Surveillance of monthly antimicrobial consumption rates stratified by patient-care area: a tool for triggering and targeting antibiotic policy changes in the hospital.

The profile and temporal trends of antimicrobial use were investigated at a university hospital. Aggregate data were analyzed according to the ATC/DDD methodology. During 1998-2002, hospital-wide antimicrobial use increased by 22%, from 86.97 to 106.24 defined daily doses per 100 bed-days [DDD/100BD]. Pooled usage rates in DDD/100BD, overall percentage increases and annual average increase rates were respectively 109.97, 35.6%, 8.1 for Medical wards, 98.21, 48.7%, 9.1 for Intensive Care Units and 74.46, 34.3%, 5.7 for Hemato-oncology wards. Surgical wards had a fairly constant usage rate (98.36). A shift towards the newer broad-spectrum antibiotics, to the detriment of the older penicillins and cephalosporins, was noted in all hospital areas. Surveillance of antimicrobial consumption using the ATC/DDD system provided a clear picture of its profile. Monthly rates over a sufficient surveillance period allowed the assessment of temporal trends. Stratification of rates according to clinical service allowed areas of concern to be specified and targeted antibiotic policy changes to be initiated.

Availability of antidotes in hospital pharmacies in Greece.

We determined the availability of poisoning antidotes in the pharmacies of state hospitals in Greece and in Health Centers of the island of Crete. A questionnaire survey was sent to all pharmacy directors of hospitals with emergency departments, asking them to report anonymously the amount currently in stock of each of 12 common antidotes. Questionnaires were sent to 100 pharmacy directors and 68 (68%) of them replied. Only 2 (3%) of the 68 hospitals stocked all 12 antidotes. The percentage of sufficient stocking for individual antidotes ranged from 6% (for digoxin immune fab) to 91% (for methylene blue). Recent circulation of government guidelines for antidote stocking and hospital type had no significant effect on antidote stocking. In a multiple regression analysis, hospital type (prefectural, regional, university hospital) and smaller hospital size were not predictors of the number of antidotes sufficiently stocked. Storing of key poisoning antidotes is inadequate in regional as well as in prefectural hospitals in Greece. Antidotes, including those which should be used without delay to be effective, are often not available, even for the commoner poisons in Greece such as pesticides.

Acute poisonings and sudden deaths in Crete: a five-year review (1991-1996).

Fatal and non-fatal acute poisonings and other sudden deaths examined in the Toxicology Laboratory of University Hospital of Iraklion, Crete, from 1991 to 1996 mainly involved the abuse of drugs (heroin, flunitrazepam and other psychoactive substances), accidental poisonings or suicide attempts with pesticides (carbamates, organophosphates, paraquat), other chemicals (cyanide salts, paint thinner, chlorine), traffic accidents, drownings and violent deaths (gunshots). Many of the cases were related to poisonous gases or volatiles (carbon monoxide, methylbromide). Fatalities due to alcohol and methylene-dioxy-ethyl amphetamine were also examined. Amphetamine and alcohol-related deaths due to drowning were more recent. A significant number of cases were related to the accidental ingestion of alcohol, drugs or suicide attempts by children. Some of the cases were treated successfully in various Cretan hospitals, while others had fatal outcomes due to late hospital admission.

Determination of phenytoin in sections of head hair: a preliminary study to evaluate the history of drug use.

Phenytoin (PH) levels were determined in the head hair of twenty five patients (fourteen males and eleven females, aged from five to seventy seven years old) who were receiving this drug chronically. The assay method involved sectional hair analysis by dissolution and liquid phase extraction procedures, using both high pressure liquid chromatography (HPLC) and immunoassay (Abbott TDx) techniques. Five sections were studied, the first being the one closet to the root. The phenytoin levels of the hair sections ranged: a) 1st: 0.68 to 39.56 micrograms/g (mean 16.12 micrograms/g), b) 2nd: 0.85 to 34.15 micrograms/g (mean 9.45 micrograms/g), c) 3rd: 1.33 to 27.90 micrograms/g (mean 3.72 micrograms/g), d) 4th: 1.10 to 10.96 micrograms/g (mean 3.04 micrograms/g) and e) 5th: 1.05 to 7.00 micrograms/g (mean 2.84 micrograms/g) according to the HPLC analysis. The immunoassay technique gave similar results. The mean values of phenytoin in the hair sections according to the immunoassay technique were: 16.28; 9.47; 3.77; 3.22; 2.97 micrograms/g, respectively from the 1st to the 5th section. A reduction of drug concentrations in hair from the first to the consecutive segments was observed. Higher amounts of phenytoin were deposited in black, untreated hair in comparison to blond brown or grey hair. Phenytoin concentrations in hair sections correlated with the oral daily dosage of the drug. Our data indicate to the use of hair testing as a marker of the dosage history and evaluation of the compliance of patients under long treatment with phenytoin.