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1.
PLoS One ; 17(2): e0263437, 2022.
Article in English | MEDLINE | ID: covidwho-1793528

ABSTRACT

BACKGROUND: During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine. OBJECTIVES: We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017-2019. METHODS: Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days. RESULTS: In the period 2017-2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017-2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017-2019. CONCLUSIONS: Our data showed increased azithromycin distribution in the period 2017-2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.


Subject(s)
Azithromycin/therapeutic use , Drug Utilization/trends , Practice Patterns, Physicians'/trends , Anti-Bacterial Agents , Anti-Infective Agents , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Croatia/epidemiology , Databases, Factual , Drug Therapy, Combination , Hospitalization , Humans , Hydroxychloroquine/therapeutic use , Pandemics , Practice Patterns, Physicians'/statistics & numerical data , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity
2.
Drug Saf ; 43(8): 699-709, 2020 08.
Article in English | MEDLINE | ID: covidwho-1482336

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic that hit the world in 2020 triggered a massive dissemination of information (an "infodemic") about the disease that was channeled through the print, broadcast, web, and social media. This infodemic also included sensational and distorted information about drugs that likely first influenced opinion leaders and people particularly active on social media and then other people, thus affecting choices by individual patients everywhere. In particular, information has spread about some drugs approved for other indications (chloroquine, hydroxychloroquine, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, favipiravir, and umifenovir) that could have led to inappropriate and therefore hazardous use. In this article, we analyze the rationale behind the claims for use of these drugs in COVID-19, the communication about their effects on the disease, the consequences of this communication on people's behavior, and the responses of some influential regulatory authorities in an attempt to minimize the actual or potential risks arising from this behavior. Finally, we discuss the role of pharmacovigilance stakeholders in emergency management and possible strategies to deal with other similar crises in the future.


Subject(s)
Coronavirus Infections , Drug Utilization/trends , Information Dissemination , Pandemics , Pneumonia, Viral , Public Health , Attitude to Health , Betacoronavirus , COVID-19 , Coronavirus Infections/classification , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Humans , Information Dissemination/ethics , Information Dissemination/methods , Medication Therapy Management/ethics , Medication Therapy Management/standards , Pharmacovigilance , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Public Health/methods , Public Health/standards , SARS-CoV-2 , Social Media/ethics , Social Media/standards , Social Medicine/ethics , Social Medicine/standards
3.
Circ Heart Fail ; 14(10): e008573, 2021 10.
Article in English | MEDLINE | ID: covidwho-1443687

ABSTRACT

BACKGROUND: An unprecedented shift to remote heart failure outpatient care occurred during the coronavirus disease 2019 (COVID-19) pandemic. Given challenges inherent to remote care, we studied whether remote visits (video or telephone) were associated with different patient usage, clinician practice patterns, and outcomes. METHODS: We included all ambulatory cardiology visits for heart failure at a multisite health system from April 1, 2019, to December 31, 2019 (pre-COVID) or April 1, 2020, to December 31, 2020 (COVID era), resulting in 10 591 pre-COVID in-person, 7775 COVID-era in-person, 1009 COVID-era video, and 2322 COVID-era telephone visits. We used multivariable logistic and Cox proportional hazards regressions with propensity weighting and patient clustering to study ordering practices and outcomes. RESULTS: Compared with in-person visits, video visits were used more often by younger (mean 64.7 years [SD 14.5] versus 74.2 [14.1]), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%) individuals (P<0.05 for all). Remote visits were more frequently used by non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person). During remote visits, clinicians were less likely to order diagnostic testing (odds ratio, 0.20 [0.18-0.22] video versus in-person, 0.18 [0.17-0.19] telephone versus in-person) or prescribe ß-blockers (0.82 [0.68-0.99], 0.35 [0.26-0.47]), mineralocorticoid receptor antagonists (0.69 [0.50-0.96], 0.48 [0.35-0.66]), or loop diuretics (0.67 [0.53-0.85], 0.45 [0.37-0.55]). During telephone visits, clinicians were less likely to prescribe ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers)/ARNIs (angiotensin receptor-neprilysin inhibitors; 0.54 [0.40-0.72]). Telephone visits but not video visits were associated with higher rates of 90-day mortality (1.82 [1.14-2.90]) and nonsignificant trends towards higher rates of 90-day heart failure emergency department visits (1.34 [0.97-1.86]) and hospitalizations (1.36 [0.98-1.89]). CONCLUSIONS: Remote visits for heart failure care were associated with reduced diagnostic testing and guideline-directed medical therapy prescription. Telephone but not video visits were associated with increased 90-day mortality.


Subject(s)
COVID-19 , Cardiologists/trends , Heart Failure/therapy , Practice Patterns, Physicians'/trends , Telemedicine/trends , Aged , Aged, 80 and over , Diagnostic Techniques and Procedures/trends , Drug Prescriptions , Drug Utilization/trends , Emergency Service, Hospital/trends , Female , Guideline Adherence/trends , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization/trends , Humans , Male , Middle Aged , Practice Guidelines as Topic , Telephone/trends , Time Factors , Treatment Outcome , Videoconferencing/trends
4.
Scand J Trauma Resusc Emerg Med ; 29(1): 30, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1069576

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period. METHODS: This was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed. RESULTS: During the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (- 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1-9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p < 0.01); shockable rhythm (VT/VF) (18% vs 29%, p = 0.05) and defibrillation were more frequent in the pandemic period (20% vs 35%, p < 0.05). Resuscitation times, rates of ROSC and post-CA characteristics were comparable in both periods. The severity of illness (SAPS II/SOFA), frequency of mechanical ventilation and frequency of vasopressor therapy after IHCA were higher during the 2020 period. Overall, 43 patients (12 with & 31 without COVID-19), presented with respiratory failure at the time of IHCA. The Horowitz index and resuscitation time were significantly lower in patients with COVID-19 (each p < 0.01). Favourable outcomes were observed in 42 and 10% of patients with and without COVID-19-related respiratory failure, respectively. CONCLUSION: Hospital admissions declined during the pandemic, but a higher incidence of IHCA was observed. IHCA in patients with COVID-19 was a common finding. Compared to patients with non-COVID-19-related respiratory failure, the outcome was improved.


Subject(s)
COVID-19/epidemiology , Heart Arrest/epidemiology , Aged , Cardiopulmonary Resuscitation/statistics & numerical data , Cohort Studies , Drug Utilization/trends , Electric Countershock/trends , Female , Germany/epidemiology , Heart Arrest/therapy , Humans , Incidence , Male , Middle Aged , Organ Dysfunction Scores , Pandemics , Patient Admission/trends , Respiration, Artificial/trends , Respiratory Insufficiency/epidemiology , Retrospective Studies , Vasoconstrictor Agents/therapeutic use
9.
Med Hypotheses ; 140: 109756, 2020 07.
Article in English | MEDLINE | ID: covidwho-620753
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