ABSTRACT
BACKGROUND: Amphotericin-B (AMB) is associated with toxicity such as renal impairment, hypokalemia and infusion-related events (IRE). With the advent of AMB lipid formulations and newer antifungal drugs, presenting improved safety profiles, it was suggested that using the conventional deoxycholate (AMB-D) formulation should no longer be regarded acceptable. OBJECTIVES: Evaluation of real-life incidence of AMB-D-related adverse-drug effects (ADE) and associated costs. SETTING: Hadassah Hebrew University Medical Center, Jerusalem, Israel, a tertiary 1,100-bed teaching hospital. METHODS: A 1-year single-center prospective observational study following all patients administered AMB-D. Various parameters related to AMB-D administration were recorded. Main outcome measures Subsequent ADE-related events, discontinuations, switch to alternative antifungals and related resource-utilization were monitored. RESULTS: Among 119 patients (60 children, 59 adults) receiving AMB-D, serum creatinine doubling from baseline, hypokalemia and IRE occurred in 14.3 % (15 % in children, 13.6 % in adults), 16.8 % (16.6 % in children, 16.9 % in adults) and 10.9 % (10 % in children, 11.8 % in adults), respectively. AMB-D was discontinued due to an ADE in 12.6 % of patients (6.7 % in children, 18.6 % in adults). The total annual cost associated with AMB-D use was
Subject(s)
Amphotericin B/adverse effects , Amphotericin B/economics , Antifungal Agents/adverse effects , Antifungal Agents/economics , Deoxycholic Acid/adverse effects , Deoxycholic Acid/economics , Drug Costs/statistics & numerical data , Health Care Costs/statistics & numerical data , Adolescent , Adult , Aged , Child , Child, Preschool , Drug Combinations , Female , Humans , Infant , Israel , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Appropriate antibiotic use is of both clinical and economic significance to any health system and should be given adequate attention. Prior to this study, no in-depth information was available on antibiotic use patterns in the emergency department of Hadassah Medical Center. OBJECTIVES: To describe the use and misuse of antibiotics and their associated costs in the emergency department of Hadassah Medical Center. METHODS: We analyzed the charts of 657 discharged patients and 45 admitted patients who received antibiotics in Hadassah's emergency department during a 6 week period (29 April - 11 June 2007). A prescription was considered appropriate or inappropriate if the choice of antibiotic, dose and duration by the prescribing physician after diagnosis was considered suitable or wrong by the infectious diseases consultant evaluating the prescriptions according to Kunin's criteria. RESULTS: The overall prescribing rate of antibiotics was 14.5% (702/4830) of which 42% were broad-spectrum antibiotics. The evaluated antibiotic prescriptions numbered 1105 (96 prescriptions containing 2 antibiotics, 2 prescriptions containing 3 antibiotics), and 54% of them were considered appropriate. The total inappropriate cost was 3583 NIS (1109 USD PPP) out of the total antibiotic costs of 27,300 NIS (8452 USD PPP). The annual total antibiotic cost was 237,510 NIS (73,532 USD PPP) and the annual total inappropriate cost was 31,172 NIS (9648 USD PPP). The mean costs of inappropriate prescriptions were highest for respiratory (112 NIS, 35 USD PPP) and urinary tract infection (93 NIS, 29 USD PPP). There were more cases when the optimal cost was lower than the actual cost (N = 171) than when optimal cost was higher than the actual cost (N = 9). In the first case, the total inappropriate costs were 3805 NIS (1178 USD PPP), and in the second case, -222 NIS (68.7 USD PPP). CONCLUSIONS: The use of antibiotics in emergency departments should be monitored, especially in severely ill patients who require broad-spectrum antibiotics and for antibiotics otherwise restricted in the hospital wards. Our findings indicate that 12% of the total antibiotic costs could have been avoided if all prescriptions were optimal.
Subject(s)
Anti-Bacterial Agents/economics , Emergency Service, Hospital/statistics & numerical data , Inappropriate Prescribing/economics , Anti-Bacterial Agents/therapeutic use , Drug Utilization , Guideline Adherence , Humans , Inappropriate Prescribing/statistics & numerical data , IsraelABSTRACT
Cannabinoids have been used for pain relief for centuries and recent studies have investigated their analgesic and anti-inflammatory mechanisms, as well as clinical efficacy, in treating chronic pain. We report an open-label study addressed to evaluate the effect and adverse events of orally administered Delta-9-tetrahydrocannabinol (Delta-9-THC) in 13 patients with chronic nonmalignant pain (CNMP) unresponsive to conventional pharmacotherapy. The effect of the treatment was assessed on an eight-item HRQoL questionnaire. Five out of 13 patients reported adequate response to the treatment while eight patients reported inadequate or no response. Seven patients did not experience any adverse events (AEs), six patients reported AEs, two of which discontinued the treatment. We conclude that oral THC may be a valuable therapeutic option for selected patients with CNMP that are unresponsive to previous treatments, though further research is warranted to characterize those patients.