rational use of antibacterial drugs.

Family Medicine Residents Awareness of Rational Drug Use in Geriatric Patients and Their Need for a Web Application

The term polypharmacy is generally known as the simultaneous use of five or more medicines. An increase in polypharmacy is also observed with chronic diseases, which increases with age. The main complications of polypharmacy are medicine side effects, inappropriate medicine use, drug-drug interaction, and drug-disease interactions. Family physicians are the most effective physician group in coordinating medicine therapy, as they provide continuous, longitudinal, and comprehensive medical care to the individual. In this study, it was aimed to determine the need of an auxiliary web application regarding family medicine residents' awareness of polypharmacy side effects in geriatric population and to identify the barriers to rational drug use in their daily clinical practice. The research is a cross-sectional observational study, and all residents actively working in the Ankara City Hospital Family Medicine Clinic were planned to be included and were invited to the study. The study was conducted through survey application method under observation. It was determined that geriatric patients mostly referred to their "clinical experience" in rational drug use according to the participants. The obstacles faced by the participants in rational drug use were mostly in that of "not having enough knowledge" and "patient-centered medicine regulation to be difficult and time consuming". 75.3% of respondents (n=70) marked strongly agree and 18.3% marked agree (n=17) for the statement "I would like to have an easily accessible an artificial intelligence aided web application that I can use in my daily practice regarding polypharmacy side effects, such as drug-drug interactions, drug-chronic disease incompatibility, potentially inappropriate medicine (PIM) in the elderly" and the mean value of this proposition was determined as 4.65±0.7. This study showed that the resources used to detect polypharmacy and its complications were not used adequately and appropriately. Moreover, the study results present the need and demand for time-saving and facilitating auxiliary web applications to minimize PIM, drug-drug interaction, drug-chronic disease interaction in the elderly and to evaluate it in the light of current data to provide person-centered and comprehensive care in the clinician's practice.

Comparing the cost-effectiveness of sintilimab + pemetrexed plus platinum and pemetrexed plus platinum alone as a first-line therapy for Chinese patients with nonsquamous non-small cell lung cancer.

Pemetrexed plus platinum alone is the conventional first-line therapy for locally advanced metastatic nonsquamous non-small cell lung cancer (NSCLC) without targetable genetic aberrations. The ORIENT-11 trial revealed that sintilimab + pemetrexed plus platinum could yield more survival benefits for patients with nonsquamous NSCLC. The present study aimed to assess the cost-effectiveness of sintilimab + pemetrexed plus platinum vs. that of pemetrexed plus platinum alone as the first-line therapy for patients with nonsquamous NSCLC to inform clinically rational drug use and provide a basis for medical decision-making. A partitioned survival model was created to evaluate the cost-effectiveness of two groups from the perspective of the healthcare system in China. The clinical data for adverse event probabilities and extrapolating long-term survival originally collected in a phase III clinical trial (ORIENT-11) were retrieved. Local public databases and literature were used to acquire data on utility and cost. The heemod package in R software was used to calculate the life years (LYs), quality-adjusted LYs (QALYs), and total costs in each group to generate the incremental cost-effectiveness ratio (ICER) in the base case and to conduct deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA). Our base case analysis (BCA) revealed that sintilimab combined with pemetrexed plus platinum provided an increase of 0.86 in QALYs with an increasing cost of United State dollar (USD) $4,317.84 relative to pemetrexed plus platinum in Chinese patients with nonsquamous NSCLC who were negative for targetable genetic variations, which induced an ICER of USD $5,020.74/QALY. The ICER value was lower than the set threshold value. The results exhibited strong robustness in the sensitivity analysis. In DSA, the parameter for the overall survival (OS) curve in chemotherapy and the cost of best supportive care were the main factors that impacted the result of the ICER. The PSA indicated that sintilimab and chemotherapy combination therapy was cost-effective. This study suggests that the combination of sintilimab + pemetrexed plus platinum is cost-effective as a first-line therapy in Chinese patients with nonsquamous NSCLC who are negative for targetable genetic variations from the perspective of the healthcare system.

A Study on Prescribing Patterns of Drugs in Geriatric Patients in a Tertiary Care Hospital: A Cross-sectional Study

Abstract: Background: Rational drug use plays even more significant role in case of geriatrics as they are the majority of drug consumers compared to the rest of the population. Objectives: The main objectives of this study were to determine the prevalence of PIMs in geriatric prescriptions and to determine the association between number of PIMs prescribed with total number of drugs prescribed, number of comorbidities and age. Materials and Methods: The data of 110 patients who were all above 60 years of age were collected. And analysed and interpreted using google forms and IBM SPSS Statistics 28.0 version. In this study, prevalence of PIMs and the association between number of PIMs prescribed with total number of drugs prescribed, number of comorbidities and age will be determined. Results: Most prescriptions that is 22.7% prescriptions had 4 PIMs present. The correlation between number of drugs prescribed and number of PIMs is having medium positive correlation as R=0.570 and correlation between number of PIMs and Age is having low positive correlation as R=0.262 and correlation between number of PIMs and number of comorbidities is having medium positive correlation as R=0.317. Conclusion: The study revealed that the prescribing patterns in the hospital was irrational as there was at least one PIM present in each prescription that was studied. This study accentuates the fact that physicians and pharmacists must be made aware of guidelines or criteria like the Beers criteria to practise safer prescribing patterns in elderly. Keywords: Beers criteria, Geriatrics, Potentially inappropriate medications (PIMs), Rational drug use, Polypharmacy.

Judicial and legislative practice and related suggestions on off-label drug use in China

BackgroundOff-label drug use exists widely in medical practice and is also an area which easily triggers controversy between patients and medical institutions. Previous studies have identified the reasons why off-label drug use long exists. However, there is no multidimensional analysis on real judicial precedents about off-label drug use. This study aimed to investigate the dispute points on off-label drug use based on real cases in China, and proposed suggestions based on newly-leased Physicians Law.MethodsOur study is a retrospective study with all the 35 judicial precedents on off-label drug use extracted from China Judgments Online from 2014 to 2019. This study mainly used the methods of statistical analysis, inferential analysis, exemplification, literature summarization and comparative analysis.ResultsAccording to the analysis of the 35 precedents of jurisdictions from 11 different aspects, it can be seen that the second-instance and retrial rates of this kind of cases are high, and the disputes between patients and medical institutions are fierce. In judicial practice of off-label drug use, medical institutions are determined whether to bear civil liability according to the constituent elements of medical tort liability: the rate of medical institutions’ bearing liability for off-label drug use is not high, and medical institutions are not directly identified as infringing acts and they don’t bear tort liability. The clear provisions about off-label drug use in Law of the People’s Republic of China on Physicians which was implemented in March 2022 confirm this at the legislative level.ConclusionsBy analyzing the current judicial practice of China’s off-label drug use cases, and summarizing the dispute points between medical institution and patients, the constituent elements of tort liability, and the rules of evidence etc., suggestions are proposed to further regulate off-label drug use and promote safe and rational drug use.

Private sector antimalarial sales a decade after "test and treat": A cross-sectional study of drug shop clients in rural Uganda.

The World Health Organization has promoted "test and treat" guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing. The purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria. Most drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative. Despite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.

Decision Support System for Choosing the Best General Practitioner with Additive Ratio Assessment (ARAS) Method

A general practitioner is a medical practitioner who focuses on treating sudden or chronic illnesses, and is often considered a first-line doctor. In health services in hospitals, doctors are an important asset. Previously, the selection of the best general practitioner at Bhakti Medan Hospital was done manually, namely through an evaluation of the number of patients cured and the opinions of the nurses who worked with the doctor. However, this method is not effective enough in assessing the professionalism and quality of a doctor. However, determining the best doctor is not easy and requires many criteria, such as communication skills, ability to listen to patients, compliance with the obligations and rights of doctors and patients, rational use of drugs, and adherence to professional ethics. Therefore, a computer-based decision support system is used to assist in selecting the best doctor effectively. Decision support systems are part of a computer-based information system that is used to assist decision making within an organization or company. In this study the authors used the Additive Ratio Assessment (ARAS) method. With the ARAS method the problem of determining the best general practitioner will be easier because the ARAS method in general does a lot of ranking by comparing with other alternatives so as to get the ideal and best results. Based on the results of calculations that have been done previously, in this study it can be concluded that alternative A3 is with a value of 0.1855 on behalf of Dr. Lenny Tampubolon as the best general practitioner at Bhakti General Hospital

Drug Utilization Of Anti-Diabetic And Anti-Hypertension Drugs At Tertiary Care Teaching Hospital, Bangalore, India

Background: Hypertension is extremely prevalent in patients with diabetes. Limited data exist on utilization patterns of antihypertensive in this population are consistent with evidence-based practice guidelines.&#x0D; Objective: The present study is aimed to evaluate utilization patterns of antihypertensive agents among hypertensive diabetic patients.&#x0D; Methodology: The study was conducted in the patient pharmacy department of Bangalore.&#x0D; A prospective observational study was conducted for a period of 6 months in at Tertiary Care Teaching Hospital, Bangalore, India. We included 150 hypertensive diabetic patients with or without other comorbid conditions and patients aged below 18 years and pregnant women were excluded. All the prescribed medications along with other medications and relevant information will be noted in a customized data collection. The study patients will be followed daily until their discharge. The Micromedex, Medscape, articles and relevant references books will be used as tools to review the collected data. The prescribed medication will be checked for their existence in the hospital and also the reelevating calculation. Check for any error in prescription such as doses, frequency and route of administration and analysis.&#x0D; Result: Out of 150 patients, 50% were male and 50% were female. Maximum patients belonged to age group of 51-60 years. Chronic Kidney Disease (18%) the was the most common associated disease with hypertension and diabetes mellitus. More than half of the patients had received one antihypertensive drug (60%), followed by two (28%), three (10%) and four (2%) antihypertensive drugs. Amlodipine (CCB) was the most commonly prescribed antihypertensive drug (64%).&#x0D; Conclusion: Amlodipine and furosemide were the most frequently prescribed antihypertensive drugs. Prescription of antihypertensive drugs for some patients with compelling indications were not in congruent with JNC 8 guidelines. This study highlights some therapeutic rationality in this health center. However, targeted education of the prescription-givers and dissemination of treatment guideline could facilitate rational use of drugs and adherence to treatment guide lines.

Reporting Antimicrobial-Related Adverse Drug Events in Jordan: An Analysis from the VigiBase Database

This study aims to assess the reporting of antimicrobial-related adverse drug events (ADEs) in Jordan between 2003 and 2022. Data regarding the antimicrobial-related ADEs were extracted from the WHO's global database (VigiBase) by the Rational Drug Use and Pharmacovigilance Department at the Jordan Food and Drug Administration (JFDA). A total of 279 Individual Case Safety Reports (ICSRs) were recorded. The number of ICSRs increased from 2019 onwards (219 out of 279 cases). This increase in the reported ADEs was influenced by the actions of the JFDA, including the introduction of electronic reporting forms, updating the national pharmacovigilance guidelines, which encouraged adverse drug reactions reporting, the implementation of the AMR-national action plan, the encouragement to report due to COVID-19 vaccine, and the continuous awareness campaigns and training programs. Skin and subcutaneous tissue disorders (n = 105; 19.48%) were the most reported antimicrobial-related ADEs. The highest number of ADEs was reported for tetracyclines (n = 101; 18.74%) followed by fluoroquinolones (n = 54; 10.02%), third-generation cephalosporines (n = 48; 8.9%), and carbapenems (n = 42; 7.79%). From the top 10 consumed antibiotics, the number of ADEs in patients who consumed Watch group antibiotics (97 ADEs) was higher than those who consumed Access group antibiotics (28 ADEs). The findings highlight the need to monitor and rationalize the use of Watch antibiotics. Enhanced reporting of antimicrobial-related adverse drug reactions is needed to inform antimicrobial stewardship and improve the pharmacovigilance system in Jordan.

Prevalence of Potential Drug-Drug Interactions Among Hypertensive Pregnant Women Admitted to a Tertiary Care Hospital.

The aim is to determine the frequency of potential drug-drug interactions (pDDIs) and to analyze the clinically relevant drug interactions among hypertensive pregnant women. This was an observational, cross-sectional study conducted at a tertiary care hospital. The prescriptions of the hypertensive pregnant women admitted to the hospital from June 2021 to December 2021 were analyzed for potential drug-drug interactions using the database from Lexicomp ® Solutions android mobile application version 7.5.4(Wolters Kluwer, The Netherlands). A total of 127 patients were evaluated during the study period of 6 months, of which 70 (55.12%) had pDDIs. The total number of pDDIs was 85, of which 70 (82.35 %) were clinically relevant interactions with the majority of them having moderate severity (81.17%) followed by minor severity (17.65%) and major severity (1.18%). The most frequently interacting pDDIs were between Labetalol and Lornoxicam (42.35%), followed by Labetalol and Diclofenac (22.35%). This study highlights the high prevalence of potential drug interactions among hypertensive pregnant women and the need for rational drug use and strict vigilance in their monitoring.

Evaluation to Treatment Adherence, Rational Drug Use in Hemodialysis Patients and Predictive Factors on Dialysis Adequacy

Objective: This study aimed to evaluate treatment adherence and rational drug use in hemodialysis patients and investigate predictive factors on dialysis adequacy. Materıals and Methods: This is a cross-sectional descriptive study. The data were obtained by examining face-to-face questionnaires and patient files. The Hospitalized Patient Questionnaire and the End Stage Kidney Disease Compliance Questionnaire (ESRD-AQ) were administered to the patients. Kt/V was used for dialysis proficiency. By examining the obtained data, the variables that can be associated with the Kt/V value were investigated. Results: A total of 145 patients were included in the study. Sixty nine percent of the participants were over 51 years of age and 54.5% were male. Median Kt/V level was 1.38 (Q1=1.25; Q3=1.54). As for the medications, those with Kt∕V≥1.2 were found to be using more antihypertensive agents, folic acid, vitamin B12, and vitamin C but less levocarnitine concerning the group with Kt/V&amp;lt;1.2 (p&amp;lt;0.05). The Median Score on the End-Stage Renal Failure Adherence Questionnaire was 1150 (Q1=1050; Q3=1200). Total Adherence Score was found to be statistically significantly higher in the group with Kt/V≥1.2 (p&amp;lt;0.05). Conclusıon: It was determined that the level of treatment adherence of the patients participating in the study were considerably high. The probability of receiving adequate dialysis increased as total adherence scores increased. The knowledge level of patients on rational drug use affects adherence. In this study, folic acid, vitamin C, and levocarnitine were associated with dialysis adequacy.

Over-the-counter antibiotic dispensing: knowledge and practice of community pharmacists in the United Arab Emirates

Abstract Objectives This paper aimed to assess the knowledge and practice of community pharmacists in regard to dispensing over-the-counter (OTC) antibiotics with the aim of bringing their professional knowledge up to date and promoting best practices to optimize the use of antibiotics and slow the rise in resistance. Methods A cross-sectional descriptive study design was used to assess the knowledge and practice of community pharmacists towards OTC Antibiotic Dispensing. Participants were issued an invitation through verified and official WhatsApp and Facebook accounts of community pharmacists residing in the United Arab Emirates to fill in a validated-web-based questionnaire. The questionnaire was composed of four sections. It aimed to gather basic demographic data, and address knowledge and practice amongst pharmacists of dispensing OTC antibiotics. Data were analysed using SPSS version 26. Key findings A total number of 438 participating community pharmacists in the study completed the whole questionnaire. The average knowledge score was 68.6% with a 95% confidence interval (CI) of [66.9%, 70.2%]. The average practice score was 71.4% with a 95% confidence interval (CI) of [69.5%, 73.2%]. Conclusions It is recommended that several interventions are launched to promote improved prescribing behaviour, particularly ensuring that all pharmacies receive standardized guidelines on antibiotic use and inviting pharmacists to workshops and other training programmes dedicated to promoting rational drug use. Moreover, regulatory bodies must devise, enforce and monitor the implementation of policies governing how antibiotic prescriptions and patient consultations are managed by community pharmacists.

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Metabolic interaction between biflavonoids in Ginkgo biloba leaves and tacrolimus.

The aim of this study was to investigate the effect of biflavonoids in Ginkgo biloba leaves on tacrolimus metabolism. First, the inhibitory effects of five main biflavonoids (amentoflavone, sciadopitysin, ginkgetin, isoginkgetin, bilobetin) in G. biloba leaves on tacrolimus metabolism were investigated in vitro in human liver microsomes (HLM), and the concentration-dependent inhibition was further calculated. Then the time-dependent inhibition activities of five biflavonoids were studied and the drug interaction was studied in Sprague-Dawley (SD) rats. Finally, the molecular mechanism of inhibition was explored by molecular docking. The results of in vitro incubation in HLM showed tacrolimus metabolism was strongly inhibited by amentoflavone, ginkgetin, and bilobetin, whose IC50 value was 5.57, 3.16, and 5.03μM, respectively. The time-dependent inhibition of the three above biflavonoids at 50μM was 33.47%-50.89%. In the in vivo study in rats, the AUC0-t and Cmax of tacrolimus increased 3.8-fold and 2.5-fold after oral preadministration with amentoflavone. The molecular docking results showed that the inhibitory effect may be related to the formation of hydrogen bonds. The results showed that long-term combination of G. biloba leaves and tacrolimus may cause drug-drug interactions. This study provided theoretical and experimental basis for rational drug use in clinical practice.

Attitudes Toward Rational Drug Use and Medication Self-management Among Parents of Children with Epilepsy

Background: Epileptic seizures are controlled with antiepileptic drugs (AEDs). The purpose of using AEDs is to prevent seizures by maintaining the effective dose of one or more AEDs. Using a medication according to its prescription involving dosage and dosing times is expressed as medication adherence. Objectives: This study was performed to assess medication self-management and attitudes toward rational drug use among parents of children with epilepsy. Methods: A descriptive and cross-sectional design was used in this study. The data were collected using a data collection form, the Parental Attitude Scale for Rational Drug Use (PASRDU), and the Turkish Pediatric Epilepsy Medication Self-management Questionnaire (PEMSQ-TR). Results: The mean scores of participants (n = 192) on the PASRDU were 156.02 (standard deviation [SD] = 9.86), 133.02 (SD = 7.74), and 23 (SD = 7.58) on the total scale, accurate and conscious use subdimension, and effective and safe use subdimension, respectively. The mean scores of participants on the PEMSQ-TR were 81.38 (SD = 7.13), 42.4 (SD = 6.32), 24.3 (SD = 1.6), 11.36 (SD = 4.35), and 3.32 (SD = 1.94) on the total scale, information about epilepsy and treatment subdimension, adherence to treatment and clinic appointments subdimension, treatment-related obstacles subdimension, and treatment and social life subdimension, respectively. Parents’ educational status (F = 0.01, P &lt; 0.05), child’s age at first seizure (U = 0.026, P &lt; 0.05), frequency of seizure (U = 0.043, P &lt; 0.05), age of the child (χ2 = 0.002, P &lt; 0.05), and parents’ age (F = 0.036, P &lt; 0.05) had a significant effect on the total and subscale scores of the PASRDU and PEMSQ-TR. Conclusions: This study showed that although parents of children with epilepsy had positive attitudes toward rational drug use, their epilepsy medication self-management was relatively poor. The improvement of the understanding of medication self-management can ultimately increase adherence, which will affect the clinical outcomes and quality of life in children with epilepsy.

Artificial intelligence-supported web application design and development for reducing polypharmacy side effects and supporting rational drug use in geriatric patients.

The main complications of polypharmacy, which is known as the simultaneous use of more than five drugs, are potentially inappropriate medicines(PIMs), drug-drug, and drug-disease interaction. It is aimed to prepare an auxiliary tool to reduce the complications of polypharmacy and to support rational drug use(RDU), by evaluating the patient with age, drugs, and chronic diseases in this study. In the first phase of this study, as methodological research, an up-to-date and comprehensive auxiliary tool as a reference method was generated with a database containing interaction information of 430 most commonly used drug agents and chronic diseases in geriatrics in the light of current and valid 6 PIM criteria for geriatric patients, and medication prospectuses, relevant current articles, and guidelines. Then, an artificial intelligence(AI) supported web application was designed and developed to facilitate the practical use of the tool. Afterward, the data of a cross-sectional observational single-center study were used for the rate and time of PIM and drug interaction detection with the web application. The proposed web application is publicly available at https://fastrational.com/. While the PIM coverage rate with the proposed tool was 75.3%, the PIM coverage rate of EU(7)-PIM, US-FORTA, TIME-to-STOPP, Beers 2019, STOPP, Priscus criteria in the web application database respectively(63.5%-19.5%) from the highest to the lowest. The proposed tool includes all PIMs, drug-drug, and drug-disease interaction information detected with other criteria. A general practitioner detects interactions for a patient without the web application in 2278 s on average, while the time with the web application is decreased to 33.8 s on average, and this situation is statistically significant. In the literature and this study, the PIM criteria alone are insufficient to include actively used medicines and it shows heterogeneity. In addition, many studies showed that the biggest obstacle to drug regulation in practice is "time constraints." The proposed comprehensive auxiliary tool analyzes age, drugs, and diseases specifically for the patient 60 times faster than the manual method, and it provides quick access to the relevant references, and ultimately supports RDU for the clinician, with the first and only AI-supported web application.

A pharmacological perspective on the use of Benzylpenicillin-G in the production of veterinary medicine in Latin America

Benzylpenicillin-G (BP-G) is one of human and veterinary medicine’s most widely used antibacterial drugs. It represents a large market for the Phar­maceutical Industry, and various combinations with frail pharmacological support have been made available to veterinarians. The crystalline sodium and potassium salts of BP-G and the benzathine salt of BP-G have been incorporated into many existing preparations, arguing that higher and more prolonged concentrations are obtained. However, there are not evidence published. Notwithstanding the above, these preparations are presented as sustained-release ones and capable of achieving therapeutic concentrations. There are no pharmacokinetic bases for such combinations of BP-G deriva­tives. It is unlikely that such combinations provide better serum profiles than those offered by an adequate dose of only procaine BP-G. The incorporation of the BP-G benzathine is prohibited in many countries. In Latin America, such combinations limit the amount of procaine BP-G that should be in­jected, ideally ≥ 20 000 IU/kg of body weight every 12-24 h. Within the framework of the rational use of antimicrobial drugs in veterinary medicine advanced by the World Health Organization (WHO) and based on pharma­cological considerations, it is proposed that combinations of BP-G derivatives be restricted, allowing only BP-G procaine preparations. Also, formulations of BP-G incorporating other active principles should offer solid pharmacological support. To date, combined preparations of BP-G have shown no formal pharmacological support. Based on the information presented in this review, it is feasible to conclude that the only BP-G derivative that should be available for veterinary medicine is procaine BP-G.

Meta-analysis of the impact of pharmaceutical care on the outcome of gestational diabetes

ObjectivePharmaceutical care is based on pharmacy, effective organization, and the management of drugs and patients throughout the medication process, to promote the scientific and rational use of drugs. This study evaluated the clinical application value of pharmaceutical care in gestational diabetes mellitus through meta-analysis. MethodsUsing “gestational diabetes mellitus + pharmacist/pharmaceutical care/pharmaceutical service” as the search term, the CNKI, Wanfang, VIP, PubMed, and Wed of Science databases were searched from the establishment of the database to September 1, 2022. Quality assessment and meta-analysis were performed on the randomized controlled trial (RCTs) that met the inclusion conditions. ResultsA total of 1 092 patients were included from nine studies. The results showed that pharmaceutical care could improve the incidence of adverse drug events, medication compliance, medication deviation, satisfaction rate of blood glucose control, pregnancy-induced hypertension, polyhydramnios, premature membrane rupture, macrosomia, premature delivery, neonatal hypoglycemia, and neonatal asphyxia [(P<0.000 1)][relative risk degree (RR)=0.63, P<0.000 1], 95% confidence interval (CI) (0.52–0.76); RR=1.18, 95%CI (1.11–1.26); RR=0.65, 95%CI (0.56,0–76); RR=1.20, 95%CI (1.11–1.29); RR=0.28, 95%CI (0.17–0.44); RR=0.29, 95%CI (0.18–0.45); RR=0.24, 95%CI (0.13–0.46); RR=0.32, 95%CI (0.20–0.52); RR=0.35, 95%CI (0.24–0.52); RR=0.38, 95%CI (0.25–0.58); RR=0.36, 95%CI (0.23–0.56); RR=0.29, 95%CI (0.17–0.49), respectively]. In the pharmaceutical care group, the rate of mastery of self-management skills, the incidence of neonatal hyperbilirubinemia, and the incidence of fetal distress were all better than those in the traditional medical care group, the difference was statistically significant (0.000 01<P<=0.05) [RR=1.35, 95%CI (1.11–1.64), P<0.003; RR=0.46, 95%CI (0.22–0.93), P<0.05; RR=0.24, 95%CI (0.13–0.46), P<0.000 1]. After excluding the articles with high heterogeneity, the analysis showed that gestational diabetes women in the pharmaceutical care group had higher rates of self-management skills, cesarean section, and neonatal hyperbilirubinemia than those in the traditional medical care group; these differences were statistically significant (P<0.000 01) [RR=1.45, 95%CI (1.27–1.67); RR=0.73, 95%CI (0.64–0.84); RR=0.32, 95%CI (0.18–0.58)]. ConclusionPharmaceutical care can improve the maternal and fetal outcomes of gestational diabetes mellitus.