Detección y resolución de Problemas Relacionados con Medicamentos en un servicio de Atención Farmacéutica en Argentina / Detection and resolution of Drug Therapy Problems in a Pharmaceutical Care service in Argentina

Introducción: La Atención Farmacéutica consiste en un proceso asistencial sistemático para detec-tar, resolver y prevenir Problemas Relacionados con Medicamentos. El objetivo del presente trabajo es describir el número y perfil de problemas detecta-dos y resueltos en un conjunto de pacientes adul-tos atendidos en una Unidad de Optimización de la Farmacoterapia en Argentina, durante un segui-miento farmacoterapéutico promedio de un año.Método: Se realizó un estudio cuasi-experimental, abierto y prospectivo en 40 pacientes ambulatorios. Se registraron las características clínicas y medica-mentos, así como su adherencia o no al servicio. Se empleó la clasificación de Problemas Relacionados con Medicamentos de Minnesota, registrando su dimensión, categoría, causa, patología o condición clínica asociada, medicamento asociado, estado de riesgo, estado final y método de resolución.Resultados: Los grupos farmacoterapéuticos mayormente utilizados fueron beta-bloqueantes, estatinas, vitaminas y minerales, analgésicos, inhibidores de la bomba de protones y benzodiace-pinas. Los problemas de indicación, especialmente por necesidad de farmacoterapia adicional, prevale-cieron como los más frecuentes, incluyendo la falta de farmacoterapia preventiva con vacunas. Se lo-gró resolver el 73,6% de los problemas detectados, de los cuales el 60,3% se hizo a través de informes a los médicos tratantes. El resto se pudo abordar mediante la educación al paciente, especialmente los de adherencia.Conclusiones: La Atención Farmacéutica permitió una descripción sistemática del perfil de problemas farmacológicos detectados y resueltos en un con-junto de pacientes adultos mayores ambulatorios, principalmente de sexo femenino, en el contexto de una Unidad de Optimización de la Farmacoterapia montada en un hospital universitario de Argentina. (AU)

Introduction: Pharmaceutical Care is a systematic process to detect, solve, and prevent Drug Relat-ed Problems. The aim of this study is to describe the number and profile of problems detected and solved in a group of adult patients interviewed in a Pharmacotherapy Optimization Unit in Argentina, during an average pharmacotherapeutic follow-up of one year.Method: A quasi-experimental, open-label, pro-spective study was carried out in 40 outpatients. The Clinical characteristics and medications were revealed, as well as their adherence to the service. The Minnesota classification of Drug Therapy Problems was used, recording dimension, category, cause, associated clinical condition, associated medication, risk status, final status, and resolution method.Results: The most widely used pharmacotherapeu-tic groups were beta-blockers, statins, vitamins and minerals, analgesics, proton pump inhibitors, and benzodiazepines. Indication problems, especially due to the need for additional pharmacotherapy, prevailed as the most frequent, including the lack of preventive vaccines. It was possible to solve 73.6% of the detected problems, of which 60.3% was done through reports to the treating physicians. The rest could be addressed through patient education, especially those related to adherence.Conclusions: Pharmaceutical Care allowed a systematic pharmacotherapy work-up of Drug Related Problems detected and solved in a group of elderly outpatients, mainly female, in the context of a Pharmacotherapy Optimization Unit set up in a university hospital in Argentina. (AU)

Comparative assessment of different ivermectin and doramectin formulations for mange control in grazing steers.

Psoroptic mange causes relevant losses of productivity in cattle. Macrocyclic lactones are one of the main pharmacological tools recommended for controlling it. The aim of the current work was to compare the relationship between the pharmacokinetic behavior and the effectiveness of both ivermectin (IVM) and doramectin (DRM) following their administration as either the traditional (1 %) or long-acting (3.15-3.5 %) injectable formulations to cattle naturally infected with Psoroptes ovis. The overall work involved three trials (1, 2 and 3) carried out on commercial beef cattle farms (grazing systems). In Trial 1, 20 grazing steers with active mange infection were allocated into 2 groups (n = 10) and treated subcutaneously (SC) with either IVM (1 %) or DRM (1%) at 0.2 mg/kg. In Trial 2, 16 grazing steers with active mange divided in 2 groups (n = 8) were treated SC with either IVM 1 % (0.2 mg/kg) or IVM 3.15 % long-acting (0.63 mg/kg). In Trial 3, 2 groups of mange infected steers (n = 8) were treated SC with either IVM 3.15 % (0.63 mg/kg) or DRM 3.5 % (0.7 mg/kg). Blood samples were collected of each experimental group and the drug systemic availability was estimated by measuring of IVM/DRM concentrations by HPLC. Skin scraping samples were collected from each animal and mites were counted at 14, 21 and 28 days post-treatment. In Trial 1, the mite density score on day 14 was significantly lower for DRM (0.60) compared to IVM (1.80) (P = 0.019). Based on the number of animals clinically cured (negative to the presence of mites), the efficacy of DRM was higher (80 %) than that obtained for IVM (10 %) (P < 0.05). DRM systemic exposure measured as AUC was 1.37-fold higher compared to IVM. In Trial 2, even though IVM exposure was significantly greater after the long-acting (3.15 %) compared to the traditional formulation (1 %), none of the treatments significantly reduced the mite density score, with a percentage of animals cured between 0 % and 37.5 % after both IVM treatments. In Trial 3, the 100 % of cured animals were achieved at day 21 (IVM 3.15 %) and at day 28 (DRM 3.5 %) post-treatment. In conclusion, DRM treatment could offer some therapeutic advantages in field situations where IVM fails to control mange. Depending on the level of susceptibility of the mite population, long-acting pharmaceutical formulations can be useful to control Psoroptic mange in cattle. The use of macrocyclic lactones for mange control in cattle should be based on appropriate diagnosis on each individual farm.

Antinematodic effect of Enterococcus faecalis CECT7121 using Trichinella spiralis as a model of nematode infection in mice.

Nematode infections affect a significant percentage of the human population worldwide, especially in developing countries. There are a small number of drugs available to treat these infections, with variable outcomes. Therefore, the potential use of probiotics to help control parasitic infections has emerged as a suitable option. The main goal of this work was to assess the antinematodic effect of the probiotic Enterococcus faecalis CECT7121 (EFCECT7121) in vitro and in vivo, using Trichinella spiralis as a nematode model of infection. The in vitro assay showed a reduction in T. spiralis larvae viability of 31.6% when compared with the control group (6.3%) after 48 h incubation with EFCECT7121. Nevertheless, the isolated antimicrobial peptide AP7121 when inoculated at different concentrations did not reveal any larvicidal effect. Different EFCECT7121 treatment schemes in mice were evaluated, and the reduction of the enteral and parenteral burden of T. spiralis was determined. In addition, the protective effect of EFCECT7121 combined with the conventional anthelmintic albendazole (ABZ, 5 mg/kg) was also assessed. The oral administration of EFCECT7121 previous T. spiralis infection produced a reduction in the larvae per gram (LPG) of mice muscle tissue ranging from 32.8 to 47.9% on the 28th day post-infection. ABZ alone and the combination EFCECT7121 + ABZ produced a reduction of the LPG of muscle tissue of 62 and 60.7%, respectively. Results obtained in the current work support the hypothesis that probiotics such as EFCECT7121 have an antinematodic effect, and their combination with conventional anthelmintic drugs may result useful for improving clinical and parasitological outcomes.

Evaluation of the efficacy of polymeric antigen BLSOmp31 formulated in a new cage-like particle adjuvant (ISPA) administered by parenteral or mucosal routes against Brucella ovis in BALB/c mice.

Brucella ovis is an economically important cause of epididymitis in rams worldwide. Polymeric BLSOmp31 was previously identified as a protective immunogen against this pathogen. In this study, BLSOmp31 was formulated with a modified version of ISCOMATRIX adjuvant called ISPA (BLSOmp31/ISPA) and was administered in BALB/C by the subcutaneous and ocular route. The systemic and mucosal immune responses, the opsonic activity of antibodies and the protection conferred against B. ovis were evaluated. BLSOmp31+ISPA injected subcutaneously or by ocular route induced significantly higher IgG antibody levels with a mixed Th1/Th2 profile compared to non-immunized mice. IgA and IgG were detected in sera and nasal, tracheobronchial, vaginal secretions, tears and faeces, from SC immunized mice while in the group immunized by the ocular route a slight increase in both isotypes was mainly observed in all secretions, except in vaginal fluid. Opsonic antibodies stimulated binding and increased uptake of PHrodo™ Green-labelled B. ovis by neutrophils and monocytes. BLSOmp31 administered subcutaneously induced the highest levels of IFN-É£. The ocular immunization not only produced significant levels of this cytokine but also IL-4 compared to non-immunized mice. Both, subcutaneous and ocular routes of immunization, significantly protected against B. ovis infection. These results indicate that BLSOmp31/ISPA administered parenterally or by ocular route is a safe and effective vaccine against B. ovis in the murine model.

Monepantel pharmaco-therapeutic evaluation in cattle: Pattern of efficacy against multidrug resistant nematodes.

The goal of the current work was to perform an integrated evaluation of monepantel (MNP) pharmacokinetics (PK) and pharmacodynamics, measured as anthelmintic efficacy, after its oral administration to calves naturally infected with GI nematodes resistant to ivermectin (IVM) and ricobendazole (RBZ) on three commercial farms. On each farm, forty-five calves were randomly allocated into three groups (n = 15): MNP oral administration (2.5 mg/kg); IVM subcutaneous (SC) administration (0.2 mg/kg); and RBZ SC administration (3.75 mg/kg). Eight animals from the MNP treated group (Farm 1) were selected to perform the PK study. Drug concentrations were measured by HPLC. The efficacy was determined by the faecal egg count reduction test (FECRT). MNP and MNP-sulphone (MNPSO2) were the main analytes recovered in plasma. MNPSO2 systemic exposure was markedly higher compared to that obtained for MNP. Higher Cmax and AUC values were obtained for the active MNPSO2 metabolite (96.8 ± 29.7 ng/mL and 9220 ± 1720 ng h/mL) compared to MNP (21.5 ± 4.62 ng/mL and 1709 ± 651 ng h/mL). The MNPSO2 AUC value was 6-fold higher compared to the parent drug. Efficacies of 99% (Farm 1), 96% (Farm 2) and 98% (Farm 3) demonstrated the high activity of MNP (P < 0.05) against GI nematodes resistant to IVM (reductions between 27 and 68%) and RBZ (overall efficacy of 75% on Farm 3). While IVM failed to control Haemonchus spp. and Cooperia spp., and RBZ failed to control Coooperia spp. and Ostertagia spp., MNP achieved 100% efficacy against Haemonchus spp., Cooperia spp. and Ostertagia spp. However, a low efficacy of MNP against Oesophagostomum spp. (efficacies ranging from 22 to 74%) was observed. In conclusion, oral treatment with MNP should be considered for dealing with IVM and benzimidazole resistant nematode parasites in cattle. The work described here reports for the first time an integrated assessment of MNP pharmaco-therapeutic features and highlights the need to be considered as a highly valuable tool to manage nematode resistant to other chemical families.

Field trial assessment of ivermectin pharmacokinetics and efficacy against susceptible and resistant nematode populations in cattle.

The study compared the pharmacokinetic (PK) behaviour and anthelmintic efficacy against susceptible and resistant nematodes following subcutaneous (SC) and oral administration of ivermectin (IVM) to cattle. Six commercial farms were involved: Farms 1 and 2 (IVM-susceptible nematode population) and Farms 3, 4, 5 and 6 (IVM-resistant nematode population). On each farm, forty-five calves naturally infected with gastrointestinal (GI) nematodes were randomly allocated into three groups (n = 15): untreated control, IVM SC administration, and IVM oral administration (both at 0.2 mg/kg). PK assessment (plasma and faeces) was performed on Farm 1. Efficacy was determined by Faecal Egg Count Reduction Test. IVM systemic availability upon SC administration (421 ±â€¯70.3 ng·d/mL) was higher (P < 0.05) compared to the oral treatment (132 ±â€¯31.3 ng·d/mL). However, higher (P < 0.05) faecal IVM concentrations were observed following oral treatment (9896 ±â€¯1931 ng·d/mL) compared to SC administration (4760 ±â€¯924 ng·d/mL). Similar (91-93%) IVM efficacy was observed on Farms 1 and 2 by both routes. Efficacy against resistant nematodes was slightly higher on Farms 3 and 4 after the oral (63 and 82%, respectively) compared to the SC (36 and 68%, respectively) treatment. However, there was complete therapeutic failure (0% efficacy) on Farm 5 and a very low response on Farm 6 (40 and 41% for SC and oral administration, respectively). Although larger faecal concentrations following IVM oral administration may increase drug exposure of GI adult worms, this does not always improve efficacy against resistant nematodes. The potential therapeutic advantages of oral treatments should be cautiously assessed, especially in presence of anthelmintic resistance.