ABSTRACT
Abstract Background Helicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to these treatments is increasing. It is currently considered a public health problem. Aims to identify regimens used for H. pylori eradication by age group, year of treatment and geographical region of Colombia. Methods A cross-sectional study that identified regimens used H. pylori eradication in outpatient consultations over a 6-year period based on a medication dispensing database of 8.5 million people affiliated to the Colombian Health System. The appropriate regimens were those that included a proton pump inhibitor, associated with two antibiotics recommended by clinical practice guidelines (amoxicillin, clarithromycin, levofloxacin, moxifloxacin, tetracycline, doxycycline, metronidazole, tinidazole, and furazolidone). Results A total of 12,011 patients with a diagnosis of acid-peptic disease and H. pylori infection were identified, who had undergone 12,426 eradication treatment courses. Of these, 98.0% used a proton pump inhibitor (PPI), and 91.1% used amoxicillin. A total of 56.1% of the regimens were considered adequate; of these, 42.0% were a combination of PPI, amoxicillin/clarithromycin. This regimen predominated between 2015 and 2017 for all age groups. Conclusions The management of H. pylori infection in the majority of patients is heterogeneous and inconsistent with current recommendations based on evidence of antimicrobial resistance.
ABSTRACT
Abstract Introduction: Falls and bone fractures are important causes of morbidity and mortality in the elderly. Its etiology is multicausal, including inadequate prescriptions and osteoporosis. The aim was to identify the clinical and pharmacological characteristics of a group of older adults diagnosed with fractures in Colombia. Methods: Cross-sectional study that analyzed the prescriptions made one month before the fracture, during hospitalization and discharge. Patients aged 60 years and over were selected, assisted in three reference centers in Colombia. The quality of the prescriptions was analyzed using the STOPP criteria. Results: 220 pa- tients with fractures were included, with a mean age of 75.3±10.3 years and 68.2 % were women. Hip fracture was the most frequent (37.7 %) and in-hospital mortality was 2.3 %. Prescription of calcium/vitamin D supplements and antiabsortive therapy at discharge was 23.7 % and 12.1 %, respectively. Prescriptions potentially inappropriate to discharge were identified in 11.6 % of patients and having five or more comorbidities was associated with greater probability of having them (OR:9.44, 95 % CI: 2.16-41.20). Conclusions: Medical staff generally do not formulate antiosteporotic medications as secondary prevention or improve the quality of prescriptions for fractured patients once they are hospitalized and discharged, so it is necessary to develop pharmacological strategies to help prevent new episodes of falls and fractures.
Resumen Introducción: las caídas y fracturas óseas son causas importantes de morbilidad y mortalidad en ancianos. Su etiología es multicausal comprendiendo, entre otros, prescripciones inadecuadas y osteoporosis. El objetivo fue identificar las características clínicas y farmacológicas de un grupo de adultos mayores con fracturas. Materiales y métodos: estudio de corte transversal que analizó las prescripciones realizadas un mes antes de la fractura, durante la hospitalización y al egreso de 220 pacientes de 60 o más años atendidos en tres centros de referencia de Colombia. Se analizó la calidad de las prescripciones mediante los criterios STOPP. Resultados: la edad media fue de 75,3±10,3 años y 68,2 % eran mujeres. La fractura de cadera fue la más frecuente (37,7 %) y se presentó una mortalidad intrahospitalaria del 2,3 %. La prescripción de suplementos de calcio/vitamina D y terapia antiabsortiva al egreso fue de 23,7 % y 12,1 %, respectivamente. Las prescripciones potencialmente inapropiadas al egreso se identificaron en 11,6 % de pacientes y tener cinco o más comorbilidades se asoció con mayor probabilidad de tenerlas (OR:9,44, IC95 %: 2,16-41,20). Conclusiones: generalmente, el personal médico no formula medicamentos antiosteporóticos como prevención secundaria, ni mejoran la calidad de las prescripciones de los pacientes con fracturas una vez que son dados de alta, por lo que se hace necesario el desarrollo de estrategias farmacológicas para ayudar a prevenir nuevos episodios de caídas y fracturas.