Evaluation of the follow-up of children treated for congenital syphilis in a municipality in the state of Espírito Santo, when it lacked crystalline penicillin / valiação do acompanhamento de crianças tratadas para sífilis congênita em município do estado do espírito santo em época de falta de penicilina cristalina

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. In Brazil, its incidence has increased, along with the lack of penicillin, the antibiotic of choice for congenital syphilis, from 2014 to 2017. During this period, children were treated with alternative drugs, but to date, data from the scientific literature do not recommend another antibiotic. Objective: To compare the progression, according to the established treatment, and evaluate the follow-up in health care facilities in Vila Velha (Espírito Santo) of children with congenital syphilis aged up to two years, born in Hospital Infantil e Maternidade Alzir Bernardino Alves ­ a reference in neonatology and low-risk pregnancy in the state at the time ­ from 2015 to 2016, when the hospital experienced a greater lack of penicillin. Methods: This is a retrospective cross-sectional observational study based on data from medical records of the hospital and other healthcare facilities in the city. We performed statistical analyses, per health district, of epidemiological and sociodemographic data, as well as those related to visits, their frequency, and clinical profile, according to the follow-up parameters proposed by the Ministry of Health at the time. Results: Medical records of 121 children were evaluated, presenting as the main findings: only 35% of the children completed the follow-up; among those treated with ceftriaxone, 55.2% completed the follow-up, and 100% of the children whose venereal disease research laboratory was greater than that of their mother at birth completed the follow-up. Of the symptomatic children at birth who remained or became symptomatic at follow-up, 58.8% used ceftriaxone. Conclusion: Among symptomatic children at birth, most of those treated with ceftriaxone remained symptomatic at follow-up. The Counseling and Testing Center was the most successful facility in the follow-up of these children. District 5 had the lowest success rate in the follow-up of these patients, and districts 1 and 2 showed the lowest rates of appropriate approach to congenital syphilis during follow-up. (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível causada pela bactéria Treponema pallidum. No Brasil, sua incidência vem aumentando, acompanhada da falta de penicilina, antibiótico de escolha para a sífilis congênita, no período de 2014­2017. Nesse período, as crianças foram tratadas com medicamentos alternativos, porém dados da literatura científica até o momento não recomendam outro antibiótico. Objetivo: Comparar a evolução, de acordo com o tratamento instituído, e avaliar o acompanhamento nas unidades de saúde em Vila Velha (ES), até os dois anos de idade, das crianças com sífilis congênita nascidas no Hospital Infantil e Maternidade Alzir Bernardino Alves ­ referência em neonatologia e gravidez de baixo risco no estado na época ­ de 2015 a 2016, período em que houve maior falta de penicilina no hospital. Métodos: Estudo observacional do tipo transversal, retrospectivo, baseado em dados dos prontuários do hospital e outras Unidades de Saúde do município. Foram analisados estatisticamente, por região de saúde, dados epidemiológicos, sociodemográficos, bem como relativos às consultas, sua periodicidade e ao perfil clínico, de acordo com os parâmetros de seguimento propostos pelo Ministério da Saúde na época. Resultados: Avaliaram-se os prontuários de 121 crianças, obtendo-se como principais achados: somente 35% das crianças tiveram seguimento completo; das crianças tratadas com ceftriaxona, 55,2% tiveram seguimento completo, e 100% das crianças que tiveram VDRL maior que o da mãe no parto completaram o seguimento. Das crianças sintomáticas ao nascimento e que permaneceram ou ficaram sintomáticas no seguimento, 58,8% fizeram uso de ceftriaxona. Conclusão: Das crianças sintomáticas ao nascimento, as tratadas com ceftriaxona, em sua maioria, mantiveram-se sintomáticas no seguimento. O Centro de Testagem e Aconselhamento teve maior êxito no acompanhamento dessas crianças. A região 5 teve a menor taxa de êxito no seguimento desses pacientes, e as regiões 1 e 2 menor taxa de abordagem correta para sífilis congênita durante o seguimento. (AU)

Percepción de la automedicación con antibióticos en los usuarios externos de un hospital público en Lima-Perú / Perception of self-medication with antibiotics in the external users of a public hospital in Lima, Peru

PROBLEMA: ¿Cuál es la percepción sobre la automedicación con antibióticos en los usuarios de consultorio externo del Hospital Nacional Arzobispo Loayza? Hipótesis: Existe relación directa entre el grado de instrucción y la automedicación con antibióticos en los sujetos de estudio. Objetivo: Identificar las percepciones más comunes sobre la automedicación con antibióticos en los usuarios de consultorio externo del HNAL. MATERIAL Y METODOS: Estudio tipo encuesta, de carácter prospectivo observacional, descriptivo y transversal. Población: Usuarios de Consultorios Externos del Hospital Nacional Arzobispo Loayza, Lima Perú, a partir del mes de Noviembre del año 2011 en adelante. Muestra: n=369. RESULTADOS: El 58 por ciento de los usuarios se auto medican con antibióticos, el grado de instrucción superior es menos prevalente en quienes se auto medican (38 por ciento) comparado con quienes no practican esta actividad (53,8 por ciento), (p=0,003). Los síntomas respiratorios fueron la causa más común para la automedicación y el 84,5 por ciento consideran a los antibióticos en el tratamiento del resfrío común. También perciben motivos no relacionados al estado de la salud para automedicarse, como tratamiento "Ya conocido", "Confianza en el personal de la farmacia" o "tiempo prolongado de espera en el hospital previo a la consulta médica". Los antibióticos más usados en la automedicación son los Betalactámicos, Quinolonas y Aminoglucósidos. Durante la automedicación, el 49,3 por ciento acceden a los antibióticos por petición directa y el 33,3 por ciento por sugerencia del personal de la farmacia. Durante el consumo de antibióticos sin receta médica, el 89,2 por ciento consideran "mejoría de sus síntomas". CONCLUSIONES: El 58 por ciento de los usuarios de consultorio externo del HNAL practica la automedicación con antibióticos, siendo probablemente las infecciones respiratorias, la causa más común, sin embargo se describen otras causas no relacionados al estado de salud...

PROBLEM: What is the perception of self-medication with antibiotics in outpatient users Hospital Nacional Arzobispo Loayza?. HYPOTHESIS: There is a direct relationship between the level of education and self- medication with antibiotics in the study subjects. Objective: To identify more usual perceptions on self medication with antibiotics in outpatient users the HNAL. MATERIAL AND METHODS: Interview-study. A prospective, observational, descriptive and transversal. Population: External Doctor users Hospital Nacional Arzobispo Loayza, Lima Peru, from the month of November, 2011 onwards. Sample: n=369. RESULTS: 58 per cent of users did self medicate with antibiotics, higher educational attainment is less prevalent in those who selfmedicate (38 per cent) compared to those who do not practice this activity (53.8 per cent), (p=0.003). Respiratory symptoms were the most common cause for self-medication and 84.5 per cent considered to antibiotics in the treatment of the common cold. Also reasons related to perceived health status to self-medicate, as treatment "already known", "Trust in the pharmacy staff" or "long time waiting in the hospital before medical consultation." The antibiotics used in self-medication are the beta-lactams, quinolones and aminoglycosides. During the self-medication, 49.3 per cent use direct request antibiotics and 33.3 per cent at the suggestion of pharmacy staff. During the consumption of antibiotics without prescription, 89.2 per cent consider "improvement in their symptoms". CONCLUSIONS: The 58 per cent of outpatient users of HNAL practiced self-medication with antibiotics, respiratory infections being probably the most common cause, however described other causes unrelated to health status as "therapy known as", "confidence in the pharmacy staff" or "prolonged delay before medical consultation" as possible causes of self-medication. Antibiotics groups used for this practice were the beta-lactams, quinolones and aminoglycosides.

Consumo comunitario de antimicrobianos en Chile, 2000-2008 / Community antibiotic consumption in Chile, 2000-2008

Background: The Chilean Ministry of Health has implemented regulatory rules for the consumption of anti-biotics since September 1999, with sales restriction limited only with medical prescription. Aim: To analyze the impact of established regulatory measures from 2000 to 2008. Material and Methods: A retrospective analysis of antibiotics sales in pharmacies from 2000 to 2008 was performed. The information was obtained from the International Marketing System (IMS Health), an auditing system of pharmacy sales. The consumption unit used was the Defined Daily Dose per 1000 inhabitants/day (DDD). Results: From 2000 to 2002 the regulatory rules had a great impact, but since 2002 the antibiotic consumption increased, especially amoxicillin, returning to similar levéis observed in 1998. Conclusions: The regulatory measures had an initial impact, but there was not reinforcement in the time and there was no further control. It is necessary to assume a permanent task and support of the authorities of health to edúcate the population about the implications of the inadequate use of antimicrobials and his effect on the microbial ecology.

Introducción: El Ministerio de Salud de Chile reguló el consumo de antimicrobianos en el mes de septiembre de 1999, mediante restricción de venta limitada sólo a venta con receta médica. El objetivo de este estudio es conocer el impacto de las medidas regulatorias entre los años 2000 y 2008. Metodología: Se realizó un análisis retrospectivo de las ventas en farmacias privadas desde el año 2000 al 2008. La información se obtuvo del International Marketing System Health (IMS Health), una empresa internacional encargada de auditar las ventas de farmacias. La unidad de consumo usada fue la DDD/1.000 habitantes-día. Resultados: A partir del año 2000 al 2002, las medidas regulatorias tuvieron un gran impacto; sin embargo, desde el año 2002 el consumo de antimicrobianos aumentó, especialmente amoxicilina, obteniéndose valores similares a los existentes en 1998. Conclusiones: Las medidas regulatorias tuvieron un impacto inicial; sin embargo, no fueron reforzadas ni controladas en el tiempo. Es necesario que las autoridades de salud del país asuman la tarea pennanente de educar a la comunidad acerca del uso inadecuado de antimicrobianos y su efecto sobre la ecología bacteriana.

Evaluation of antibiotics dispensing profile in Tubarão, Santa Catarina, Brazil / Avaliação do perfil de distribuição de antibióticos em Tubarão, Santa Catarina, Brasil

Antibiotics are drugs widely used in prophylaxis and treatment of a great number of diseases. However, their use must be carefully controlled as acquisition in pharmacies, often without medical prescription, is elevated. The role of pharmacists in these circumstances is to practice dispensation in a rational manner. Through a structured questionnaire with open and closed questions, this study investigated the profile of antibiotics dispensed in pharmacies of Tubarão, Santa Catarina, Brazil. From the responses, it was observed that 85.0 percent dispense this class of medicine without medical prescription, mainly for treatment of respiratory (62.8 percent) and urinary (12.0 percent) tract disorders. Moreover, pharmacists' guidance was largely focused on posology (66.6 percent) and drug interaction (12.6 percent), in addition to the interactions with contraceptives, alcohol and milk. The importance of avoiding antibiotics dispensation without medical prescription must be emphasized, as well as the benefits of educating the population to promote the rational use of medicines.

Antibióticos são fármacos amplamente utilizados na profilaxia e no tratamento de grande número de doenças. Entretanto, seu uso deve ser cuidadosamente controlado nas farmácias, uma vez que nestas a aquisição sem prescrição médica é elevada. O papel dos farmacêuticos nessas circunstâncias é o de praticar a dispensação de maneira racional. Por meio de questionário estruturado, com questões abertas e fechadas, investigou-se o perfil dos antibióticos dispensados em farmácias de Tubarão, Santa Catarina, Brasil. Pelas respostas, observou-se que 85 por cento das dispensa essa classe de medicamentos sem prescrição médica, principalmente para o tratamento de problemas dos tratos respiratório (62,8 por cento) e urinário (12,0 por cento). Além disso, a orientação dos farmacêuticos se focou amplamente na posologia (66,6 por cento)e nas interações com fármacos (12,6 por cento), em adição às interações com anticoncepcionais, álcool e leite. A importância de se proibir a dispensação sem prescrição médica deve ser enfatizada, assim como os benefícios da educação da população para promover o uso racional de medicamentos.

Utilização de um sistema de gerenciamento de benefícios farmacêuticos (PBM) para a caracterização do perfil de prescrição e aquisição de antibióticos / Use of pharmacy banafits management (PBM) system to describe the profile of antibiotic prescription and purchase

No Brasil o PBM (Pharmacy Benefits Management) é de utilização relativamente nova, podendo-se classificá-lo como um sistema de gerenciamento de saúde que administra benefícios na compra e venda de medicamentos. Considerando que o surgimento de bactérias resistentes está relacionado à prescrição inapropriada de antibióticos ou ao uso de antibióticos de baixa atividade, este estudo avaliou se o sistema PBM pode fornecer informações úteis sobre os perfis de prescrição e aquisição de antibióticos de efeitos sistêmicos, a partir da base de dados de uma empresa de PBM brasileira, referente a um grupo formado por 6 525 metalúrgicos de uma empresa da região de Campinas, SP, e seus dependentes, cobrindo o período de janeiro a abril de 2005. Observou-se que 7,7 por cento de todos os medicamentos adquiridos eram antibióticos sistêmicos, numa média 2,4 antibióticos e ao custo de R$ 51,80 por receita. A amoxicilina foi o fármaco mais prescrito e em 92,7 por cento dos casos o usuário adquiriu o medicamento até um dia após a consulta médica. A partir das listas das especialidades farmacêuticas adquiridas (por unidade de venda), dos laboratórios fabricantes, dos antibióticos que compunham cada produto, das datas de emissão das receitas e da dispensação, foi possível concluir que o sistema permite extrair informações relevantes sobre o tema enfocado.

Pharmacy Benefits Management (PBM), a system that manages benefits in the purchase and sale of drugs, is of relatively recent implementation in Brazil. Taking into account that the development of bacterial resistance is related to the inadequate prescription of antibiotics or to the use of low activity antibiotics, this study sought to assess the capability of PBM to provide useful information on the profiles of prescription and purchase of systemic antibiotics. The data used for this purpose were collected from the database of a Brazilian PBM company and related to a group of 6 525 metalworkers of a company located in the region of Campinas, SP, and to their dependents, covering the period from January to April 2005. Of the drugs purchased, 7.7 percent were systemic antibiotics, with a mean of 2.4 antibiotics and a mean cost of R$ 51.80 per prescription. Amoxicillin was the most prescribed drug. In 92.7 percent of cases, users purchased the prescribed drug within one day of the medical visit. Based on the lists of purchased pharmaceutical specialties (per retail package), manufacturers, antibiotics present in the composition of each product, prescription dates, and dispensation dates, the system was found capable of providing relevant information on the theme investigated.

Educational intervention program to optimize the use of antibiotics: impact on prescribing habits, consumption of antimicrobial agents and cost savings

Antimicrobials are among the most frequently used drugs worldwide, especially in developing countries, where there are limited data on the use of these therapeutic agents. The Pharmacy Service and the Hospital Infection Control Commission (HICC) of a medium complexity university hospital, concerned about the rational use of broad-spectrum antimicrobials, have devised a sequential intervention program to improve the use of the antibiotics ceftazidime, ciprofloxacin, imipenem and vancomycin in Intensive Care Units (ICUs). The program was developed in three successive steps lasting six months each: baseline data collection (November 2001 to April 2002), initial intervention period (May 2002 to October 2002), educational intervention program (November 2002 to April 2003). All the ICU antimicrobial prescriptions were reviewed and consumption was converted into Defi ned Daily Doses per 100 patient-days and tabulated to compare different periods and the respective costs. A total of 459 ICU patients were followed through. A change in the profile of antimicrobial prescriptions was observed: a reduction in the use of broad spectrum antimicrobials, reduced number of antimicrobials per patient and improvement in etiological investigation of infection. Significant reductions of ciprofl oxacin (69.2%), imipenem (56.3%) and vancomycin (39.0%) consumption were observed. Total cost savings, based on the data for the four drugs, was US$31,523.58 (58.6%). The multidisciplinary educational intervention program was thus responsible for both an improvement in the use of broad-spectrum antimicrobials in the ICU and cost savings.

Dispening and quality of Amoxicillin Preparations in Retail Pharmacies on Tanzania Market

A study on dispensing practice and quality of amoxycillin capsules and syrups was conducted in retail pharmacies in 5 regions of Tanzania. Data on dispensing practice was collected by interviewing 75 dispensers through structured questionnaires. Quality of amoxycillin capsule formulations and dry powder for suspension preparations from six different manufacturers was evaluated for chemical content at the Tanzania Food and Drug Authority (TFDA) in Dar es Salaam. The study showed that of all the dispensers only 17.3were pharmacists; 21.3pharmaceutical technicians and 28were nurses of different ranks. Results indicated that the most dispensed amoxicyllin was the locally produced preparation which accounted for 41.3. Affordability determined the most dispensed and lowest priced generic brand; amoxycillin by 68. Results revealed that only 46.6dispensers refused to dispense amoxycillin without a prescription while 53.4dispensed. Out of the ones who dispensed; 42.5gave patients the most expensive preparations and 22.5just dispensed according to the patients' demands. Similarly patients with prescriptions written in a generic name; the dispensers (28) issued them with the most expensive brand while others were issued the brand they specifically demanded by 32of the dispensers. For patients who came to the pharmacy with less money; results revealed that 66.7of the dispensers dispensed incomplete doses and then requested them to come back for the remainder and 13.3just gave out incomplete doses without any further counseling. Responses regarding reconstitution of the dry powder for suspension showed that only 10.7dispensers reconstituted before giving it out to patients and the rest just instructed patients on how to reconstitute at home. Further; 74.7of dispensers instructed the patients to use teaspoons to measure 5ml of the suspension. The results from the assessment of chemical contents showed that all capsules and dry powder for suspensions complied with respect to pharmacopoeial limits. It is concluded that dispensers should continually undergo continuing education on good dispensing practices

Uso inadequado de antimicrobianos e custos hospitalares: estudo em hospital de pequeno porte no interior de Säo Paulo / Inadequated use of antimicrobial and hospital costs : study in the small hospital in the Säo Paulo

Através da análise da utilizaçäo inadequada de antimicrobianos e seus reflexos nos custos hospitalares de um hospital de pequeno porte do interior do Estado de Säo Paulo, discute-se a importância da existência de atividades de controle de antimicrobianos, para o melhor direcionamento dos gastos hospitalares