[Antibiotic treatment optimization by means of antibiotic treatment experts participation]. / Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos.

BACKGROUND: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions. METHODS: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. RESULTS: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalization-bed/day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. CONCLUSIONS: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable.

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos / Antibiotic treatment optimization by means of antibiotic experts participation

Antecedentes: Los antibióticos representan un porcentaje elevado del gasto de farmacia de un hospital. Una elevada proporción de las prescripciones se consideran inapropiadas. La ayuda prestada por infectólogos con una formación extensa en el manejo de los antibióticos podría mejorar la prescripción de este tipo de medicamentos. Métodos: Revisión diaria de las prescripciones antibióticas realizadas en cuatro salas de hospitalización de varias especialidades quirúrgicas. Examen diario de los casos que cumplían algunos de los signos de sospecha de prescripción inadecuada. Si existían casos sugestivos de este tipo de prescripción se efectuaba una recomendación a los médicos prescriptores. La intervención se realizó durante 4 meses. Se compararon los resultados con un periodo similar del año anterior. Resultados: Se revisaron 562 tratamientos en 393 pacientes. Se realizaron 524 recomendaciones (el 90% fueron aceptadas). Se logró una reducción importante de prescripciones consideradas inadecuadas. Se consiguió una disminución del gasto en antibióticos de 29.363 € (7.240 €/mes), lo que supone un ahorro de 2,35 €/cama de hospitalización/día. No hubo diferencias estadísticamente significativas ni en la en mortalidad ni en el aislamiento de bacterias nosocomiales resistentes Conclusiones: Empleando un programa de asesoramiento sobre el tratamiento antibiótico se consiguió una mejor utilización y una disminución del gasto en antibióticos, sin variaciones en la mortalidad. El programa fue muy bien aceptado por los médicos de los servicios implicados

Background: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions Methods: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. Results: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalizationbed/ day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. Conclusions: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable

[A pharmacoeconomic study of in-hospital treatment against community-acquired pneumonia]. / Estudio farmacoeconómico del tratamiento hospitalario de numonía adquirida en la comunidad.

INTRODUCTION: A computer-driven unit-dose drug-dispensing system allows for improved knowledge on pharmaceutical costs per DRG and clinical department, between-hospital pharmacoeconomic studies to be carried out, as well as deviation analysis. METHODS: A retrospective, cost-minimization study was undertaken to both analyze and compare prescriptions for a number of antibiotics and bronchodilators, and their costs in both 89 and 90 DRGs, as well as their cost per hospital stay in patients admitted to the Internal Medicine Departments of two hospitals in Areas 6 (HUPH) and 9 (SVO) in CAM (Autonomous Community of Madrid). A statistical analysis was performed using the Kolmogorov-Smirnov test, Student 's "t" test, Mann-Whitney test, and least squares method. RESULTS AND CONCLUSIONS: Patient samples are similar, with no significant differences existing in clinical status at admission or in cure percentage. Also, no significant differences exist in antibiotic use, except for clarithromycin and ceftriaxone, which were more commonly used at SVO (P = 0.001 and P = 0.003, respectively), and levofloxacin, which was more commonly prescribed at HUPH (P < 0.001). For identical results measured by using the cure index and mean stay, the cost of antibiotic therapy was significantly higher at HUPH (113.57 euro) versus SVO (78.32 euro), which related to a wider use of levofloxacin; while no statistical relation to clinical status was found that warranted its choice. No differences were seen in bronchoinhaler use which, together with antibiotics, represent 82.6% of cost at HUPH and 72% at SVO.

[In-hospital Radio-Pharmacy Unit: creation and development]. / Unidad de Radiofarmacia Hospitalaria: creación y desarrollo.

Regarding the creation of an In-Hospital Radio-Pharmacy Unit within Clínica Puerta de Hierro University Hospital, as well as the compliance with Real Decreto 479/1993 on the regulation of radio-drugs for human use, the steps to be taken to bring it service are laid out and discussed. An overall review of the differential characteristics of radio-drugs is undertaken. The adequate distribution of spaces and the Unit's functioning regulations are presented, and the responsibilities of the person in charge of the ionisation chamber are clearly placed on record. The professional responsible of the Unit should define performance and quality control protocols for each test. The responsibility for coordinating the Unit's operation is assigned to the Heads of Nuclear Medicine and Pharmacy Departments, within the Pharmacy and Therapeutics Committee and the Nuclear Medicine Quality Committee.

Unidad de Radiofarmacia Hospitalaria: creación y desarrollo / In- Hospital Radio-Pharmacy Unit: creation and development

Para la creación de la Unidad de Radio-farmacia Hospitalaria en el Hospital Universitario Puerta de Hierro y para la adaptación al Real Decreto 479/1993 sobre regulación de radiofármacos de uso humano, o se presentan y discuten los pasos que deben realizarse para su puesta en funcionamiento. Se realiza una revisión general de las características diferenciales de los radiofármacos. Se presentan la distribución adecuada de los espacios y las normas de actuación en la Unidad, dejando expresa constancia de las responsabilidades del encargado de la cámara caliente. Se especifica que el facultativo responsable de la Unidad debe elaborar los protocolos de realización y de control de calidad de cada una de las pruebas. Se asigna a los Jefes de Servicio de Medicina Nuclear y de Farmacia, en las Comisiones de Farmacia y Terapéutica y en la de Calidad en Medicina Nuclear, la responsabilidad de coordinar el funcionamiento de la Unidad (AU)