Acute medication poisoning causing hospital admissions in childhood: a 3-year prospective observational single-center study.

Although the risks of medication poisoning in children are often reported, there is a lack of studies addressing this issue. The majority of papers deal with a wide range of xenobiotics poisoning and, in particular, alcohol intoxications. All hospital admissions during three years were prospectively recorded. Patients younger than 19 years of age admitted for acute drug intoxications were further evaluated. A total of 15,069 children were admitted. Of them, 55 were hospitalized for acute medication poisoning. The condition was more common in girls (72.7 % vs. 27.3 %, p<0.01). Toddlers were the largest patient group (36.4 %). Non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently used agents, with ibuprofen being the leading drug (20 % of all cases). The route of intoxication was almost exclusively oral. Solid drug forms were involved in 40 (72.7 %) cases. There was one fatal accidental poisoning. The highest occurrence of accidental drug intoxications was in the age group from one to three years. Attempted suicides were most frequent among adolescents. We are currently actively dealing with the issue. The cohort has been expanded to include a period of ten years and is being analyzed.

The use of antiplatelet medication in hospitalised elderly patients.

BACKGROUND: The use of antiplatelet agents is strongly recommended for the secondary prevention of ischemic events such as myocardial infarction, stroke/transient ischemic attack (TIA). OBJECTIVES: The aim of our study was to analyse the use of antiplatelet medication in patients after myocardial infarction, stroke/TIA, and patients with both conditions and to identify patient-related characteristics, which determine the use of such drugs in elderly patients. METHODS: Study sample (n=372) was derived from 2,157 patients admitted to long-term care departments of three municipal hospitals. The study included patients aged ≥65 years after myocardial infarction, stroke/TIA or both. RESULTS: Antiplatelet medications were prescribed in 54.8 % and 68.5 % of patients at hospital admission and discharge, respectively. Hospitalisation led to a significant increase in the use of antiplatelet medication in patients after myocardial infarction and in those with the combination of both events. However, in patients after only stroke/TIA, we did not find any significant difference comparing the use of antiplatelet medication at the time of hospital admission and discharge, respectively. CONCLUSION: Our study revealed that physicians are more aware of the benefits of antiplatelet medication in elderly patients after myocardial infarction or those after both myocardial infarction and stroke/TIA in comparison with patients after only stroke/TIA (Tab. 3, Ref. 32).

Suboptimal use of gastroprotective medication in elderly antiplatelet users.

BACKGROUND: Use of acetylsalicylic acid (ASA) or thienopyridines in monotherapy or combination of both drugs is associated with increased risk of gastrointestinal (GI) bleeding. The administration of drugs inhibiting gastric acid production represents an effective way to avoid GI disorders associated with antiplatelet therapy. OBJECTIVES: The aim of our study was to evaluate the use of gastroprotective medication in elderly antiplatelet users in relation to risk factors for GI bleeding. METHODS: Patients (n = 428) aged ≥ 65 years who were prescribed low dose ASA or clopidogrel in monotherapy or combination at hospital discharge were enrolled in the study. RESULTS: Only 39.7 % of patients with 2 or more risk factors for GI bleeding were prescribed gastroprotective medication at hospital discharge. The probability of elderly antiplatelet drug user for prescription of gastroprotective medication was improved with following risk factors: age ≥ 85 years (OR = 2.99); history of peptic ulcer disease/ GI bleeding (OR = 15.79); other GI disorders (OR = 15.48); concomitant therapy with drugs increasing the risk of GI bleeding - systemic corticosteroids (OR = 29.03) and NSAIDs (OR = 4.79). CONCLUSION: Results of our study indicate the necessity to increase the awareness of GI bleeding risk in long-term antiplatelet users among prescribing physicians.

[The incidence of dyslipidemia in a sample of asymptomatic probands established by the means of Lipoprint system]. / Výskyt aterogénnej dyslipidémie vo vzorke asymptomatických probandov vysetrením pomocou metódy Lipoprint.

Method of lipoprotein determination on polyamideacryl gel Lipoprint enables an exact quantification nonatherogenic and atherogenic plasma lipoproteins. For its use in human medicine this method was recently approved by FDA. According to majority of nonatherogenic, or atherogenic lipoproteins in their spectrum this method can distinguish nonatherogenic type A vs atherogenic type B. After their identification, there is the possibility for exact means of interventions among patients with higher cardiovascular risk. Also in the group of clinically healthy asymptomatic controls with normolipemia it is possible using this method to estimate the certain group of risk of development of premature atherothrombosis.

Modified problem-based learning in pharmacology.

OBJECTIVE: The aim of this study was to determine differences between PBL as compared to modified PBL with special focus on acquiring EBM principles. METHODS: Two groups consisted of total 152 students (139 respectively). The use of EBM principles means integrating individual expertise with the best available external clinical evidence by using available data sources and national guidelines. CONCLUSION: Our findings suggest that modified PBL with extended EBM approach could be superior to "classical" PBL (Fig. 3, Ref. 29). Full Text (Free, PDF) www.bmj.sk.

Factors influencing the use of potentially inappropriate medication in older patients in Slovakia.

BACKGROUND: Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce. OBJECTIVES: The aims of the present study were: to identify risk factors enhancing the probability of use of potentially inappropriate medication in hospitalized older patients under the conditions of the Slovak healthcare system and to compare our results with previously published European studies. METHODS: The evaluation was performed in 600 patients aged > or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. To identify the use of potentially inappropriate medication, the Beers 2003 criteria were applied. Particular socio-demographic and clinical characteristics, as well as comorbid medical conditions were evaluated among possible factors enhancing the probability of use of potentially inappropriate medication. RESULTS: At least one potentially inappropriate medication was prescribed to 126 (21%) of 600 patients. Multivariate analysis identified polypharmacy [odds ratio (OR) 2.38; 95% confidence interval (CI): 1.50-3.79], depression (OR 2.03; 95% CI: 1.08-3.82), immobilization (OR 1.87; 95% CI: 1.16-3.00) and heart failure (OR 1.73; 95% CI: 1.13-2.64) as factors associated with an increased risk of use of inappropriate medication. In contrast, patients aged > or =75 years had a lower risk of being prescribed potentially inappropriate medication (OR 0.58; 95% CI: 0.39-0.88). CONCLUSIONS: Polypharmacy, immobilization, heart failure and depression were documented as predictors of use of potentially inappropriate medication. In depressive patients, drugs other than antidepressants contributed to the extensive use of potentially inappropriate medication. The observed prevalence of use of potentially inappropriate medication in older hospitalized Slovak patients was lower than the prevalence previously documented in Poland and the Czech Republic, but higher than in Croatia and Turkey. The identified risk factors were consistent with previous findings from other parts of Europe.

Current opinions on the role of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the main cases of mortality and morbidity of population worlwide. In spite of enormous efforts there are not pharmacological agents evidently influencing natural course of disease available. Besides looking for new drugs influencing the long term outcome of patients with COPD, there is also running the process of reevaluation of the role of several already established drug groups. METHODS: Through the use of recent knowledge and results from large-scale clinical studies as well as metaanalyses we give a view on action of inhaled corticosteroids in the pathophysiological mechanisms of COPD and complex summary of their role in the therapeutic management of the disease. CONCLUSION: Contrary to systemic corticosteroids, agreement regarding usage of inhaled corticosteroids necessary by acute exacerbations of disease has not been reached yet. Recent meta-analyses of the long-term clinical studies have clearly demonstrated that inhaled corticosteroids could pose with ability of slowing down the progressive deterioration of lung functions and lead to the prolongation of life in broad population of patients with COPD. Benefit of treatment insists in decrease of frequency and severity of exacerbations, mildering symptoms, improving overall health state as well as exercise tolerance in patients with COPD. Clinical relevant is also reduction of the number of hospitalizations and mortality related to progression of COPD (Tab. 2, Ref 45) Full Text (Free, PDF) www.bmj.sk.

Perception of drug risk in the database of Drug Information Centre in Bratislava.

OBJECTIVE: The aim of the presented study was to analyse the types and quantity of inquiries received at Drug Information Centre in Bratislava during the period from May 1997 to May 2006. The study analyses also the profile of the users of the latter centre with focus on the perception of drug risk, adverse drug reactions, and drug interactions. BACKGROUND: The Drug Information Centre (Druginfo) was established in Slovak Republic as part of the Department of Pharmacology in May 1997. In 2002 Druginfo became a member of International Register of Drug Information Services of the Society of Hospital Pharmacists of Australia. Druginfo provides voluntary free of charge drug information for healthcare professionals. METHODS: Statistical processing of all inquiries received at Druginfo during a 10-year period focused on the aspect of drug risk perception. RESULTS: 867 inquiries were received in total. The most frequent inquiries came from hospital teaching clinics in Bratislava. Questions concerning pregnancy/lactation (25 %), adverse drug reactions (16 %), basic information about drugs (14 %) and interactions (13 %) were asked most frequently. CONCLUSION: The types of inquiries and inquirers using the service are generally similar to those recorded at many others Druginfos within Europe and USA. The number of questions is lower than in other centres. Druginfo in Bratislava has a very important role in providing independent drug information (Tab. 1, Fig. 8, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Perception of potentially inappropriate medication in elderly patients by Slovak physicians.

PURPOSE: The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available. METHODS: The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis. RESULTS: Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600). CONCLUSIONS: The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

[Consultation activity of two Slovak centres for pharmacotherapy during pregnancy and lactation]. / Konzultacná cinnost' dvoch slovenských centier pri farmakoterapii v gravidite a laktácii.

BACKGROUND: In our paper we present analysis based on number and structure of consultations concerning drug used in pregnancy and lactation in the Drug Information Centre in Bratislava and at the Department of Clinical Pharmacology in Nitra during period 2000 to 2003. METHODS AND RESULTS: In both centres the questions related to pregnancy and lactation represented the significant part of total sum of the requested information. Vast majority of consulted drugs belonged to C category concerning FDA pregnancy drug risk classification. In these drugs animal studies have revealed a risk, but studies in pregnant women were not available and thus the drugs had limited applicability from view point of safety. Decisions of consultants regarding drug use were based on the availability of information sources. A serious problem is the evaluation of retrospective drug risks in cases of drugs administered before pregnancy was confirmed. CONCLUSIONS: The evaluation of drug risk in fertile age, especially in early pregnancy, long-term drug administration during pregnancy and lactation becomes indispensable within professional field of clinical pharmacy and pharmacology in developing local teratogen surveillance system.

Experience with problem oriented teaching in pharmacology.

Pharmacology is one of the core subjects for further graduation in both preclinical and clinical area. Medical education is being performed either in the "classical" way (lecture based learning--LBL) or in a more advanced form, such as problem based learning (PBL). According to the Medline database, the interest in PBL is still increasing. At our department, the PBL has been introduced using the knowledge obtained at the the Mac Master University and University of Groningen. PBL in pharmacology requires well-qualified staff with clinical experience. A common character of PBL is the use of selected clinical cases as models and starting points to study certain topics with a student centred approach. In an interview we made on a sample of 88 students of our medical faculty in the last study year, 65.5% of them found the amount of information concerning pharmacotherapy not sufficient for their future clinical practice and 83.3% did not feel able to use the knowledge obtained. More than 90% of students did not see enough opportunities for pharmacotherapy training during clinical subject courses. These results are in support of our orientation of teaching towards the PBL. This type of teaching forces students to be active, trains their skills in communication and selection of knowledge, which is believed to enhance the long-term knowledge retention. By using the hybrid PBL-LBL model at our department we respect the principal proposal of medical education and attempt to improve skills in decision making in training of future medical doctors. (Tab. 3, Fig. 2, Ref. 13.)

The Slovak Drug Information (Druginfo) Centre during the period 1997-2004.

OBJECTIVES: The aim of the presented study was to evaluate the profile of users, the number and character of questions which were received during the period May 1997-December 2004. BACKGROUND: The drug information centre (Druginfo) has been established in Slovak Republic at the Department of Pharmacology in May 1997. Since 2002 Druginfo is a member of International Register of Drug Information Services of the Society of Hospital Pharmacists of Australia. Druginfo provides voluntarily free of charge drug information for healthcare professionals. METHOD: Druginfo receives questions addressed via phone, fax and e-mail. The questions were replied by consulting pharmacologists on duty. The data for this study were obtained from records which include list the received questions and the basic information about the questioners. RESULTS: The Druginfo received 495 questions during the period May 1997-December 2004. Questions were mostly from hospital physicians, followed by outpatient physicians and employees of the Faculty of Medicine. The most frequent specializations of the asking physicians were internal medicine, gynaecology-obstetrics, clinical pharmacology and general medicine. The most common topic was basic information about drugs, followed by questions concerning the use of drugs in pregnancy and lactation. According to the ATC classification the questions were most often related to antiinfective drugs, cardiovascular drugs and psychiatric drugs. CONCLUSION: The existence of Druginfo in Slovak Republic represents a possibility of an open access to independent drug information. (Fig. 3, Ref. 11.)

[Pharmacoeconomic profile of antibiotics used in the treatment of lower respiratory tract infections in geriatric patients]. / Farmakoekonomický profil antibiotík pouzitých v liecbe infekcií dolných dýchacích ciest u geriatrických pacientov.

The paper aims to evaluate the pharmacoeconomic profile of antibiotics (ATB) used in the treatment of lower respiratory tract (LRT) infections and thus contribute to rationalization of therapeutic procedures. Of 2870 patients hospitalized at the Geriatric Clinic of the Medical Faculty of Comenius University from 1 January 1999 to 31 December 2001, 189 patients with acute infections of the LRT were included in the retrospective study. For pharmacoeconomic evaluation, cost effectiveness analysis was employed, the principal parameter of which, cost effectiveness coefficient, was the ratio of the price of ATB treatment in Slovak crowns (SK) and the criterion of effectiveness (E), the number of asymptomatic days in a month. The authors separately evaluated ATBs administered perorally (p.o.); intravenously (i.v.), and sequentially, and they also compared i.v. and the corresponding sequentially administered ATBs. Statistical comparison revealed significant differences in the prices and cost effectiveness coefficients of individual alternatives of ATB treatment. Employed ATBs did not significantly differ in the criteria of effectiveness. According to the cost effectiveness coefficient (SK/asymptomatic day), fluoroquinolones were less expensive (median price/E: pefloxacin: p.o. 19.3; i.v. 29.1; sequentially administered 26.0, and ciprofloxacin: p.o., 14.7, i.v., 54.1, sequentially administered, 31.7). Sequential administration of ATBs (ampicillin-sulbactam, cefuroxime, amoxicillin-klavulanate, ciprofloxacin) was significantly cheaper in comparison with i.v. administration. With therapeutic equivalence, the total pharmacoeconomic profile of ATB treatment depended on the price parameter. In the selection of ATB it is also necessary to consider the price of the drug.

Assessing skills in pharmacology in medical students.

The results of this pilot survey have shown the importance of evaluation of medical student knowledge in pharmacology using three independent parts of the examination. The final mark includes the results of a written test, oral examination and evaluation of seminar essay. We evaluated students with final grade A (n=76) and F (n=61) in relation to the results of tests and seminar essays. Most of the students with grade A (88.2 %) wrote the test in the upper range (90-99 %) and their seminar essay evaluations were grade A in 82.9 %. A significant correlation between the results in the test and the mark obtained in the seminar essay was found (r=0.22, p<0.05). Another group of students with grade F obtained low scores in the test (57.4 %), and a relatively large part of students got satisfactory results in test (42.6 %). In this group the quality of seminar essays was variable ranged from A to E. The evaluation showed that in students with final grade A were all three independent part of exam in agreement with final classification. The differences occurred in group of unsuccessful students who performed much better in written part than in the oral examination. The experience with the final assessment of medical student knowledge in pharmacology showed that the most important essay evaluation seems to be the oral form of exam. The results of seminar evaluations correspond satisfactory with the performance of students during the final exam and their effort may continue in diploma work, which is mandatory for all medical students (Tab. 2, Fig. 1, Ref. 2).

[Polypharmacotherapy in clinical gerontology]. / Polyfarmakoterapie v klinické gerontologii.

Multimorbidity frequently develops in old age and it is usually accompanied with pharmacotherapy of elderly patients. The growing number of seniors and comparatively low attention given to this reality among the medical community makes the problem highly significant for the practical medicine. Solution requires in the broad medical community a deeper knowledge of gerontopharmacotherapy and of its specific features, including the pharmacodynamics and pharmacokinetics in elderly organism. Non-geriatric physicians will face in their daily clinical praxis the questions of drug interactions and undesirable general and local side effects. Moreover, some foods, beverages or preservatives can influence the pharmacological effect. Due to multimorbidity in the senescence, such problems can be linked to large geriatric syndromes (instability with downfalls, immobility, decubitus, incontinency, intellectual and sensory defects of vision and hearing).

Cost-effectiveness analysis of switching from intravenous to oral administration of antibiotics in elderly patients.

OBJECTIVE: The aim of the introduced work was to evaluate pharmacoeconomic advantages of timely switching from intravenous to oral administration of antibiotics (ATB). METHODS: The evaluated group was selected out of 2870 patients, who were hospitalised at the Clinic of Geriatric Medicine of the Faculty of Medicine of Comenius University in Bratislava from January 1st 1999 to December 31st 2001. In our retrospective study we analysed 96 patients with community-acquired pneumonia successfully treated by ATB. In 43 of them ATB were given intravenously and in 53 the therapy was switched, i.e. the intravenous administration was used at the beginning and oral administration when the condition improved. We applied a cost-effectiveness analysis to the pharmacoeconomic evaluation. The cost-effectiveness coefficient was calculated as the ratio of ATB price (Slovak Crowns) to the effectiveness criterion (number of asymptomatic days in month). RESULTS: According to the cost-effectiveness coefficient, the switch therapy was significantly less expensive in all evaluated ATB (except for pefloxacin) in comparison with intravenous administration: ampicillin-sulbactam 93.9 vs 168.1; cefuroxime 90.0 vs 123.3; amoxicillin-clavulanate 74.0 vs 116.3; ciprofloxacin 31.7 vs 54.1. CONCLUSIONS: A timely switching from intravenous to oral administration of ATB in a suitable patient is an effective way to save financial resources. (Tab. 5, Ref: 21.)

[Antibiotics in ambulatory practice in Slovakia 1999-2001]. / Antibiotiká v ambulantnej praxi na Slovensku v rokoch 1999-2001.

Evaluation of the consumption of antimicrobial drugs is an important component of antibiotic policy and provides a picture of rationality of treatment. In the present paper, the authors analyzed the consumption of antibacterial agents of the ATC group J01 for systemic use in out-patient practice in Slovakia in 1999-2001. The data were taken from materials of all Slovak insurance companies provided by the Ministry of Health of the Slovak Republic. The paper evaluated the total out-patient consumption of antimicrobial agents and the financial costs of antibiotic therapy, analyzed the consumption of the individual groups of antibiotics and the consumption of individual agents, and compared the found out-patient consumption with that of Finland. The DDD values in the period under study gave evidence of a high but stable consumption of antibiotics. The analysis according to the groups of antibiotics revealed the dominance of penicillins with wider spectra, penicillins sensitive to beta-lactamases, and macrolides. The evaluation of individual antimicrobial agents showed a positive tendency of the growth of amoxicillin consumption, compensated by a decrease in the consumption of less advantageous ampicillin. The comparison of the Slovak and Finnish consumptions of macrolide antibiotics showed a prevailing consumption of roxitromycin and klaritromycin in Slovakia, and azitromycin in Finland. As far as cephalosporins are concerned, the preparations of the first generation dominated in Finland, and those of the second generation in Slovakia.

Risks of antibiotic treatment.

Adverse effects of antibiotics can cause a failure of antibiotic treatment. The authors give a survey of antibiotic toxicity manifestations, according to the target organ systems, with emphasis on identification of at-risk patients and on possible prevention of particular adverse effects. Although antibiotics belong to relatively safe pharmaceuticals, many of them can be a cause of a serious damage to the human organism. Beta-lactam antibiotics are considered the least dangerous. A considerable number of adverse effects, especially the dose-dependent ones, are preventable on condition that the risk factors, as the patient's age, functional capacity of eliminating organs (kidney, liver), associated diseases and simultaneous administration of drugs, are considered. In conclusion, the clinically significant drug interactions of antibiotics are pointed out, being of increasing importance especially in patients with multiple diseases and polypragmatic manner of treatment. (Tab. 2, Ref. 48.)

Eradicative effect of cotrimoxazole and quinolones on non-typhoid salmonellae.

Opinions on antibiotic treatment of salmonella gastroenteritis are still different. Many authors support an opinion that antimicrobial treatment has no effect on salmonella elimination. The authors of the study have tried to prove that fluoroquinolones shorten the elimination of salmonellae and therefore they are useful not only for the treatment of salmonella gastroenteritis in immunocompromised patients to prevent sepsis and extraintestinal manifestations of the infection, but also for eradication of salmonellae in food industry workers, whose carrier state might exclude them from their work. (Tab. 3, Ref. 10.)