Vancomycin utilization review in patients undergoing bone marrow transplantation

Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus [MRSA]. In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation [BMT] patients. In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation [56.9%, 43.1%]. About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network [NCCN] guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0 +/- 11.9 microg/mL. Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug

Evaluation of community pharmacists' knowledge, attitude and practice towards good pharmacy practice in Iran

The principles of pharmaceutical care are embedded in the concept of Good Pharmacy Practice [GPP]. GPP is poorly applied in community pharmacies not only in Asian countries, but even in United States and Europe. The present study was undertaken to evaluate the knowledge, attitude and practice of the community pharmacists in Iran, regarding GPP. A total of 794 pharmacists were evaluated with a reliable and validated KAP [Knowledge, Attitude, and Practice] questionnaire regarding GPP in September 2008. The most important finding in the present study was the pharmacists' low knowledge [Mean= 13.42] and practice [Mean= 29.85] level about GPP, while their attitude towards this subject was at a high level [Mean= 74.83]. Increase in their knowledge of good pharmacy practice aligned with an increase in their attitudes towards this issue. Also increase in our pharmacists' knowledge and attitude aligned with an increase in quality of their practice. The current practice of Iranian community pharmacists needs further improvement. National pharmaceutical organizations should organize educational programs for the community pharmacists to equip them for their main role in community practice: promoting rational drug use.

Penicillin allergy and cross-reactivity with other beta-lactams

Beta-lactams are a group of antibiotics with a broad spectrum of both Gram-negative and Gram-positive coverage. The goal of this study is to evaluate the results from studies regarding Ig-E mediated hypersensitivity to Penicillin and cross-reactivity with other beta-lactams. Review was conducted of both retrospective and prospective studies by searching in PubMed and Medline for the original and systematic review articles by using the keywords: penicillin allergy, beta-lactams and cross-reactivity. The rate of true Penicillin allergy is about 10% of reported cases by the patients. The rate of Ig-E mediated cross-reactivity between Penicillin and Cephalosporins is less than 10% for the first and second generations and less than 5% for the third and fourth generations. According to the reviewed studies, Imipenem has between 9.2% to 25.6% cross-reactivity with Penicillin. Recent studies have shown safe use of Meropenem in patients with penicillin allergy even with positive skin test. The only member of Monobactam family, Aztreonam, has no cross-reactivity with any of Penicillins, Cephalosporins [with the exception of Ceftazidime] and Carbapenems. Due to the low rate of true Penicillin allergy, the patient's self report of this adverse reaction must be justified carefully before avoiding beta-lactams. Even in the cases of true penicillin allergy, Meropenem appears to be safe, if indicated. There are also a few case reports regarding hypersensitivities to Clavulanate itself and also its cross-reactivity with Penicillin.

Evaluation and monitoring of isotretinoin use in Iran

Isotretinoin [13-cis retinoic acid] is used for treatment of nodular cystic acne unresponsive to conventional therapy. It is an expensive, potent teratogenic drug with serious adverse drug reaction [ADRs]. Recently, use of this drug has increased in Iran. To date, there are no published data about the use of isotretinoin in Iran; therefore, this study aims to assess its use in this country. This was a prospective, drug utilization evaluation [DUE] study conducted in an institutional community pharmacy affiliated with Tehran University of Medical Sciences [TUMS]. Drug prescription, administration, and evaluation of appropriateness were recorded and compared with standard protocols. Collected data were analyzed by SPSS software. A total of 274 outpatients treated with isotretinoin enrolled in the study. Of these, 51.3% were prescribed isotretinoin under the usual recommended daily doses of 0.5mg/kg/day. Data also indicated that 33.5% of the patients were given total doses of less than 100 mg/kg [72.4 +/- 17.2 mg/kg] and 12.2% received more than 150 mg/kg. With regards to the teratogenic effects of isotretinoin, only 6.8% of couples simultaneously used two methods of contraception [P = 0.001]. In addition, we detected improper use of isotretinoin for mild and moderate acne in about 20% of cases. The most important finding of this study is that the doses of isotretinoin are incorrect in many cases. Incorrect dosages would decrease drug efficacy and increase the risk of relapse. In addition, patients have not been adequately counseled about isotretinoin's teratogenicity and the seriousness of its adverse effects

Knowledge, attitudes and practice of nurses regarding adverse drug reaction reporting

Adverse drug reactions [ADR] are ranked as some of the major causes of patient morbidity and mortality. Spontaneous reporting of ADRs has remained the cornerstone of pharmacovigilance and is important in maintaining patient safety. This study was conducted to assess the nurses' knowledge and attitude towards pharmacovigilance, reasons for not reporting ADRs, and their pharmacovigilance practice. A questionnaire was prepared to investigate knowledge, attitude and practice [KAP] of nurses regarding ADR reporting. In November 2009, the questionnaires were given to 500 nurses of a teaching hospital in Tehran. Knowledge and practice of participants were not satisfying; however, their attitude towards pharmacovigilance was at a high level. About 91% of the nurses had never reported an ADR. Most nurses liked to report the ADRs to the physicians [87.1%] and pharmacists in hospital's ADR center [1.8%] rather than the ADR National Center. The main cause of under-reporting of the suspected ADRs was unawareness about the existence of such a national center. Among nurses who had reported ADR for at least once, the majority preferred using phone [10 out of 50] or Yellow Cards [7 out of 50]. Only 1 person out of 50 preferred using internet for submitting the reports. Since the nurses in this study had little knowledge and poor practice regarding the pharmacovigilance and spontaneous reporting system, interventions such as holding pharmacovigilance workshops in the hospitals focusing on the aims of pharmacovigilance, completing the Yellow Card and clarifying the reporting criteria are strongly recommended.