[Experience with nebulised colistin in patients with non-cystic fibrosis bronchiectasis colonised with Pseudomonas aeruginosa]. / Experiencia con colistina nebulizada en pacientes con bronquiectasias no fibrosis quística colonizadas por Pseudomonas aeruginosa.

OBJECTIVE: Chronic colonisation/infection by Pseudomonas aeruginosa of the bronchiectasis is related to a faster deterioration of lung function, an increase in the number of exacerbations and a higher morbidity and mortality. Nebulised colistin decreases bacteria load. Therefore, a reduction in the number and in the severity of exacerbations and a delay of pulmonary decline is expected. The main objective is to evaluate if the treatment with nebulised colistin, for at least 6 months reduces the number of admissions and visits to the emergency department. METHODS: Observational, retrospective and non-interventionist study carried out in an organizational structure with an integrated management. Patients with non-cystic fibrosis bronchiectasis colonised / infected by P. aeruginosa, older than 18 years, were selected. Patients must have received nebulized colistin during at least 6 months. Clinical, microbiological and therapeutic data from the patients were collected from the SERGAS computerized clinical history (IANUS® v.4.20.0503) and the electronic prescription, which were divided into two time periods: 1) 6 months pre-treatment and during the treatment and 2) 12 months pre-treatment and during the treatment, in those who completed 1 year of treatment. RESULTS: Forty-four patients were included and of these, 29 (65.9%) had a follow-up of 12 months. The use of nebulized colistin decreased significantly the number of visits to the emergency (at 6 months), the frequency and duration of hospitalizations admissions (at 6 and 12 months), the antibiotic consumption (at 6 and 12 months) and the positive cultures. The treatment was well tolerated in almost all patients. CONCLUSIONS: The treatment with nebulised colistin during 6 and 12 months of non-cystic fibrosis bronchiectasis, colonised/infected by P. aeruginosa, seems beneficial for the patient, from the clinical and quality of life point of view, and could reduce the economic cost of the process.

[Drug administration in patients on enteral nutrition: the nasoenteral route versus the parenteral route]. / Administración de medicamentos en pacientes con nutrición enteral: vía nasoenteral frente a vía parenteral.

The administration of medications through a nasoenteral tube or enterostomy is an alternative to the parenteral route, as this is more comfortable, less aggressive for the patient, and cheaper. The objective of this study was to potentiate the nasoenteral route versus the parenteral route and the quantify the economic repercussions. For this we carried out a prospective study of the prescriptions in 100% of the patients with enteral nutrition through a tube over a six month period. Informative notes were sent to the clinicians for those patients who met the established inclusion criteria and who were candidates for changing the route of administration. Of the 542 medications susceptible to the change, 217 were changed to the nasoenteral route. The economic savings during this period were 1,401,095 pesetas, and we consider the main advantage of the change in method is not economical, but rather the greater degree of satisfaction that the patient derives from this, as well as making a release from hospital with at home enteral nutrition easier.

Administración de medicamentos en pacientes con nutrición enteral: vía nasoenteral frente a vía parenteral / Administration of medication in patients with enteral nutrition: nasoenteral route versus parenteral route

The administration of medications through a nasoenteral tube or enterostomy is an alternative to the parenteral route, as this is more comfortable, less aggressive for the patient, and cheaper. The objective of this study was to potentate the nasoenteral route versus the parenteral route and the quantify the economic repercussions. For this we carried out a prospective study of the prescriptions in 100% of the patients with enteral nutrition through a tube over a six month period. Informative no-tes were sent to the clinicians for those patients who met the established inclusion criteria and who were candidates for changing the route of administration. Of the 542 medications susceptible to the change, 217 were changed to the nasoenteral route. The economic savings during this period were 1,401,095 pesetas, and we consider the main advantage of the change in method is not economical, but rather the greater degree of satisfaction that the patient derives from this, as well as making a release from hospital with at home enteral nutrition easier (AU)

La administración de medicamentos por sonda nasoenteral-enterostomía constituye una alternativa a la vía parenteral, por ser más cómoda, menos agresiva para el paciente y más económica. El objetivo de este estudio fue potenciar la vía nasoenteral frente a la parenteral y cuantificar la repercusión económica. Para ello se ha realizado un estudio prospectivo de las prescripciones del 100 por ciento de los pacientes con nutrición enteral por sonda durante un período de seis meses. Se enviaron notas informativas al clínico para aquellos pacientes que cumplían los criterios de inclusión establecidos dos y por tanto eran candidatos al cambio de vía de administración. De los 542 medicamentos susceptibles de cambio, 2,17 fueron desviados a sonda nasoenteral. El mayor grado de aceptación al cambio fue para la digoxina, seguida de ranitidina y furosemida. Aunque el ahorro económico durante el período de estudio fue de 1.401.095 ptas., consideramos que la principal ventaja del cambio de vía no es la económica sino la derivada de un mayor grado de satisfacción para el paciente, además de facilitar el alta domiciliaria con nutrición enteral domiciliaria (AU)

[Drug administration through a tube to patients with enteral nutrition. Centralization in in pharmacy service]. / Administración de medicamentos por sonda en pacientes con nutrición enteral. Centralización en el servicio de farmacia.

The administration of a drug through the nasogastric tube, in most cases requires a modification of the pharmaceutical form in order to achieve a good absorption and to avoid adverse effects. In this way, placing a tube in the duodenum or the jejunum requires administration of the drug in a manner that is dispersed, diluted and adequate in osmolarity. This study discusses the factors that must be taken into consideration in order to adapt the pharmaceutical base form for the nasoenteric administration of the drugs in order to decrease the number of complications derived from using this route, ensure the efficacy of the treatment, and to potentiate the nasoenteral-enterostomy route as opposed to the parenteral route. Keeping these factors in mind, the Pharmacy Department established a program for centralizing the preparation of extemporeal mixtures of medications in single dose syringes that are ready for nasoenteral use.