Patrones de uso de anticonceptivos hormonales en una población de Colombia

Objetivo: El uso de anticonceptivos hormonales ha crecido progresivamente en muchos países del mundo. Determinar los patrones de utilización de anticonceptivos hormonales, frecuencia de comorbilidades y medicaciones concomitantes en mujeres mayores de 15 años afiliadas al Sistema de Salud de Colombia. Materiales y métodos: Estudio de corte, que incluyó datos de mujeres mayores de 15 años con prescripciones y dispensaciones de algún anticonceptivo hormonal durante al menos tres meses continuos (abril a junio-2016). Se creó una base de datos con información sociodemográfica, farmacológica (tipo de anticonceptivos, dosis, comedicaciones y comorbilidades. Se realizaron análisis descriptivos y multivariados buscando identificar factores asociados con comedicaciones de riesgo. Resultados: Se identificaron 34309 mujeres que recibieron anticonceptivos hormonales, con edad media de 27,2±7,0 años (rango:13-60,8 años). Los anticonceptivos más utilizados fueron inyectables de aplicación mensual (63,0 %), inyectables de aplicación trimestral (19,1 %), de administración oral (12,1 %), los implantes subdérmicos (7,4 %) y finalmente los dispositivos intrauterinos hormonales con 0,4 %. El 5,7 % de las pacientes (n=1957), estaban recibiendo alguna comedicación, especialmente con antihipertensivos (2,9 %) y antimigrañosos (1,9 %). Ser mayor de 45 años (OR:2,3; IC95 %:1,7-3,0), utilizar dispositivo intrauterino hormonal (OR:2,4; IC95 %:1,4-4,1) y anticonceptivo inyectable trimestral (OR: 1,7; IC95 %:1,3-2,3) se asociaron con mayor probabilidad de recibir comedicaciones. Conclusiones. Las mujeres colombianas que acceden a anticonceptivos hormonales a través del Sistema de Salud están empleando principalmente presentaciones inyectables, con muy baja frecuencia de las orales, y en general tienen pocas comorbilidades que requieran tratamiento farmacológico, pese a que algunas tienen condiciones cardiovasculares que pueden implicar un potencial riesgo de eventos trombóticos.

Objective: The use of hormonal contraceptives has grown progressively in many countries of the world. The aim was to determine the patterns of use of hormonal contraceptives, frequency of comorbidities and concomitant medications in women over 15 years of age affiliated with the Colombian Health System. Methods: Cross-sectional study, which included data on women over 15 years of age with prescriptions and dispensations of a hormonal contraceptive for at least three continuous months (April-June-2016). A database with sociodemographic, pharmacological information (type of contraceptives, doses, comedications and comorbidities) was created. Descriptive and multivariate analyzes were conducted seeking to identify factors associated with risk comedications. Results: 34309 women who received hormonal contraceptives were identified, with a mean age of 27.2 ± 7.0 years (range: 13-60.8 years). The most commonly used contraceptives were injectable of monthly application (63.0 %), injectable of quarterly application (19.1 %), oral administration (12.1 %), subdermal implants (7.4 %) and finally the hormonal intrauterine devices with 0.4 %. 5.7 % of the patients (n = 1957) were receiving some medication, especially with antihypertensives (2.9 %) and anti-migraines (1.9 %). Be over 45 years old (OR:2.3; 95 %CI: 1.7-3.0), use hormonal intrauterine device (OR: 2.4; 95 % CI:1.4-4.1) and quarterly injectable contraceptive (OR:1.7; 95 %CI:1.3-2.3) were associated with a higher probability of receiving comedications. Conclusions: Colombian women who access hormonal contraceptives through the Health System are mainly using injectable presentations, with very low frequency of oral ones, and in general they have few comorbidities that require pharmacological treatment, although some have cardiovascular conditions that may involve potential risk of thrombotic events.

Naltrexona em baixa dose (LDN): tendência de consumo nas capitais brasileiras e Distrito Federal, 2014-2020 / Low-dose naltrexone (LDN): consumption trend in Brazilian capitals and the Federal District, 2014-2020

Resumo Estudo ecológico com objetivo de determinar o consumo de naltrexona em baixa dose (LDN) nas 26 capitais brasileiras e Distrito Federal e acompanhar a tendência entre os anos de 2014 e 2020. A coleta de dados da dispensação de naltrexona manipulada, se deu por meio do Sistema Nacional de Gerenciamento de Produtos Controlados, publicizado em 2020, considerando-se baixa dose prescrições de até 5 mg. O cálculo dos coeficientes de dispensação utilizou as estimativas populacionais do Instituto Brasileiro de Pesquisa Geografia e Estatística. Utilizou-se análise estatística descritiva e de regressão generalizada de Prais-Winsten para a série temporal. As tendências observadas foram classificadas em crescentes, estáveis ou decrescentes, com intervalo de confiança de 95% e nível de significância de 5%. Os resultados demonstraram maiores coeficientes de consumo de LDN nas regiões Centro-Oeste, Sul e Sudeste e menores nas Norte e Nordeste. Observou-se dispensação de LDN crescente em 55,6% das capitais, estacionária em 44,4% e ausência de coeficientes decrescentes. Apesar das evidências limitadas quanto à farmacoterapia de LDN e da sua prescrição off-label, os dados demonstram que a prescrição, dispensação e consumo vem crescendo no Brasil, com ênfase nas regiões centro-sul do país.

Abstract The scope of this paper is an ecological study to determine the consumption of low-dose naltrexone (LDN) in the 26 Brazilian capitals and the Federal District and monitor the trend between the years 2014 to 2020. Data collection on the dispensation of manipulated naltrexone was done through the National Management System of Controlled Products, published in 2020, considering low-dose prescriptions of up to 5 mg. The calculation of the dispensation coefficients used the population estimates of the Brazilian Institute of Geography and Statistics. Descriptive statistical analysis and generalized Prais-Winsten regression analysis were used for the time series analysis. The trends observed were classified as increasing, stable, or decreasing, with a 95% confidence interval and 5% significance level. The results showed higher LDN consumption coefficients in the Mid-West, South and Southeast regions and lower coefficients in the North and Northeast. Increasing dispensation of LDN was observed in 55.6% of the capitals, being stationary in 44.4%, with no decreasing coefficients. Despite the limited evidence regarding LDN pharmacotherapy and its off-label prescription, the data show that prescription, dispensing, and consumption have been on the increase in Brazil, with emphasis on the central-south regions of the country.

Early death, morbidity and pharmacotherapy in extremely premature and very premature in neonatal intensive care units / Morte precoce, morbidade e farmacoterapia em prematuros extremos e muito prematuros em unidades de terapia intensiva neonatal

Abstract Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death.

Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.

Use of Psychotropic Drugs during the COVID-19 pandemic in Minas Gerais, Brazil / Perfil de utilização de psicofármacos durante a pandemia de COVID-19 em Minas Gerais, Brasil

ABSTRACT Objective: To describe the profile of dispensation of mental health drugs by analyzing trends in use before and during the COVID-19 pandemic within the Unified Health System (Sistema Único de Saúde [SUS]). Methods: Pharmacoepidemiological study based on the retrospective analysis of records regarding the dispensation of psychotropic medicines in the SUS database in the state of Minas Gerais between 2018 and 2021, considering the periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). A database with the records of dispensation of municipalities was created, and the consistency of releases was verified using the Analysis of Variance (ANOVA) test. Medicine consumption was measured in a defined daily dose (DDD) per 1,000 inhabitants/day for SUS, and the difference between periods was evaluated using Student's t-test. Results: During the COVID-19 pandemic, there was an increase in the consumption of psychotropic drugs in SUS-MG. The most consumed medicines were fluoxetine hydrochloride, diazepam and phenobarbital sodium (DDD=5.89; 3.42; 2.49) in the Basic Pharmaceutical Services Component(CBAF), and olanzapine, risperidone and quetiapine hemifumarate (DDD=0.80; 0.47; 0.38) in the Specialized Pharmaceutical Services Component (CEAF). The highest percentage increase in consumption was attributed to clonazepam (75.37%) and lithium carbonate (35.35%), in CBAF, and levetiracetam (3,000.00%) and memantine hydrochloride (340.0%) in CEAF. Conclusion: The change in the psychotropic drug dispensation profile during the COVID-19 pandemic highlights the need to produce more studies to complete, confirm or rule out this profile and monitor the use of psychotropic drugs by the population in the post-pandemic context.

RESUMO Objetivo: Descrever o perfil de dispensação de medicamentos da saúde mental analisando o uso antes e durante a pandemia de COVID-19 no âmbito do Sistema Único de Saúde (SUS). Métodos: Estudo farmacoepidemiológico a partir da análise retrospectiva dos registros de dispensação de psicofármacos na base de dados do SUS no estado de Minas Gerais (MG) nos períodos antes (2018-2019) e durante a pandemia de COVID-19 (2020-2021). Um banco de dados com os registros de dispensação dos municípios foi elaborado, sendo verificada a consistência de lançamento pelo teste de Análise de Variância (ANOVA). O consumo dos medicamentos foi mensurado em dose diária definida (DDD) por 1.000 habitantes/dia para o SUS, sendo a diferença entre os períodos avaliada pelo teste estatístico t de Student. Resultados: Durante a pandemia de COVID-19 houve aumento no consumo de psicofármacos no SUS-MG. Os medicamentos mais consumidos foram cloridrato fluoxetina, diazepam e fenobarbital sódico (DDD=5,89; 3,42; 2,49) no componente básico (CBAF), e olanzapina, risperidona e hemifumarato de quetiapina (DDD=0,80; 0,47; 0,38) no componente especializado da Assistência Farmacêutica (CEAF). Os maiores aumentos percentuais no consumo foram atribuídos ao clonazepam (75,37%) e carbonato de lítio (35,35%) no CBAF e levetiracetam (3.000,00%) e cloridrato de memantina (340,00%) no CEAF. Conclusão: A alteração do perfil de dispensação de psicotrópicos durante a pandemia de COVID-19 alerta quanto à necessidade de produção de mais estudos a fim de completar, confirmar ou afastar este perfil e monitorar o uso de psicofármacos pela população no contexto pós-pandêmico.

Relationship between anticholinergic load and self-perceived health in a population aged 44 years or older / Relação entre carga anticolinérgica e autopercepção de saúde em população com mais de 44 anos

OBJECTIVE: To investigate the relationship between anticholinergic load (ACL) and self-perceived general health in adults in a medium-sized municipality in southern Brazil. METHODS: This cross-sectional study was based on 2015 data from a medium-sized municipality in southern Brazil. All respondents aged 44 years or older who reported using drugs in the 2 weeks before the interview were included (n = 662). The Anticholinergic Drug Scale was used to measure the ACL. Self-perceived health was categorized as positive self-perception (PSP) or negative self-perception (NSP). Crude and adjusted Poisson regression analyses were conducted to investigate the association between ACL and self-perceived health. RESULTS: NSP was found in 50.91% of 662 respondents. Significant ACL, older age, lower economic status, lower education, polypharmacy, and depression correlated with a higher frequency of NSP. Individuals with significant ACL had a prevalence of NSP of 1.27 (95% confidence interval: 1.02 ­ 1.58), and each additional ACL level represented a 6.10% higher chance of worse self-perceived health, regardless of confounding factors. CONCLUSIONS: An association was found between significant ACL and NSP, with an effect dependent on ACL level

OBJETIVO: Investigar a relação entre carga anticolinérgica (CAC) e autopercepção de saúde em adultos de um município de médio porte do sul do Brasil. METODOLOGIA: Trata-se de um estudo transversal com dados de 2015, realizado em um município de médio porte do sul do Brasil. Todos os entrevistados com 44 anos ou mais que relataram uso de drogas nas duas semanas anteriores à entrevista foram incluídos (n = 662). A Anticholinergic Drug Scale (ADS) foi utilizada para medir a CAC. A autopercepção da saúde foi categorizada em autopercepção positiva (APP) ou autopercepção negativa (APN). Análises de regressão de Poisson bruta e ajustada foram realizadas para investigar a associação entre CAC e autopercepção de saúde. RESULTADOS: Entre os 662 participantes, a CAC foi encontrada em 50,91% dos respondentes. CAC significativa, idade avançada, situação econômica mais baixa, menor escolaridade, polifarmácia e depressão foram correlacionados com maior frequência de APN. Indivíduos com CAC significativo apresentaram prevalência de APN de 1,27 (intervalo de confiança de 95%: 1,02 ­ 1,58), e cada nível adicional de CAC representou uma chance 6,10% maior de pior autopercepção de saúde, independentemente de fatores de confusão. CONCLUSÕES: Encontrou-se associação entre ACL significativo e APN, com efeito dependente do valor do CAC

Iron salt supplementation during gestation and gestational diabetes mellitus

ABSTRACT OBJETIVE To evaluate the association between the use of iron salts during the first two trimesters of gestation in non-anemic women and the development of gestational diabetes mellitus. METHODS The study used maternal data from the 2015 Pelotas Birth Cohort. All non-anemic women at the 24th week of gestation (n = 2,463) were eligible for this study. Gestational diabetes mellitus was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. RESULTS Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the first two trimesters of gestation. The prevalence of gestational diabetes mellitus among those exposed was 8.7% (95%CI: 7.4-10.1) and 9.3% (95%CI: 7.4-11.6) among those who were not exposed. Iron supplementation was not associated with increased risk of gestational diabetes mellitus in crude (OR = 0.9; 95%CI: 0,7-1,3) and adjusted analysis (OR = 1.1; 95%CI :0,8-1,6). CONCLUSIONS The results suggest that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, in which prophylactic iron supplementation is recommended for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

Tratamento de dados do Sistema Nacional de Gerenciamento de Produtos Controlados para estudos de utilização de medicamentos com antimicrobianos / Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials / Procesamiento de datos del Sistema Nacional de Gestión de Productos Controlados para estudios de utilización medicamentos con antimicrobianos

Resumo: O Sistema Nacional de Gerenciamento de Produtos Controlados (SNGPC) armazena dados de dispensação de medicamentos industrializados, manipulados e insumos farmacêuticos sob controle especial e antimicrobianos, a partir dos registros de farmácias e drogarias privadas. Este trabalho explorou a qualidade dos dados inseridos no SNGPC, a partir dos registros de dispensação de antibióticos industrializados, com o objetivo de propor seu emprego em estudos de utilização de medicamentos (DUR). A pesquisa foi desenvolvida por meio de desenho descritivo e retrospectivo, examinando o conjunto dados brutos do sistema, para o período de janeiro de 2014 a dezembro de 2020. Um total de 475.805.207 registros de dispensação de medicamentos foi coletado. Os antibióticos corresponderam em média a 54,5% do total de registros. A dimensão de qualidade "não informado" foi identificada, sistematicamente, nas variáveis "princípio ativo", "sexo", "idade" e "CID-10". As quantidades de frascos e caixas variaram de 1 a 536 unidades, e as quantidades de formas farmacêuticas dispensadas de 1 a 7.500 unidades. Os resultados mostram que 25% dos registros extrapolam uma terapia individual e que o sistema não apresenta um mecanismo de crítica para evitar dispensações não conformes ao padrão terapêutico para a classe. Apesar das vulnerabilidades decorrentes da qualidade dos dados, que podem ser superadas, o SNGPC possibilita construir diferentes planos analíticos, envolvendo tempo e outras agregações, na investigação de uso comunitário de antimicrobianos e medicamentos sob controle especial, o que faz dele uma potente fonte de dados para DUR.

Abstract: The Brazilian National System of Controlled Product Management (SNGPC) stores data on the dispensing of manufactured and compounded drugs and pharmaceutical inputs, whether controlled and antimicrobial, based on the records of private pharmacies and drugstores. This study assessed the quality of SNGPC data from the dispensing records of manufactured antibiotics, aiming to propose their use in drug utilization researchs (DURs), with a descriptive and retrospective design, analyzing the raw dataset of the SNGPC from January 2014 to December 2020. A total of 475,805,207 drug-dispensing records were collected. On average, antibiotics corresponded to 54.5% of the total records. The quality dimension "unreported" was systematically identified in the variables "active ingredient", "sex", "age" and "ICD-10". The amount of vials/bottles and packages ranged from one to 536 units and the amount of pharmaceutical inputs dispensed, from one to 7,500 units. Results show that 25% of the records exceed an individual therapy and the SNGPC has no critical mechanism to avoid dispensations outside the therapeutic standard for the class. Despite vulnerabilities due to data quality, which can be overcome, the SNGPC allows for the construction of different analytical plans, involving time and other aggregations, in the analysis of community use of antimicrobials and controlled drugs, which makes it a powerful source of data for DUR.

Resumen: El Sistema Nacional de Gestión de Productos Controlados (SNGPC) almacena datos sobre la dispensación de medicamentos industrializados, manipulados, insumos farmacéuticos bajo control especial y de antimicrobianos con base en los registros de farmacias y de boticas privadas. Este trabajo analizó la calidad de los datos ingresados en el SNGPC relacionados a los registros de la dispensación de antibióticos industrializados, para proponer su posible aplicación en estudios sobre el uso de medicamentos (DUR); para ello, realizó un análisis descriptivo y retrospectivo del conjunto de datos brutos para el periodo de enero de 2014 a diciembre de 2020. Se recogieron un total de 475.805.207 registros de dispensación de medicamentos. Los antibióticos correspondieron en promedio al 54,5% del total de los registros. La dimensión de calidad "no informado" se identificó sistemáticamente en las variables "principio activo", "sexo", "edad" y "CIE-10". Las cantidades de viales y cajas oscilaron entre 1 y 536 unidades, y las cantidades de formas farmacéuticas dispensadas entre 1 y 7.500 unidades. Los resultados muestran que el 25% de los registros exceden una terapia individual y que el sistema no tiene un mecanismo crítico para evitar la dispensación que no se ajusta al patrón terapéutico de la clase. A pesar de las vulnerabilidades derivadas de la calidad de los datos, que pueden ser superadas, el SNGPC permite la construcción de diferentes planes analíticos, involucrando tiempo y otras agregaciones, en la investigación del uso comunitario de antimicrobianos y medicamentos bajo control especial, lo que hace que el Sistema sea una potente fuente de datos para DUR.

Perfil prescriptivo de corticoides en el servicio de urgencias del Hospital Odontológico de la ciudad de Formosa, Argentina / Prescriptive Profile of Corticoids in the Emergency Department of the Dental Hospital of the City of Formosa, Argentina

Objetivo: identificar el perfil prescriptivo de corticoides en pacientes que asistieron al Servicio de Urgencias del Hospital Odontológico de la ciudad de Formosa, Argentina. Métodos: se realizó un estudio transversal, observacional y descriptivo, se analizaron las prescripciones de corticoides realizadas por odontólogos que atendieron en el Servicio de Urgencias del Hospital Odontológico de la ciudad de Formosa desde marzo 2019 a febrero 2020. Las variables de estudio fueron: características demográficas del paciente, diagnóstico clínico odontológico, corticoide prescrito, dosis y forma farmacéutica. Resultados: de un total de 9.635 historias clínicas, se observaron 3.244 prescripciones de corticoides (33,6%). De acuerdo a los corticoides prescritos, se halló a la dexametasona para vía intramuscular y además se utilizó dexametasona en tratamientos combinados con dipirona para vía intramuscular e ibuprofeno para vía oral. Los diagnósticos relacionados con prescripción de estos medicamentos fueron: pulpitis, periodontitis apical aguda, flemón/absceso, entre otras. De acuerdo al valor intrínseco terapéutico potencial, los fármacos prescritos en el hospital odontológico son de valor elevado, esto significa que demostraron eficacia para el tratamiento, el diagnóstico o la prevención de enfermedades del ser humano. Conclusiones: el estudio de la utilización de medicamentos en el Hospital Odontológico de la ciudad de Formosa permitió observar situaciones donde los corticoides no están indicados. Además, se señala la prescripción excesiva de la vía intramuscular. A partir de los resultados obtenidos es necesario realizar una retroalimentación a los prescriptores, por lo que se sugieren intervenciones para elaborar propuestas de solución a los problemas identificados y formular políticas de medicamentos.

Objective: to identify the prescriptive profile of corticosteroids in patients who were treated at the Emergency Service of the Dental Hospital of the City of Formosa, Argentina. Methods: a cross-sectional, observational, and descriptive study was carried out, and corticosteroid prescriptions made by dentists who attended the Emergency Service of the Dental Hospital of the City of Formosa, from March 2019 to February 2020 were analyzed. The study variables were: demographic characteristics of the patient, dental clinical diagnosis, corticosteroid prescribed, dose, and pharmaceutical form. Results: Of 9,635 medical records, 3,244 corticosteroid prescriptions (33.6%) were observed. According to the prescribed corticosteroids, dexamethasone was found for the intramuscular route, and dexamethasone was also used in combined treatments with dipyrone for the intramuscular route and ibuprofen for the oral route. The diagnoses related to the prescription of these medications were: pulpitis, acute apical periodontitis, phlegmon/abscess, trauma, pericoronitis, hypersensitivity and alveolitis. According to the potential therapeutic intrinsic value, the drugs prescribed in the dental hospital are of high value, which means that they have demonstrated efficacy for the treatment, diagnosis or prevention of diseases that affect humans. Conclusions: the study of the use of drugs in the Dental Hospital of the City of Formosa allowed us to observe situations where corticosteroids are not indicated. In addition, the excessive prescription of the intramuscular route is pointed out. Based on the results obtained, it is necessary to provide feedback to the prescribers, so it is suggested to continue with different interventions to develop proposals for solutions to the identified problems and formulate drug policies.

Systemic lupus erythematosus: Pharmacological differences between women and men and among age groups and geographical regions

Systemic lupus erythematosus (SLE) is a chronic and potentially fatal autoimmune disease. There are clinical differences between women and men and among age groups. Its treatment involves a heterogeneous group of drugs. The objective was to determine the pharmacological treatment patterns in a group of patients with SLE and compare them according to sex, age group and geographic region. This was a cross-sectional study that identified outpatient drugs used in patients with SLE from a population database of Colombians affiliated with the Colombian Health System. Sociodemographic and pharmacological variables were considered. Descriptive and bivariate analyses were performed. A total of 4307 patients with SLE were identified (median age, 44.2 years; 89.4% women). Disease-modifying antirheumatics were the most prescribed drugs (90.5%), especially chloroquine (54.4%), which predominated in all age groups and geographical regions. Hydroxychloroquine and methotrexate were the predominant prescribed drugs for women, while corticosteroids, chloroquine, azathioprine, and mycophenolate were the predominant prescribed drugs for men. The use of corticosteroids (prednisolone and prednisone) decreased with increasing age. Differences were found in the prescription of drugs for patients with SLE between women and men and among geographic regions and age groups. The use of chloroquine predominated over hydroxychloroquine, contrasting with clinical practice guidelines.

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune crónica y potencialmente mortal. Existen diferencias clínicas entre mujeres y hombres, y entre grupos de edad. Su tratamiento involucra un grupo heterogeneo de medicamentos. El objetivo fue determinar los patrones de tratamiento farmacológico de un grupo de pacientes con LES y compararlos según el sexo, los grupos de edad y las regiones geograficas. Estudio de corte transversal que identifico los medicamentos de uso ambulatorio empleados en pacientes con LES, a partir de una base de datos poblacional de colombianos afiliados al Sistema de Salud de Colombia. Se consideraron variables sociodemográficas y farmacologicas. Se realizo un análisis descriptivo y bivariado. Se identificó a 4.307 pacientes con LES, con una mediana de edad 44,2 an˜ os y un 89,4% mujeres. Los medicamentos modificadores de enfermedad reumatica fueron los mas prescritos (90,5%), en especial cloroquina (54,4%), el cual predomino en todos los grupos de edad y las regiones geográficas. La hidroxicloroquina y el metotrexato predominaron en mujeres, mientras que los corticosteroides, la cloroquina, la azatioprina y el micofenolato, en hombres. Con el aumento de la edad disminuyo el uso de corticoides (prednisolona y prednisona). Se encontraron diferencias en la prescripción de los medicamentos empleados en los pacientes con LES entre mujeres y hombres, regiones geográficas y grupos etarios. El uso de cloroquina predomino sobre la hidroxicloroquina, en contraste con lo recomendado por las guías de practica clínica.

Use of medications by pregnant women in the Family Health Strategy in the Northeast of Brazil / Uso de medicamentos por gestantes da estratégia saúde da família no Nordeste do Brasil

Abstract Objectives: To evaluate the medication use, exposure to potential risks, and associated factors before and during pregnancy of pregnant women receiving care at the Family Health Strategy in a municipality in the Northeast of Brazil. Methods: This is a cross-sectional study of pregnant women receiving care in the municipality of Barreiras, in Bahia, Brazil. In data analysis process, prevalence and frequency of medication use were estimated. To investigate the association between variables, the outcome measure was expressed by the prevalence ratio (crude and adjusted) with a 95% confidence interval via Poisson regression. Results: The prevalence of medication use before pregnancy was 35% and during pregnancy, it was 80.7%. Analgesics and antianemics were the prevalent groups of medications before and during pregnancy, respectively. Family income (≤1 minimum wage; PR=1.62; CI95%=1.02-2.55) showed an association with prior use; health problems (PR=2.3; CI95%=1.27-4.22) and complaints in pregnancy (PR=2.39; CI95%=1.28-4.47) had an association with use during pregnancy. Conclusion: The characterization of a high prevalence of use of medicines by pregnant women, combined with a trend of failures in family planning could demonstrate the exposure of the risks of using some harmful substances in periods close to conception and pregnancy.

Resumo Objetivos: avaliar o uso de medicamentos, exposição a potenciais riscos e os fatores associados antes e durante a gestação pelas gestantes atendidas na Estratégia Saúde da Família em município do nordeste brasileiro. Métodos: trata-se de um estudo transversal realizado com gestantes atendidas no município de Barreiras, Bahia, Brasil. No processo de análise dos dados, foram estimadas as prevalências e frequências de utilização de medicamentos. Para investigar a associação entre variáveis, a medida do desfecho foi expressa pela razão de prevalência (bruta e ajustada) com intervalo de 95% de confiança pela regressão de Poisson. Resultados: a prevalência do uso de medicamentos antes da gestação foi 35% e durante de 80,7%. Os analgésicos e antianêmicos foram os grupos de medicamentos prevalentes antes e durante a gestação, respectivamente. A renda familiar (≤1 salário mínimo; RP=1,62; IC95%=1,02-2,55), mostrou associação ao uso anterior; problemas de saúde (RP=2,32; IC95%=1,27-4,22) e queixas na gestação (RP=2,39; IC95%=1,28-4,47) tiveram associação para o uso durante. Conclusões: a caracterização de uma alta prevalência do uso de medicamentos por gestantes, aliado a uma tendência de falhas no planejamento familiar pôde demonstrar a exposição dos riscos da utilização de algumas substâncias nocivas em períodos próximos da concepção e na gestação.

Producción científica de la maestría de farmacoepidemiología en Cuba: Revisión de trabajos de tesis / Scientific production of master's degree in pharmacoepidemiology in Cuba: Descriptive review of thesis works

Resumen Objetivo: Caracterizar las investigaciones realizadas en farmacoepidemiología a partir de las tesis de Maestría de Farmacoepidemiología de la Escuela Nacional de Salud Pública, La Habana, Cuba. Materiales y método: Estudio descriptivo; se analizaron 124 tesis defendidas en las cuatro ediciones de la maestría, entre los años 2010 y 2019. Las variables fueron profesión y lugar de residencia de los autores, línea de investigación de la maestría que se abordó, tipo de estudio, tipo de Estudio de Utilización de Medicamentos (EUM), grupos farmacológicos que se investigaron y si los resultados se publicaron en revistas científicas. Los resultados se resumieron en porcentajes. Resultados: La mayoría de los autores eran graduados de Medicina (50.0%) y residían en La Habana 53.2%. Las líneas de investigación más abordadas fueron calidad de la prescripción de medicamentos (43.5%) y farmacovigilancia, 30.6 %. Se identificaron 72 EUM y predominó el tipo prescripción-indicación (27.7%). Predominó el análisis de antimicrobianos (28.5%) y de los fármacos cardiovasculares (29.7%). Fueron publicadas en revistas científicas solo el 22.5% de las investigaciones. Conclusiones: Los temas de tesis de la maestría están en concordancia con las prioridades del sistema sanitario cubano para lograr un uso racional de los medicamentos; los informes de investigación que resultan como trabajo final de la maestría constituyen una referencia de la investigación en ese campo en Cuba. Se debe incentivar la participación de otros profesionales, el diseño de otros tipos de estudios y la publicación de los resultados.

Abstract Objective: To characterize the research carried out in pharmacoepidemiology based on the master's theses in Pharmacoepidemiology of the National School of Public Health, Havana, Cuba. Materials and method: It was done a descriptive study; 124 theses defended in the four editions of the master's degree were analyzed, between 2010 and 2019. The variables were profession and place of residence of authors, line of research of the master's degree that was addressed, type of study, type of Drug Utilization Research (DUR), pharmacological groups that were investigated and whether the results were published in scientific journals. The results were summarized in percentages. Results: Most of the authors were medicine graduates (50.0%) and 53.2% resided in Havana. The researched lines of most addressed were quality of drug prescription (43.5%) and pharmacovigilance, 30.6%. 72 DUR, prescription-indication type prevailed were identified (27.7%). The analysis of antimicrobials (28.5%) and cardiovascular drugs (29.7%) predominated. Only 22.5% of the investigations were published in scientific journals. Conclusions: The topics of the master's thesis are in accordance with the priorities of the Cuban health system to achieve a rational use of medicines; the research reports that result as the final work of the master's degree constitute a reference of the research in that field in Cuba. The participation of other professionals, the design of other types of studies and the publication of the results should be encouraged.

Prevalência de uso de medicamentos em população rural brasileira / Prevalence of medication use in a rural Brazilian population

Resumo Introdução Apesar da vulnerabilidade social existente na população rural brasileira, o uso de medicamentos entre agricultores é um tema ainda pouco estudado no país. Objetivo Analisar o uso de medicamentos e sua associação com características sociodemográficas, laborais, comportamentais e autoavaliação do estado de saúde em agricultores. Método Estudo epidemiológico transversal com 790 agricultores de 18 a 59 anos, de ambos os sexos, do município de Santa Maria de Jetibá. Os medicamentos foram agrupados segundo o Sistema de Classificação Anatômico-Terapêutico-Químico (ATC) nos níveis 1 e 2. Foram realizadas análise descritiva (frequências absolutas e relativas) e associações entre as variáveis e o uso de medicamentos pelo teste de qui-quadrado. As variáveis que se mostraram associadas com o desfecho com nível de significância de 5% no teste de qui-quadrado foram testadas por regressão logística binária. Resultados A prevalência de uso de medicamentos foi de 44,2%, sendo menor no sexo masculino (30,3%) do que no feminino (59,4%). Após a análise ajustada, o uso de medicamentos esteve associado ao sexo feminino, à faixa etária de 40 anos ou mais e à pior autoavaliação do estado de saúde. A prevalência de polifarmácia foi de 6,6%. Os medicamentos mais utilizados foram os anti-hipertensivos (19,3%). Conclusão O estudo evidenciou a importância de se avaliar populações rurais a fim de subsidiar políticas e recursos em saúde pública.

Abstract Background Despite the social vulnerability that exists in the Brazilian rural population, the drug use is a topic still little studied in the country. Objective The present work aims to analyze drug use and its association with sociodemographic, occupational, behavioral, and self-rated health characteristics in farmers. Method A cross-sectional epidemiological study of 790 male and female farmers from 18 to 59 years old, from Santa Maria de Jetibá. The drugs were grouped according to the Anatomical Therapeutic Classification System (ATC) at levels 1 and 2. Descriptive analysis of the data was performed (in absolute and relative frequencies) and associations between study variables and drug use by the chi-square test. The variables that were associated with the outcome with a significance level of 5% in the chi-square test were tested by binary logistic regression. Results The prevalence of drug utilization was 44.2%, being lower in males (30,3%) than in females (59,4%). After adjusted analysis, the drug use was associated with female gender, age 40 years and older and worse self-rated health status. The prevalence of polypharmacy was 6,6%. The most used drugs were antihypertensive (19,3%). Conclusion The study showed the importance of evaluating rural populations to subsidize policies and resources in Public Health.

A vigilancia farmacológica no cenário brasileiro do sáculo 21 / Pharmacological surveillance in the Brazilian scenario of the 21st century / La vigilancia farmacológica en el escenario brasileño del siglo XXI

Resumo Os estudos em vigilancia farmacológica e ecofarmacológicas possibilitam o monitoramento, identificagao e minimi-zagao de efeitos nocivos advindos do uso de medicamentos. Diante disso, o presente estudo teve como objetivo descrever o cenário atual da farmacoepidemiologia e ecofarmacovigilancia no Brasil, no que se refere a produgao, registro, comerciali-zagao e uso de medicamentos. Foi realizado um levantamento sistemático, através dos bancos de dados PubMed/Medline, Lilacs e SciELO, cuja temática envolveu pesquisas em farmacoeconomia, farmacovigilancia, ecofarmacovigilancia e estudo da utilizagao de medicamentos no Brasil de 2001 a 2019. As publicagóes distribuíram-se de forma desigual entre as regióes brasileiras. Pacientes hipertensos, oncológicos e as gestantes foram os grupos de risco mais citados e os antimicrobianos, psicotrópicos e antineoplásicos os grupos farmacológicos mais discutidos. Custo de cuidados em saúde foi a temática mais abordada no contexto da farmacoeconomia e grande parte dos trabalhos destinou-se a análise e obtengao de dados referentes ao uso de medicamentos e suas reagóes adversas. Em relagao a ecofarmacovigilancia nao foram encontradas publicagóes no Brasil que contemplem essa área. Apesar dos avangos da legislagao farmacoepidemiológica e melhorias nos processos de fiscalizagao, no que tange a vigilancia da produgao, registro, comercializagao e uso de medicamentos, ainda permanecem carencias, quanto ao aporte de uma visao científica direcionada, sobretudo ao gerenciamento e diferentes usos dos recursos terapéuticos, e económicos do sistema de saúde brasileiro, bem como uma visao ambiental referente ao uso de medicamentos.

Abstract Studies in pharmacological and ecopharmacological surveillance make it possible to monitor, identify and minimize harmful effects arising from the use of drugs. Therefore, the present study aimed to describe the current scenario of pharmacoepidemiology and ecopharmacovigilance in Brazil, about the production, registration, marketing, and use of medicines. A systematic survey was carried out through the PubMed/Medline, Lilacs, and SciELO databases, whose theme involved research in pharmacoeconomics, pharmacovigilance, ecopharmacovigilance, and the study of drug use in Brazil from 2001 to 2019. Publications were unevenly distributed between Brazilian regions. Hypertensive patients, cancer patients, and pregnant women were the most cited risk groups, and antimicrobials, psychotropics, and antineoplastics were the most discussed pharmacological groups. Cost of health care was the most discussed topic in the context of pharmacoeconomics and most of the work was aimed at analyzing and obtaining data regarding the use of drugs and their adverse reactions. Regarding ecopharmacovigilance, no publications were found in Brazil covering this area. Despite advances in pharmacoepidemiological legislation and improvements in inspection processes, regarding the surveillance of the production, registration, commercialization, and use of medicines, there are still gaps regarding the contribution of a directed scientific vision, especially to the management and different uses of resources. therapeutic and economic aspects of the Brazilian health system, as well as an environmental vision regarding the use of medicines.

Resumen Los estudios de vigilancia farmacológica y ecofarmacológica permiten controlar, identificar y minimizar los efectos nocivos derivados del uso de los medicamentos. Ante esto, el presente estudio tuvo como objetivo describir el escenario actual de la farmacoepidemiología y la ecofarmacovigilancia en Brasil, en relación con la producción, el registro, la comercialización y el uso de los medicamentos. Se realizó una encuesta sistemática, a través de las bases de datos PubMed/Medline, Lilacs y SciELO, cuya temática involucró investigaciones sobre farmacoepidemiología, farmacovigilancia, ecofarmacovigilancia y estudio del uso de medicamentos en Brasil desde 2001 hasta 2019. Las publicaciones se distribuyeron de forma desigual entre las regiones brasileñas. Los pacientes hipertensos, los pacientes oncológicos y las mujeres embarazadas fueron los grupos de riesgo más citados y los antimicrobianos, los psicotrópicos y los antineoplásicos fueron los grupos farmacológicos más discutidos. El coste de la asistencia sanitaria fue el tema más abordado en el contexto de la farmacoeconomía y la mayoría de los trabajos estaban dirigidos a analizar y obtener datos sobre el uso de los medicamentos y sus reacciones adversas. En cuanto a la ecofarmacovigilancia, no se encontraron publicaciones en Brasil que aborden esta área. A pesar de los avances en la legislación farmacoepidemiológica y de las mejoras en los procesos de inspección, en lo que respecta a la vigilancia de la producción, registro, comercialización y uso de los medicamentos, todavía falta una visión científica dirigida, sobre todo, a la gestión y a los diferentes usos de los recursos terapéuticos y económicos del sistema de salud brasileño, así como una visión ambiental en cuanto al uso de los medicamentos.

Para qué indicaciones se están utilizando los antidepresivos en adultos de Colombia / For What Indications are Antidepressants Being Used in Adults in Colombia?

RESUMEN Introducción: Los antidepresivos son útiles en el tratamiento farmacológico de diferentes trastornos depresivos y de ansiedad, además de su potencial utilidad para otras indicaciones. El objetivo del estudio es determinar las indicaciones para las que se están prescribiendo los antidepresivos a pacientes mayores de 18 años afiliados al Sistema de Salud de Colombia. Métodos: Estudio retrospectivo con datos de pacientes mayores de 18 años, de cualquier sexo, afiliados al Sistema de Salud de Colombia, a los que se prescriben antidepresivos; se revisaron las historias clínicas buscando indicaciones aprobadas y no aprobadas por agencias reguladoras. Se identificó a los pacientes aleatoriamente, así como las variables sociodemográficas, clínicas y farmacológicas que se pudieran asociar con prescripciones para indicaciones no aprobadas. Resultados: Se evaluó a 351 pacientes, con una media de edad de 60,4 ± 15,3 años; el 72,6% eran mujeres; se atendieron en 34 ciudades, y los prescriptores principalmente fueron médico general (n = 276; 78,6%) y psiquiatra (n = 42; 12,0%). Los inhibidores selectivos de la recaptación de serotonina fueron los antidepresivos más prescritos (n = 204; 58,1%), seguidos de los atípicos (n = 76; 21,7%). Las indicaciones más frecuentes fueron depresión (n = 169; 48,1%), ansiedad (n = 48; 13,7%), dolor (n = 22; 6,3%) y trastornos del sueño (n = 17; 4,8%). Un total de 188 prescripciones (53,6%) se hicieron para indicaciones aprobadas y las 163 (46,4%) restantes se catalogaron como no aprobadas. Conclusiones: Los antidepresivos se están prescribiendo para tratar depresión, ansiedad, analgesia y trastornos del sueño, especialmente a mujeres adultas mayores, pero casi la mitad de las formulaciones fueron para indicaciones no aprobadas.

ABSTRACT Introduction: Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System. Methods: Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications. Results: 351 patients were evaluated, with a mean age of 60.4 ± 15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n = 276; 78.6%), and psychiatrists (n = 42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n = 204; 58.1%), followed by atypicals (n = 76; 21.7%). The most frequent indications were for depression (n = 169; 48.1%), anxiety (n = 48; 13.7%), pain (n = 22; 6.3%) and sleep disorders (n = 17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved. Conclusions: Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.

Dispensación de antibióticos en un instituto de seguridad social universitario. Corrientes, Argentina. 2020

Objetivo Caracterizar la dispensa de antibióticos a pacientes ambulatorios en un instituto de seguridad social universitario durante el año 2020. Método Se realizó un estudio observacional, descriptivo-correlacional de utilización de medicamentos. Para cuantificar la dispensa, se utilizó la dosis diaria definida (DDD) por 1 000 habitantes por día (DHD) y la unidad de dosis, recomendadas por la Organización Mundial de la Salud (OMS), y el valor intrínseco terapéutico potencial como indicador cualitativo, según Laporte y Tognoni. Resultados Se incluyeron 4 748 dispensaciones ambulatorias. Edad promedio: 42 años; rango: 0-94 años, con predominio del sexo femenino (55%). La mayoría pertenecían al grupo de las penicilinas (51,3%) con predominio de amoxicilina en asociaciones a dosis fija o como monofármaco (48,3%), seguida por los macrólidos (21,0%) y las fluoroquinolonas (17,0%). Se pudo apreciar un consumo potencial de 7,7 DHD, lo cual implica que, en promedio, 7 de cada 1 000 afiliados de la institución estuvo expuesto a estos agentes diariamente, con predominio de amoxicilina asociada a ácido clavulánico (2,2 DHD). Conclusión La población general de universitarios estuvo expuesta a una prescripción alta de amoxicilina en asociaciones a dosis fijas, algunas de valor inaceptable o relativa, así como también a los nuevos macrólidos y fluoroquinolonas de segunda y tercera generación. Esto requiere especial atención, porque el consumo indiscriminado a nivel ambulatorio de antibióticos de amplio espectro podría convertirse en un factor de riesgo para el desarrollo de resistencia bacteriana; implica, además, un riesgo en la aparición de eventos adversos serios y un incremento en el gasto sanitario.

Objective To characterize the dispensing of antibiotics to outpatients of a university social security institute during the year 2020. Methods An observational, descriptive-correlational study of drug use was carried out. To quantify the dispensation, the defined daily dose (DDD) per 1 000 inhabitants per day (DHD) and the dose unit, recommended by the World Health Organization (WHO), were used. The classification of potential therapeutic intrinsic value, by Laporte and Tognoni, was used as a qualitative indicator. Results A total of 4 748 outpatient dispensations of antibiotics were included, 55% for the female sex. Average age: 42 years; range: 0-94 years. The majority belonged to the penicillin group (51.3%) with a predominance of amoxicillin (48.3%) in fixed-dose associations or mono-drug, followed by macrolides (21.0%) and fluoroquinolones (17.0%). A potential consumption of 7.7 DHD was observed, which implies that, on average, 7 out of every 1 000 members of the institution were exposed to these agents daily with a predominance of amoxicillin associated with clavulanic acid (2.2 DHD). Conclusion The general population of university students was exposed to high fixed-dose associations prescription of amoxicillin, some of relative or unacceptable potential therapeutic intrinsic value, as well as to the new macrolides and second or third generation of fluoroquinolones. This requires special attention because the indiscriminate outpatient use of broad-spectrum antibiotics could become a risk factor for the development of bacterial resistance. It also implies a higher risk of serious adverse events and an increase in healthcare costs.

High-risk pregnancy: characterization of medication use profile and association with clinical and sociodemographic factors / Gestação de alto risco: caracterização do perfil de utilização de medicamentos e associação com fatores clínicos e sociodemográficos

Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.

Resumo Objetivos: descrever o perfil de utilização de medicamentos e de adesão, e a associação com as características clínicas e sociodemográficas de gestantes de alto risco atendidas em um hospital universitário. Métodos: trata-se de um estudo transversal com dados coletados mediante um questionário estruturado aplicado à 386 gestantes. Resultados: a maior parte das participantes era acompanhada apenas pelo ginecologista (75,1%), iniciou o pré-natal no primeiro trimestre gestacional (86,8%), não planejou a gravidez (61,9%) e realizou em média 8,2 (DP=4,4) consultas de pré-natal. Os diagnósticos mais frequentes foram hipertensão arterial (20,5%) e diabetes mellitus (19,7%). A prevalência de uso de medicamentos foi 99,7%, com média de 5,1 (DP=2,1) medicamentos por mulher e 12,7% de automedicação. Os antianêmicos (88,9%) e analgésicos (63,2%) foram as classes farmacológicas mais prevalentes e 17,9% das gestantes referiram uso de fármacos com risco gestacional relevante. Apenas 36,5% das gestantes foram consideradas aderentes ao tratamento, 32,9% declararam desconhecer a indicação dos medicamentos em uso e 42% não receberam orientações sobre o uso de medicamentos durante a gestação. Não há evidências de associação entre o número de medicamentos utilizados e os aspectos clínicos e sociodemográficos. Conclusão: é necessário desenvolver estratégias para melhorar o atendimento desta população e o uso racional de medicamentos, com ênfase no fortalecimento do cuidado multiprofssional.

Indicación y prescripción de macrólidos en una población colombiana / Study of the indications for macrolide prescriptions in a Colombian population

Introducción. El uso inadecuado de antibióticos se asocia con aumento de la resistencia antimicrobiana, mayores costos de atención médica, más efectos adversos y peores resultados clínicos. Objetivo. Determinar los patrones de prescripción y las indicaciones aprobadas y no aprobadas para macrólidos en un grupo de pacientes en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal sobre las indicaciones de uso de macrólidos en pacientes ambulatorios a partir de una base de datos de dispensación de medicamentos de 8,5 millones, aproximadamente, de personas afiliadas al sistema de salud de Colombia. Se consideraron variables sociodemográficas, farmacológicas y clínicas. Resultados. Se encontraron 9.344 pacientes que habían recibido prescripción de macrólidos; su mediana de edad era de 40,1 años (rango intercuartílico: 27,1-53,3 años) y el 58,3 % correspondía a mujeres. El macrólido más prescrito fue la azitromicina (38,8 %) y los usos más frecuentes fueron el tratamiento de la infección por Helicobacter pylori (15,9 %) y la neumonía (15,8 %). El 31,3 % de las prescripciones correspondía a indicaciones no aprobadas, destacándose el resfriado común (7,8 %), la Covid-19 (4,0 %) y la bronquitis aguda (3,5 %). La residencia en la región Caribe (OR=1,17; IC95% 1,05-1,31), las prescripciones odontológicas (OR=2,75; IC95% 1,91-3,96), las comorbilidades respiratorias crónicas (OR=1,30; IC95% 1,08-1,56), y la prescripción de eritromicina (OR=3,66; IC95% 3,24-4,14) o azitromicina (OR=2,15; IC95% 1,92 2,41), se asociaron con una mayor probabilidad de recibir macrólidos para indicaciones no aprobadas, en tanto que tener entre 18 y 64 años (OR=0,81; IC95% 0,71-0,93), 65 o más años (OR=0,77; IC95% 0,63-0,94) y residir en Bogotá-Cundinamarca (OR=0,74; IC95% 0,65 0,85) reducían dicho riesgo. Conclusiones. La mayoría de los pacientes recibieron macrólidos para infecciones del sistema respiratorio; la eritromicina y la azitromicina se prescribieron en indicaciones no aprobadas en menores de 18 años y en quienes presentaban enfermedades respiratorias crónicas.

Introduction: The inappropriate use of antibiotics is associated with a greater risk for antimicrobial resistance, high health care costs, adverse events, and worse clinical outcomes. Objective: To determine the prescription patterns and approved and nonapproved indications for macrolides in a group of patients from Colombia. Materials and methods: This was a cross-sectional study on the indications for the use of macrolides in outpatients registered in a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian health system. Sociodemographic, pharmacological, and clinical variables were considered. Results: A total of 9.344 patients had received a macrolide prescription; their median age was 40.1 years (interquartile range: 27.1-53.3 years) and 58.3% were women. The most commonly prescribed macrolide was azithromycin (38.8%) most frequently for Helicobacter pylori infection (15.9%) and pneumonia treatment (15.8%). A total of 31.3% of the prescriptions were used for unapproved indications: common cold (7.8%), COVID-19 (4.0%), and acute bronchitis (3.5%). Residence in the Caribbean region (OR=1.17; 95%CI 1.05-1.31), dental prescriptions (OR=2.75; 95%CI 1.91-3.96), presence of chronic respiratory comorbidities (OR=1.30; 95%CI 1.08-1.56), and prescription of erythromycin (OR=3.66; 95%CI 3.24-4.14) or azithromycin (OR=2.15; 95%CI 1,92-2.41) were associated with a higher probability of macrolide use for unapproved indications while being 18-64 years old (OR=0.81; 95%CI 0.71-0.93) or 65 years or older (OR=0.77; 95%CI 0.63-0.94) and residing in Bogotá-Cundinamarca (OR=0.74; 95%CI 0.65-0.85) were associated with reduced risk. Conclusions: Most patients received macrolides for respiratory tract infections; erythromycin and azithromycin were used for unapproved indications in people under 18 years of age and those with chronic respiratory diseases.

Competencias profesionales del farmacólogo en farmacoepidemiología / The pharmacologist's professional competences in pharmacoepidemiology

Introducción: Los retos y las exigencias del mundo contemporáneo requieren de profesionales de la salud con una formación académica basada en competencias. La especialidad de Farmacología en Cuba no ha definido sus competencias profesionales. Objetivo: Definir las competencias profesionales de los especialistas en Farmacología para su desempeño como farmacoepidemiólogos. Métodos: Estudio de desarrollo en el que se obtuvieron las competencias profesionales genéricas y específicas que los especialistas en Farmacología debían alcanzar para desempeñarse como farmacoepidemiólogos. El trabajo se realizó en La Habana entre marzo de 2018 y febrero de 2019. Se aplicaron técnicas cualitativas y revisiones documentales sobre las temáticas relacionadas con el objeto de la investigación. Se trabajó con dos grupos de expertos en dos etapas. Se empleó la metodología Delphi. Resultados: Se construyeron 24 competencias, genéricas y específicas, de las áreas funcionales asistencial, investigativa, docente y gerencial, que los especialistas en Farmacología debían alcanzar para desempeñarse como farmacoepidemiólogos. Conclusiones: Las competencias definidas permiten al farmacoepidemiólogo lograr un uso racional de los medicamentos, lo cual tributa a su propósito clave: una atención de calidad durante el proceso salud-enfermedad(AU)

Introduction: The challenges and demands of the contemporary world require health professionals with competency-based academic training. The specialty of pharmacology in Cuba has not defined its professional competencies. Objective: To define the professional competences of pharmacology specialists for their performance as pharmacoepidemiologists. Methods: Development study that allowed obtaining the generic and specific professional competences that pharmacology specialists should reach to practice as pharmacoepidemiologists. The work was carried out in Havana between March 2018 and February 2019. Qualitative techniques were applied, together with documental reviews on the topics related to the research object. Two groups of experts participated in the work during two stages. The Delphi methodology was used. Results: Twenty-four competencies, either generic or specific, were determined, belonging to the functional areas of care, research, teaching and management, which pharmacology specialists should achieve to practice as pharmacoepidemiologists. Conclusions: The competencies defined allow the pharmacoepidemiologist to achieve a rational use of drugs, which contributes to the key purpose of the specialized profession: quality care during the health-disease process(AU)

Uso de medicamentos entre adolescentes rurais quilombolas e não quilombolas no interior da Bahia, Brasil / Medication use among quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil

Resumo Este estudo visa descrever o uso de medicamentos prescritos e não prescritos e fatores associados entre adolescentes residentes em comunidades rurais, quilombolas e não quilombolas, do interior da Bahia, Brasil. Trata-se de um inquérito populacional com 390 adolescentes entre 10 e 19 anos de idade, realizado em 2015. Foram estimadas prevalências e odds ratio para uso de medicamentos prescritos e não prescritos, e análise múltipla foi conduzida por Regressão Logística Multinomial. Entre os entrevistados, 13,6% fez uso apenas de medicamentos prescritos e 14,4% fez uso apenas de medicamentos não prescritos. Os quilombolas demonstraram uma maior diversidade de especialidades farmacêuticas utilizadas. A baixa prevalência no uso de medicamentos nos dois grupos de adolescentes sugere um menor acesso a esses produtos. Apesar disso, observou-se a utilização irracional de medicamentos, principalmente como automedicação. Os adolescentes quilombolas, mesmo dentro da área de abrangência das outras comunidades, apresentaram diferentes fatores associados quando comparado ao grupo não quilombola: a presença de dor de dente nos últimos 6 meses e procurar o mesmo serviço de saúde aumentaram o uso de medicamentos prescritos.

Abstract This study aims to describe the use of prescribed and non-prescribed medications and associated factors among adolescents living in rural, quilombolas and non-quilombolas communities in the interior of Bahia, Brazil. This is a population-based survey with 390 adolescents between 10 and 19 years old in 2015. Prevalence and odds ratio for use of prescribed and non-prescribed medication, and multiple analysis was conducted by Multinomial Logistic Regression. Among the interviewees, 13.6% used only prescribed medications and 14.4% only used non-prescribed medications. Quilombolas demonstrated a greater diversity of pharmaceutical specialties used. The low prevalence of medication use in both groups of adolescents suggests less access to these products. Despite this, it was observed the irrational use of medication, mainly as self-medication. Quilombola adolescents, although they belong to the same area of coverage of other communities, presented different associated factors when compared to the non-quilombola group: the presence of toothache in the last 6 months and have had a regular source of care increased the use of prescribed medications.

Vigilancia del consumo de antimicrobianos en 10 instituciones de salud entre 2013 y 2020 en Colombia / Antibiotic consumption surveillance in 10 health institutions between 2013 and 2020 in Colombia

INTRODUCCIÓN: El uso de antimicrobianos es el principal factor de resistencia bacteriana. OBJETIVO: Determinar el consumo de antimicrobianos en instituciones de salud de Santiago de Cali entre 2013 y 2020. MATERIAL Y MÉTODO: Se empleó la Dosis Diaria Definida por 100 camas-día. Se definieron como criterios de inclusión las instituciones que tuvieran como mínimo 9 reportes anuales y que el reporte fuese superior a 95%. En este caso quedaron incluidas 10 instituciones. RESULTADOS: El consumo en Unidades de Cuidados Intensivos (UCI) fue mayor que en servicios diferentes a UCI. Se consumió más ceftriaxona e imipenem en servicios diferentes a UCI, mientras que meropenem, piperacilina/tazobactam y vancomicina lo fueron en UCI. En servicios diferentes a UCI, dos instituciones aumentaron el consumo para ceftriaxona, ciprofloxacina y piperacilina/tazobactam y una para vancomicina, mientras que en UCI en una institución el consumo aumentó para piperacilina/tazobactam. CONCLUSIÓN: El sistema brindó herramientas de vigilancia prospectiva que mostraron necesidades de intervención en instituciones.

BACKGROUND: The use of antibiotics is the main factor of microbial resistance. Aim: To determine the consumption of antibiotics in health care institutions in Santiago de Cali between 2013 and 2020. METHODS: The methodology of the Defined Daily Dose per 100 beddays was employed. Institutions that had at least 9 annual reports and that the report is greater than 95% were defined as inclusion criteria. In this case, 10 institutions were included. RESULTS: Consumption in Intensive Care Units (ICU) was higher than in other units. Ceftriaxone and imipenem were more consumed in units other than ICU, whereas meropenem, piperacillin/tazobactam and vancomycin were more consumed in the ICU. In units other than ICU, two institutions increased the consumption of ceftriaxone, ciprofloxacin and piperacillin/tazobactam and one the consumption of vancomycin, whereas in the ICU, one institution increased the consumption of piperacillin/tazobactam. The endemic range identified that vancomycin located itself in the epidemic zone in one institution. CONCLUSION: The system provided tools for prospective surveillance that showed the need for intervention in institutions.