A proposal to reduce the amount of permethrin entering wastewater resultant from topical use to treat scabies.

The incidence of scabies is rising in the last years. Subsequently, the use of pharmaceuticals to treat the disease has also increased. Treatment with topical permethrin is usually recommended as a first line agent. This substance is also an aquatic contaminant that is toxic for many non-target organisms, and has been included as a priority substance in the recently published proposal of the European Water Framework Directive. Current guidelines neglect the potential environmental impact of this drug, recommending that the cream should be applied head to toe and "washed off after 8-12 h". Recently, a wiping procedure before hand washing after application of the topical treatment resulted in a 66 % reduction of the amount of diclofenac released in wastewater. The authors suggested that this method could be explored for other topical treatments. In the case of scabiosis, a protocol implicating the whole body needs to be designed. The absorption of topical permethrin is low. Considering the growing incidence of scabies, the amount of the pyrethroid reaching the environment may also be increasing. Therefore, we believe that applying the wiping procedure to the case of topical permethrin deserves consideration. Other measures to minimize the amount of permethrin residues reaching wastewater by washing clothes and bed linen such as wearing single-use pijamas should also be explored. In conclusion, we need to apply a One Health approach in the treatment with scabies, without neglecting the environmental impact of pharmaceuticals. It is not rational to forget drugs once they go down the drain.

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Utilidad de la vía subcutánea en la estrategia de atención al paciente con demencia en fase avanzada / Usefulness of the subcutaneous route in the care of patients with advanced dementia

En las fases avanzadas de la demencia, los objetivos deberían ser el confort, el adecuado control de los síntomas y evitar el sufrimiento inducido por los procedimientos fútiles, intrusivos o desproporcionados que no benefician al paciente. La vía subcutánea constituye una herramienta útil en la asistencia a estos pacientes, lo que permite la administración de líquidos y de un gran número de fármacos necesarios para conseguir estos objetivos. Su buena tolerancia y la gran facilidad de manejo hacen que pueda utilizarse sin problemas fuera del hospital, lo que permite mantener al paciente en su entorno habitual limitando los riesgos derivados de la hospitalización. Aunque un gran número de fármacos utilizados en este contexto no tienen especificada en su ficha técnica la posibilidad de administración subcutánea, existe una creciente evidencia derivada de su uso y de publicaciones médicas que es recogida en diferentes guías de práctica clínica en cuidados paliativos. Las nuevas regulaciones simplifican la implementación de estos estándares de práctica clínica (AU)

In advanced dementia, the therapeutic goals should be patient comfort, adequate symptom control, and the prevention of suffering due to futile, intrusive or disproportionate procedures. To attain these goals, the subcutaneous route is a useful tool, since it allows fluid administration and the delivery of many drugs. Because it is well tolerated and easy to apply, this route can be safely used in non-hospital settings, allowing patients to stay in their environment and avoiding the risks resulting from hospitalization. Although subcutaneous administration is outside the approved label of many drugs, clinical experience and the medical literature have produced sound evidence that has been incorporated into a number of practice guidelines in palliative care. The recent regulations simplify the implementation of these standars of clinical practice (AU)

[Usefulness of the subcutaneous route in the care of patients with advanced dementia]. / Utilidad de la vía subcutánea en la estrategia de atención al paciente con demencia en fase avanzada.

In advanced dementia, the therapeutic goals should be patient comfort, adequate symptom control, and the prevention of suffering due to futile, intrusive or disproportionate procedures. To attain these goals, the subcutaneous route is a useful tool, since it allows fluid administration and the delivery of many drugs. Because it is well tolerated and easy to apply, this route can be safely used in non-hospital settings, allowing patients to stay in their environment and avoiding the risks resulting from hospitalization. Although subcutaneous administration is outside the approved label of many drugs, clinical experience and the medical literature have produced sound evidence that has been incorporated into a number of practice guidelines in palliative care. The recent regulations simplify the implementation of these standards of clinical practice.