Profilaxis antibiótica preoperatoria en pacientes con cirugías ginecológicas en el Hospital Homero Castanier Crespo / Preoperative antibiotic prophylaxis performed on patients with gynecological surgeries at ¨Homero Castanier Crespo¨

Introducción: el uso inadecuado de los antimicrobianos constituye una preocupación mundial. En Ecuador, este problema se agrava porque no se han tomado las medidas pertinentes para controlar la situación. No se realizan programas de vigilancia de infecciones producidas por bacterias resistentes ni control en el uso indiscriminado. Existe poco conocimiento por parte de los servidores de salud y ausencia de comités de infecciones en los hospitales. Objetivo: evaluar la calidad de la prescripción y el costo del tratamiento de la profilaxis antibiótica preopereatoria mediante el seguimiento farmacoterapéutico en pacientes operadas de afecciones ginecológicas. Método: se realiza un estudio retrospectivo, y una evaluación económica, del tipo minimización de costos del tratamiento utilizado. En el hospital Homero Castanier Crespo de la Ciudad de Azogues, Ecuador desde septiembre 2015 hasta marzo 2016. Resultados: la mayoría de las pacientes tenían entre 21 y 40 años de edad. Los principales motivos de cirugía fueron quiste de ovario roto y mioma uterino. Predominaron las cirugías limpias-contaminadas. El antimicrobiano más utilizado fue la cefazolina en dosis única, cada 24, 12 y 8 horas. Aproximadamente en un 20 por ciento de los casos, se realizó cambio de tratamiento injustificadamente. Predominaron los PRM6. La mayoría de las prescripciones resultaron inadecuadas. El costo global por antimicrobianos fue de 503,09 USD. Si la profilaxis se hubiera aplicado adecuadamente, se hubiera ahorrado 435,45 USD. Conclusiones: se sugiere el rediseño del Protocolo de Profilaxis Antibiótica Preoperatoria del Hospital Homero Castanier Crespo(AU)

Introduction: The inappropriate use of antimicrobials is a world concern and in Ecuador, this problem worsens because there are not relevant measures in place to control the situation. Neither surveillance programs of infections caused by resistant bacteria nor control of the indiscriminate use of antimicrobials are implemented. The health professionals´ knowledge is poor about it and the infection commissions are nonexistent in hospitals. Objective: To evaluate the quality of prescription and the cost of treatment of preoperative antibiotic prophylaxis through drug therapy follow-up in patients operated on for gynecological problems. Method: A retrospective study and an economic assessment of treatment cost minimization type was carried out in Homero Castanier Crespo¨hospital in Ciudad de Azogues, Ecuador, from September 2015 to March 2016. Results: Most of the patients were 21 to 40 years-old. The main reasons for surgery were ruptured ovarian cyst and uterine myoma. Clean-contaminated surgeries predominated. The most used antimicrobial was cefazoline at a single dose every 8, 12 and 24 hours. Around 20 percent of cases changed their treatment with no justification. PRM6 prevailed. Most of prescriptions were inadequate. The global cost of antimicrobials was 503.09 US dollars. If prophylaxis would have been correctly applied, then 435.45 US dollars had been saved. Conclusions: It is suggested that the preoperative protocol of antibiotic prophylaxis be redesigned in Homero Castanier Crespo(AU)

Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up

The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometric and biochemical parameters were measured before and after PF. The Framingham scoring method was used to estimate changes in 10-year coronary heart disease risk scores in all patients. Ninety-six of 120 patients had characteristics of MS and were randomized into two groups (G): the control group (CG: 36) and the intervention group (IG: 38). Among the MS patients, 100% were taking a glucose-lowering drug; many were also taking anti-hypertensive drugs (CG: 72%; IG: 73%), and some patients were also taking hypolipemic drugs (CG: 12.0%; IG: 14.7%). Only 20.7% of the IG patients were considered adherent to their prescribed drugs. In the CG, an increase of coronary heart disease (CHD) risk (22±2 to 26±3; p<0.05) was observed, while in the IG, there was a reduction in CHD risk (22±2 to 14±2%; p<0.01). The PC program administered to patients with MS monitored through the primary healthcare services of the Brazilian public health system improved patient health, resulting in clinical improvements and a decrease in cardiovascular risk in IG patients over a period of ten years.

O objetivo deste estudo foi o de determinar o impacto de um Programa de atenção Farmacêutica (AF) em uma amostra de pacientes ambulatoriais de Sistema Público de Saúde do Brasil portadores de Síndrome Metabólica, randomizados em AF ou atenção à saúde usual. Realizou-se o seguimento farmacoterapêutico com 120 pacientes com diabetes tipo 2 durante seis meses. Avaliou-se o nível de aderência ao tratamento (teste Morisky), resultados clínicos negativos associados a medicamentos (RNM), parâmetros bioquímicos e antropométricos, antes e após o seguimento. O método de Framingham foi usado para calcular as variações no risco de doenças coronarianas em 10 anos em todos os pacientes. Dos 120 pacientes, 96 tiveram características de SM e foram então randomizados em dois grupos (G): Controle (GC: 36) e Intervenção (GI: 38). Entre os pacientes com SM, 100% faziam uso de medicamentos para diminuir a glicose, anti-hipertensivos (GC: 72%; GI: 73%) e hipoglicemiantes (GC: 12.0%; GI: 14.7%). Apenas 20,7% do GI foram considerados aderentes aos fármacos prescritos. No GC foi observado aumento do risco de Doença Arterial Coronariana (DAC) (22±2 para 26±3; p<0,05), enquanto no GI foi observado redução (22±2 para 14±2%; p<0,01). O Programa de AF para pacientes com SM monitorados na atenção primária do Sistema de Saúde Pública brasileiro melhora o funcionamento do serviço resultando na melhoria clínica dos pacientes com redução do risco de doença cardiovascular em um período de dez anos.