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1.
Internist (Berl) ; 61(4): 375-387, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32144476

RESUMO

Against the background of increasing antimicrobial resistance, antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. For Germany and Austria, a comprehensive S3 guideline is available, which was last updated in 2018. The control of antibiotic or anti-infective use in hospitals should be guided by specialized ABS teams. At the hospital level, ABS also includes a structured ongoing analysis of local antibiotic use and resistance data. Recommendations for locally adapted therapy regimens should be derived and implemented from this data analysis. ABS consists of regular ward rounds ("ABS visits"), during which members of the ABS team review the indication, dosage, route of administration and duration of antimicrobial therapy at the bedside. Here, the key challenge is to save antibiotics without compromising the individual patient. Digitalization and artificial intelligence offer new options for ABS, while the adaption of inpatient concepts to outpatient care is also important.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Farmacorresistência Bacteriana , Anti-Infecciosos , Inteligência Artificial , Infecções Bacterianas/microbiologia , Prática Clínica Baseada em Evidências , Alemanha , Humanos , Guias de Prática Clínica como Assunto
2.
Internist (Berl) ; 61(5): 475-486, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32112153

RESUMO

Antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. The most important ABS tools include the implementation of local guidelines, the development of a house-related list of anti-infective agents, regular ABS visits and practice-oriented internal training events. Effective strategies for therapy optimization include indication testing and therapy evaluation, dose optimization as well as determining an appropriate duration of therapy. Oralization of anti-infectives (sequence therapy) should be supported by consistent clinical criteria in in-house guidelines. The incidence of Clostridioides difficile infections (CDI) can be more than halved by restricting the so-called "4C antibiotics". Point-of-care tests help to minimize the use of antibiotics in the outpatient setting. Vaccination reduces the need for antibiotic therapy.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Anti-Infecciosos/administração & dosagem , Infecções Bacterianas/microbiologia , Infecções por Clostridium/prevenção & controle , Surtos de Doenças/prevenção & controle , Farmacorresistência Bacteriana , Alemanha , Humanos
3.
Zentralbl Chir ; 137(2): 173-9, 2012 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-21766274

RESUMO

BACKGROUND: Medication errors and subsequent drug-related problems (DRPs) result from lack of sufficient information during the prescribing step. The objectives of this study were to evaluate the contribution of having a pharmacist participate in clinical routine on a surgical unit by studying DRPs, and the classification of DRPs in the Pharmaceutical Care Network Europe (PCNE) system. MATERIALS AND METHODS: The pharmacotherapy of all patients of a visceral surgical ward was evaluated by a pharmacist in a prospective study design over a six-month period. The identified DRPs were classified using the PCNE system. RESULTS: In 29 131 prescription lines, 697 DRPs were registered. This corresponds to a mean intervention rate of 2.4 %. All DRPs were classified into the modified PCNE system with 910 causes and 1 148 interventions. The most frequent DRPs were "lack of home medication" (35.6 %), drug dosing problems (18.6 %), the inappropriate duplication of drugs of the same therapeutic group (6.7 %) and drug interactions (6.5 %). 78.6 % vs. 3.7 % of all registered DRPs were completely vs. near completely resolved by pharmacist. CONCLUSIONS: We consider the PCNE system with the four-level of classification to be a practical and easy-to-use tool in the daily hospital setting. Although we did not notice clinically relevant impairments of patient safety, a pharmacist may support the drug therapy and improve patient safety in clinics supporting the free choice of the drug therapy by the physician.


Assuntos
Comportamento Cooperativo , Comunicação Interdisciplinar , Erros de Medicação/prevenção & controle , Farmacêuticos , Padrões de Prática Médica , Centro Cirúrgico Hospitalar , Estudos de Coortes , Interações Medicamentosas , Substituição de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Alemanha , Fidelidade a Diretrizes , Humanos , Sistemas de Medicação no Hospital , Segurança do Paciente , Estudos Prospectivos , Melhoria de Qualidade , Vísceras/cirurgia
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