Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC).

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.

Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients (AU)

En la práctica clínica, un antecedente de alergia a los antibióticos, confirmada o sospechada, es frecuente y condiciona la selección de antibióticos, requiriendo con frecuencia el uso de fármacos menos eficaces, más tóxicos o más caros que los antibióticos de primera línea. La optimización del uso de antibióticos en pacientes con este antecedente es una de las prioridades de los programas de optimización de uso de antibióticos (PROA) en varios países. Estas guías pretenden formular recomendaciones para evaluar de una manera sistemática a estos pacientes mediante una aproximación basada en la evidencia. Un panel multidisciplinar constituido por alergólogos, infectólogos, farmacéuticos hospitalarios e intensivistas formularon una serie de preguntas sobre el manejo de estos pacientes; una documentalista realizó la revisión bibliográfica. Las preguntas se distribuyeron entre los miembros del grupo de trabajo, quienes seleccionaron las referencias más relevantes y formularon las correspondientes recomendaciones, que fueron revisadas y aprobadas por todos los miembros del grupo. Es necesaria una aproximación sistemática a los pacientes con antecedentes de alergia a antibióticos para optimizar la selección del tratamiento antibiótico y mejorar los resultados clínicos de estos pacientes cuando precisan antibioterapia. El presente documento recomienda una estrategia de estratificación clínica del riesgo en 3 categorías. La recomendación de realizar evaluaciones complementarias se basa en el riesgo clínico y el antibiótico de primera línea necesario. Además, se formulan recomendaciones de tratamiento antibiótico empírico para los principales síndromes infecciosos en pacientes con alergia confirmada o sospechada. Finalmente, se formulan recomendaciones sobre la implementación y monitorización del impacto de las recomendaciones de la guía (AU)

Desarrollo de un buscador de información farmacoterapéutica no publicada en revistas biomédicas / Developing a Search Engine for Pharmacotherapeutic Information that is Not Published in Biomedical Journals

Objetivo Identificar productores de información farmacoterapéutica no publicada en revistas biomédicas orientada a la evaluación y posicionamiento terapéutico de los medicamentos y desarrollar un buscador para el acceso a dicha información. Métodos Recopilación de sitios web productores de información sobre uso racional de los medicamentos e independientes de los intereses promocionales. Páginas web de acceso libre, y en castellano, gallego, catalán o inglés. Diseño de un buscador mediante aplicación «búsqueda personalizada» de Google. Resultados Se han recopilado 159 direcciones de Internet y se han clasificado en 9 etiquetas. El buscador, denominado AlquimiA y accesible desde http://www.elcomprimido.com/FARHSD/AlquimiA.htm, permite recuperar información de las fuentes seleccionadas. Conclusiones Se han identificado las principales fuentes de información farmacoterapéutica no publicada en revistas biomédicas. El buscador constituye una herramienta útil para la búsqueda y acceso a las publicaciones de «evidencia gris» en Internet (AU)

Objective To identify publishers of pharmacotherapeutic information not found in biomedical journals that focuses on evaluating and providing advice on medicines and to develop a search engine to access this information. Methods Compiling web sites that publish information on the rational use of medicines and have no commercial interests. Free-access web sites in Spanish, Galician, Catalan or English. Designing a search engine using the Google “custom search” application. Results Overall 159 Internet addresses were compiled and were classified into 9 labels. We were able to recover the information from the selected sources using a search engine, which is called “AlquimiA” and available from http://www.elcomprimido.com/FARHSD/AlquimiA.htmConclusionsThe main sources of pharmacotherapeutic information not published in biomedical journals were identified. The search engine is a useful tool for searching and accessing “grey literature” on the Internet (AU)

Medicamentos termolabiles. Protocolo de actuacion en la rotura de la cadena de frio / Thermolabile drugs. Operating procedure in the event of cold chain failure

Objetivo: Establecer un procedimiento normalizado de trabajo en caso de rotura de cadena de frio. Metodo Se seleccionaron los medicamentos termolabiles incluidos en la guia farmacoterapeutica del hospital y se reviso la bibliografia disponible, clasificandolos en categorias con un protocolo de actuacion en cada caso. Resultados Se revisaron 254 medicamentos (162 principios activos). La distribucion por categorias fue In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. Conclusions: The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses (AU)

Objective: To establish a standard operating procedure in the event of cold chain failure. Method: We selected thermolabile drugs included in the hospitals pharmaceutical guide. We performed a review of the available literature, classifying each drug into a given category with an intervention protocol for each one. Results: We reviewed 254 drugs (162 active ingredients). Categories were: A (stable ≥ 28 day sat 25◦C): 65 drugs; B (≥7 days at 25◦C): 47 drugs; C (≥48hat25◦C): 30 drugs; D (< 48 h at25◦C): 47 drugs; E (unstable> 8◦C): 12 drugs; F (batch-dependent) 22 drugs. 31 drugs were not classified in any category. The intervention protocol consisted of establishing a system to monitor the products concerned, and discarding or returning them to the laboratory if they were to exceed the time or temperature limit indicated for each category. Discussion: The aim of this study is to make intervention quicker in the event of cold chain failure (AU)

Developing a search engine for pharmacotherapeutic information that is not published in biomedical journals.

OBJECTIVE: To identify publishers of pharmacotherapeutic information not found in biomedical journals that focuses on evaluating and providing advice on medicines and to develop a search engine to access this information. METHODS: Compiling web sites that publish information on the rational use of medicines and have no commercial interests. Free-access web sites in Spanish, Galician, Catalan or English. Designing a search engine using the Google "custom search" application. RESULTS: Overall 159 internet addresses were compiled and were classified into 9 labels. We were able to recover the information from the selected sources using a search engine, which is called "AlquimiA" and available from http://www.elcomprimido.com/FARHSD/AlquimiA.htm. CONCLUSIONS: The main sources of pharmacotherapeutic information not published in biomedical journals were identified. The search engine is a useful tool for searching and accessing "grey literature" on the internet.