[Impact of Integrated Model for Rational Use of Antibiotics in a health area (project MIURA)]. / Impacto de un modelo integrado para el uso racional de antimicrobianos (Proyecto Miura) en un área de salud.

BACKGROUND: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. METHOD: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants/day). RESULTS: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven't showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. CONCLUSIONS: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions.

Impacto de un modelo integrado para el uso racional de antimicrobianos (proyecto Miura) en una área de salud / Impact of integrated model for rational use of antibiotics in a health area (project MIURA)

Fundamento: MIURA (Modelo Integrado para el Uso Racional de Antimicrobianos) es un proyecto que se inicio en enero de 2004 y finalizó en diciembre de 2006. Mediante intervenciones trimestrales y formativas dirigidas a médicos, farmacéuticos y pacientes, pretendió mejorar el uso de antibióticos en un área de salud. El objetivo ha sido analizar la evolución en el consumo de antibióticos y evaluar la repercusión de la implantación de este proyecto en un área de salud. Método: Se realizó un estudio comparativo sobre la evolución de la dispensación de antibióticos con receta durante los periodos 2000-03 (pre-MIURA), 2004-06 (MIURA) y 2007-08 (post-MIURA) en el Departamento de Salud 11 de la Comunidad Valenciana. La información se obtuvo a través de la aplicación informática GAIA (Generalitat Valenciana) que recoge información sobre los medicamentos facturados por las oficinas de farmacia a través de las recetas oficiales. Como unidad técnica de medida se empleó la DHD (Dosis diaria definida/1.000 Habitantes/Día). Resultados: Durante el periodo de implantación del proyecto (2004 a 2006), se detectó un descenso global de 4,02 DHD en el consumo de antibióticos, lo que representa una reducción global y significativa del 15% (p<0.05). Durante el periodo del MIURA se observó una disminución estadísticamente significativa en los valores de DHD para los grupos terapéuticos de macrólidos (especialmente claritromicina) y de cefalosporinas; también se detectó una disminución, aunque no significativa, para el grupo de las quinolonas, mientras que los grupos correspondientes a las penicilinas y a otros antibióticos no presentaron cambios. En el periodo post-MIURA se detectó un nuevo incremento en la dispensación de los antibióticos. Conclusiones: El programa MIURA ha influido positivamente en la disminución de la prescripción de antibióticos en nuestra área de salud, como demuestra el descenso en DHD durante el periodo de intervenciones(AU)

Background: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. Method: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants / day). Results: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven’t showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. Conclusions: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions(AU)

Chemotherapy dose intensity reductions due to adverse drug reactions in an oncology outpatient setting.

OBJECTIVE: the aim of this study was to establish the incidence of adverse drug reactions (ADRs) that prevent administration of planned dose intensity antineoplastic chemotherapy in clinical practice. METHODS: a retrospective cohort study was made of adult oncology patients who received intravenous chemotherapy in an outpatient ward during 2005. Dose delays, dose reductions, dose omissions, or treatment discontinuations with respect to the planned chemotherapy regimen were obtained, and causes were evaluated to identify ADRs. RESULTS: a total of 532 patients were included, involving the administration of 631 chemotherapy regimens. The total number of cycles evaluated was 3553. The incidence of nonadherence to planned treatment due to ADRs was 12.9% cycles (95% CI: 11.8-14.0). Differences according to patient's age were found, patients younger than 65 years showed higher rates of nonadherence due to ADRs. Myelosuppression was the main cause of dose delays, and gastrointestinal and neurological toxicity were reported as the main causes of dose reductions. CONCLUSIONS: the incidence of ADRs preventing planned dose intensity administration has been estimated. Follow-up of nonadherence to antineoplastic chemotherapy prescriptions can be used to evaluate tolerance in the clinical setting. Continuous evaluation of security in clinical practice provides information on benefits outweighing the deleterious effects in specific patient populations where the available data are limited.