Prescripción e indicaciones de uso de fluoroquinolonas en un grupo de pacientes ambulatorios de Colombia / Prescription and indications for the use of fluoroquinolones in a group of outpatients in Colombia

Introducción. Existen evidencias sobre el uso indiscriminado de antibióticos en el tratamiento de diversas enfermedades. Objetivo. Determinar los patrones de prescripción y de indicaciones de uso de las fluoroquinolonas en un grupo de pacientes ambulatorios en Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo farmacoepidemiológico del tipo de prescripción e indicaciones de uso a partir de una base de datos poblacionales que incluía pacientes con prescripciones ambulatorias de fluoroquinolonas entre mayo y octubre de 2018. Se recabó la información sobre las variables sociodemográficas, farmacológicas y clínicas (diagnóstico según la Clasificación Internacional de Enfermedades, versión 10) y se estableció la proporción del uso de fluoroquinolonas en indicaciones aprobadas y no aprobadas por las agencias reguladoras. Resultados. Se identificaron 23.373 pacientes que habían recibido fluoroquinolonas; su edad media era de 47,9 ± 18,1 años y 15.767 eran mujeres (67,5 %). La ciprofloxacina fue el medicamento más prescrito (n=19.328; 82,7 %), seguida de la norfloxacina (n=3.076; 13,2 %), la levofloxacina (n=573; 2,5 %) y la moxifloxacina (n=394; 1,7 %). Las principales indicaciones fueron la infección de las vías urinarias en sitio no especificado (n=10.777; 46,1 %), la diarrea y la gastroenteritis de presunto origen infeccioso (n=3.077, 13,2 %) y la cistitis aguda (n=956; 4,2 %). El 76 % (n=17.759) de las prescripciones correspondía a indicaciones aprobadas y el resto a usos no aprobados, como la rinofaringits o las infecciones de tejidos blandos. El ser hombre (odds ratio, OR=1,26; IC95%: 1,18-1,34) y tener menos de 35 años (OR=1,92; IC95%:1,48-1,50) se asociaron con una mayor probabilidad de uso de fluoroquinolonas en indicaciones no aprobadas. Conclusión. Las fluoroquinolonas, en particular la ciprofloxacina, se están prescribiendo especialmente a mujeres con infecciones de las vías urinarias, pero hasta la cuarta parte de los pacientes las recibieron para usos no aprobados por las agencias reguladoras.

Introduction: There is evidence of the indiscriminate use of antibiotics for different pathologies. Objective: To determine the prescription patterns and indications for the use of fluoroquinolones in a group of outpatients in Colombia. Materials and methods: We conducted a descriptive pharmaco-epidemiological study on prescription-indication using a population database where patients with outpatient fluoroquinolone prescriptions were included from May to October, 2018. We obtained the information on sociodemographic, pharmacological, and clinical variables, as well as on the diagnosis according to the International Classification of Diseases, version 10, and we established if the use was approved by the regulatory agencies or if it was off-label. Results: A total of 23,373 patients were identified who were using fluoroquinolones; their mean age was 47.9 ± 18.1 years and women predominated (n=15,767, 67.5%). Ciprofloxacin was the medication most commonly prescribed (n=19,328, 82.7%), followed by norfloxacin (n=3076, 13.2%), levofloxacin (n=573, 2.5%), and moxifloxacin (n=394; 1.7%). The main indications were urinary tract infection in unspecified site (n=10,777, 46.1%), diarrhea and gastroenteritis of presumed infectious origin (n=3077, 13.2%), and acute cystitis (n=956; 4.2%). The prescriptions followed approved indications in 76% (n=17,759) of cases while the rest were used off-label or without indication for nasopharyngitis or soft-tissue infections, for example. Being male (OR=1.26, 95%CI:1.18-1.34) and under 35 years of age (OR=1.92, 95%CI:1.48-1.50) were associated with a greater probability of using fluoroquinolones in unapproved indications. Conclusions: Fluoroquinolones, particularly ciprofloxacin, are being prescribed especially to women with urinary tract infections, but up to a quarter of the patients received them for unapproved indications by regulatory agencies.

Uso de abreviaturas inseguras en la prescripción médica y errores de medicación: una revisión narrativa / Unsafe abbreviations in medical prescriptions and their association with medication errors: a review

The prescription of medications is a weak link in the therapeutic chain of a drug. Medication errors can be associated with the use of so-called unsafe abbreviations in medical prescription. When they are mistakenly interpreted by the person who reads the prescription, error becomes imminent. We herein review the literature about the use of unsafe abbreviations in medical prescriptions and their association with medication errors. PubMed and Lilacs were reviewed, and 29 studies were analyzed, extracting information about the use of abbreviations, common abbreviations, reasons for their use and tools to reduce this conduct. A list with the main risky health abbreviations adapted to Chile was generated. It became clear that the use of abbreviations has increased, appearing in almost all medical prescriptions. The most commonly used abbreviations are the acronym "u" referring to units, followed by "sc" referring to subcutaneous. One of the causes for the use of acronyms the limited time that doctors have at the time of prescription. One way to reduce the use of these abbreviations, is to remind constantly about those that may have the greatest risk in each health institution. A list of unsafe abbreviations, to be used by Chilean health services, is proposed.

Evaluación de una intervención para el uso de tromboprofilaxis basada en el envío de alertas electrónicas a médicos residentes de primer año de dos hospitales de Lima, Perú / Evaluation of an intervention for the use of thromboprophylaxis based on electronic alert transmission to first-year medical residents from two hospitals of Lima, Peru

RESUMEN Objetivos. Evaluar la aplicación de una intervención basada en el envío de mensajes de texto y correos electrónicos dirigido a médicos residentes de medicina interna para lograr el incremento de la prescripción de tromboprofilaxis acorde a Guías de Práctica Clínica (GPC). Materiales y métodos. Se realizó un estudio tipo cuasiexperimental en los servicios de hospitalización de medicina interna de dos hospitales generales de Lima, Perú, uno seleccionado para aplicar la intervención y el otro como control. La unidad de análisis fue la hoja de prescripción médica. Se consideró que la intervención debería incrementar la prescripción acorde a GPC con respecto a la evaluación inicial y también respecto al hospital control. Resultados. Se evaluaron 394 hojas de prescripción médica, 227 (57,4%) procedentes del servicio intervenido y 167 (42,4%) correspondieron del control. En el servicio intervenido, inicialmente el 64,5% tuvo una prescripción acorde a GPC, para disminuir a 54,4% luego de la intervención; el sobreuso aumentó de 13,6 a 26,8%. Conclusiones. La intervención basada en el envío de mensajes de texto y correos electrónicos no tuvo impacto, observándose una tendencia al sobreuso de tromboprofilaxis posintervención.

ABSTRACT Objectives. To assess the implementation of an intervention based on the sending of text messages and e-mails to internal medicine residents in order to achieve an increase in the prescription of thromboprophylaxis according to Clinical Practice Guidelines (CPG). Materials and methods. A quasi-experimental study was conducted in the inpatient units of internal medicine at two general hospitals in Lima, Peru: one selected to implement the intervention and the other as control. The unit of analysis was the therapeutic order sheet. It was considered that the intervention should increase the order of thromboprophylaxis according to CPG with respect to the initial assessment and also in relation to the control hospital. Results. Atotal of 394 therapeutic order sheets, 227 (57.4%) from the intervention hospital and 167 (42.4%) from the control, were evaluated. In the intervention hospital, 64.5% initially had an order of thromboprophylaxis according to CPG, which decreased to 54.4% after the intervention; overuse increased from 13.6 to 26.8%. Conclusions. Intervention based on sending text messages and e-mails had no impact, showing a tendency to overuse of thromboprophylaxis post-intervention.