[Antibiotic stewardship programs in the Spanish emergency services: PROA-URG Study]. / Programas de optimización del uso de antimicrobianos en los servicios de urgencias españoles: Estudio PROA-URG.

OBJECTIVE: Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know the extent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units. METHODS: Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist. RESULTS: Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0). CONCLUSIONS: Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units.

Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria / Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose

Objetivo: Analizar si el cambio de tratamiento antirretroviral a efavirenz/emtricitabina/ tenofovir en dosis única diaria (EETu) incrementa la adherencia y mantiene la efectividad del mismo, y establecer el incremento de coste provocado por dicho cambio. Métodos Estudio observacional, retrospectivo e intrasujeto, realizado en la unidad de dispensación a pacientes externos. El periodo de estudio fue un año (seis meses antes y seis meses después del cambio). Se revisaron los registros informáticos de dispensación y los días de hospitalización durante el periodo de estudio y se calculó la diferencia de adherencia al tratamiento. Para determinar la eficacia del tratamiento, se revisaron los datos de carga viral y linfocitos CD4 antes y después del cambio. Se recogió el coste de los tratamientos previo y posterior para cada paciente y se determinó el incremento de coste anual y por paciente. Resultados Se incluyeron en el estudio 127 pacientes. La diferencia de adherencia fue del 0,6%. El porcentaje de malos adherentes fue del 35,43 y del 40,94% antes y después del cambio de tratamiento, respectivamente. Los niveles de linfocitos CD4 y carga viral no cambiaron significativamente con el tratamiento. En análisis económico reveló un incremento de 25.374,60€ anuales y 199,80€/paciente. Conclusiones El uso de EETu no mejora el control de la infección por el VIH en términos de efectividad ni de adherencia y supone un aumento del gasto farmacéutico, por lo que su elección como tratamiento antirretroviral deberá basarse en criterios diferentes a los anteriormente descritos (AU)

Objective: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. Methods: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change).Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. Results: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25 374.60 and €199.80 per patient. Conclusions: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above (AU)

[Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose]. / Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria.

OBJECTIVE: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. METHODS: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change). Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. RESULTS: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25,374.60 and €199.80 per patient. CONCLUSIONS: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above.