RESUMEN
A multicentre, prospective, controlled study compared the clinical efficacy, safety and economic impact of a pharmacist intervention to promote sequential intravenous to oral clindamycin conversion. A total of 473 patients receiving intravenous clindamycin for at least 72 hours were included in the study. Two groups were established: an intervention group (204 patients) in which an informative sheet recommending the sequential treatment was provided, and a control group (269 patients). Clindamycin was prescribed for respiratory infections in 38.9% and for prophylaxis in surgery in 25.4% of the patients (71% were contaminated surgery). No difference between groups regarding sex, infection severity, health status or clinical progress was observed. Both the step-down treatments after 72 hours of intravenous clindamycin and the change to the oral route later on, were significantly increased with the intervention (p < 0.001, p < 0.001 respectively). No significant differences between both groups were found in the number of patients with adverse effects associated with the i.v. therapy, although the incidence tended to be lower in the intervention group (49/204 intervention versus 85/269 control, p = 0.07). Compliance with the recommended clindamycin dosing regimen was significantly higher in the intervention group, in which 1.3 days reduction of intravenous therapy provided an average cost savings of PTA5246 (95% CI 2556-7935) per treatment. A higher reduction of 1.7 days was achieved in those patients candidates for switch therapy on the third day of intravenous clindamycin. A sequential program with clindamycin may provide a cost-effective alternative to conventional therapy and the introduction of an information sheet is a cost-effective strategy to promote it.
Asunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/economía , Clindamicina/administración & dosificación , Clindamicina/economía , Administración Oral , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/economía , Clindamicina/uso terapéutico , Análisis Costo-Beneficio , Costos y Análisis de Costo , Femenino , Hospitalización , Hospitales Públicos , Humanos , Inyecciones Intravenosas , Tiempo de Internación , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Farmacéuticos , Servicio de Farmacia en Hospital , EspañaAsunto(s)
Infecciones Comunitarias Adquiridas/complicaciones , Infecciones por VIH/complicaciones , Neumonía Estafilocócica/complicaciones , Infecciones Estafilocócicas/complicaciones , Adulto , Técnicas Bacteriológicas , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/microbiología , Humanos , Huésped Inmunocomprometido , Masculino , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiología , Radiografía , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
A patient with SLE whose initial manifestation was with a rare delirious disorder manifested as pseudocyesis is described. The psychiatric manifestations were considered to be due to SLE and treated with pulse steroid therapy. Special attention is focused on treatment and MRI.