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What is Known and Objective: Antibiograms gives an overview of the cumulative susceptibility of formal antibiotics to bacterial isolates, which reflects the portion of each bacterium susceptible to a given antibiotic formulation by using antimicrobial susceptibility testing. The objective of this study is to gather and analyse data from drug utilization evaluation (DUE) studies and antimicrobial susceptibility tests in order to create an antibiogram toolkit that will help clinicians to select appropriate antimicrobial agents for initial empirical antibiotic therapy at point of care settings and avoid irrational use of antibiotics. Methods: A prospective interventional study was conducted at tertiary care hospital, biological samples of infectious patients were collected from various wards as per Clinical & Laboratory Standards Institute CLSI M39‐A4 guidelines. Antimicrobial susceptibility results were analysed using WHONET software. Antibiotic stewardship committee was formed and involved in monitoring the usage of antibiotics, measuring outcomes, collecting feedback and finding the scope for improving the application of antibiogram toolkit in the hospital. Antibiotic usage tracking method was followed to know the level of adherence to the prescribing guidelines by the health care professionals. Results and Discussion: A total of 157 samples were obtained from various wards of the hospital. In that, Escherichia coli, Staphylococcus aureus and Klebsiella Pneumoniae were isolated in significant numbers. Antibacterial susceptibility results were collected, an initial antibiogram was developed for 18 antibacterial agents with respect to 3 gram‐positive (+) and 1 gram‐negative (−) organisms. 90% of prescribers mentioned that the antibiogram was useful, and 76% of them adhered to the guidelines. 26% were not adhered due to the patient‐related factors. What is New and Conclusion: In our study, we have used qualitative and quantitative evaluation of drug utilization (DUE) reports to understand the existing prescribing pattern of antibiotics and setting target organisms and antibacterials to develop the hospital antibiogram. Combining DUE studies and antibiogram development was helpful in implementing effective antibiotic policies for the hospital. Further, this study pattern will be continued on a yearly basis and focused on developing cumulative antibiograms to understand the changes in resistance pattern of antimicrobials and utilization of antibiotics in the hospital. [ABSTRACT FROM AUTHOR]

What is known and objective: Oral anticoagulants (OACs), including warfarin and newer direct‐acting OACs (DOACs), have been used for decades to prevent thromboembolic diseases. A drug utilization study was performed to determine the prescribing patterns of OACs. Methods: Data were extracted from the Cooperation Project of Hospital Prescription Analysis in China. A total of 455,490 prescription records from 43 tertiary hospitals in five cities of China (Beijing, Shanghai, Guangzhou, Hangzhou and Chengdu) were selected for inclusion. Quarterly trends of defined daily doses (DDDs) and defined daily dose cost (DDDC) from 1 January 2015 to 31 December 2019 were calculated. Results and discussion: Warfarin was the most widely used OAC with DDDs between 189,982 and 176,323 from the first quarter (Q1) of 2015 to the fourth quarter (Q4) of 2019, whereas the use of DOACs increased rapidly during this period. DDDs of rivaroxaban increased from 5409 in Q1 of 2015 to 125,800 in Q4 of 2019, whereas the DDDC declined from 160.5 to 45.7. From Q1 of 2018, rivaroxaban became the most prescribed OAC, surpassing warfarin, in patients diagnosed with deep vein thrombosis. In addition, the DDDs of rivaroxaban exceeded those of warfarin in patients diagnosed with non‐valvular atrial fibrillation since the second quarter (Q2) of 2019. DDDs in outpatients and inpatients increased by 80.6% and 71.4%, respectively, and the DDDC for outpatients in Q4 of 2019 was 6.7‐fold higher than that in Q1 of 2015. Among patients of all ages, the DDDs in elderly patients increased from 36.8% in Q1 of 2015 to 59.4% in Q4 of 2019. Moreover, the departments of cardiology and cardiothoracic surgery prescribed the majority of the OACs. What is new and conclusion: In this study, we describe OAC prescription patterns in China. DOACs, especially rivaroxaban, contribute to the continuous increase in the use of OACs. In the investigated population of China, outpatients and elderly patients were observed to be administered the highest proportion of DOACs. [ABSTRACT FROM AUTHOR]

What is known and objective: The aim of this study was to evaluate the appropriateness and clinical outcomes of edoxaban use, and to determine the role of clinical pharmacists in improving the efficacy and safety of edoxaban use. Methods: A retrospective study was performed by using an electronic medical record and anticoagulation clinical data from 600 patients who received edoxaban from 1 March 2016 to 16 July 2017 at a tertiary teaching university hospital. The appropriateness of edoxaban use was assessed using eight criteria based on drug use evaluation criteria developed by the American Society of Health‐System Pharmacists drug use evaluation guidelines, details in Korea Food and Drug Administration approval of edoxaban. Clinical outcomes were evaluated between the appropriately prescribed and inappropriately prescribed groups regarding the incidence of thrombosis and bleeding episodes. Results and discussion: After excluding 86 patients due to the inability to assess renal function, 514 were eligible. Appropriate use was found in 294 patients (57.2%). The most frequent inappropriate use of edoxaban was dose adjustment (60.8%) in accordance with the dosing recommendation in patients with renal insufficiency (creatinine clearance [CrCl] of 15‐50 mL/min) and a low body weight of <60 kg. Moreover, there were three cases of edoxaban use in patients with prosthetic heart valves and moderate‐to‐severe mitral stenosis, and 15 cases of non‐valvular atrial fibrillation in patients with CrCl >95 mL/min in whom edoxaban use is not recommended. Furthermore, we found that the factors related to the appropriateness of edoxaban use were <60 kg body weight (adjusted odds ratio [OR]: 0.310; confidence interval [CI]: 0.197‐0.488) and CrCl <50 mL/min (adjusted OR: 0.629; CI: 0.404‐0.980). There were 45 events (8.75%) of any bleeding, 9 (1.8%) of stroke/transient ischaemic attack (TIA) and four events (0.8%) of deep vein thrombosis (DVT)/pulmonary embolism (PE). However, there was no difference between the appropriately prescribed group (294 patients) and inappropriately prescribed group (220 patients) in the incidence of bleeding events (27 [9.2%] vs 18 [8.2%]), stroke/TIA (7 [2.4%] vs 2 [0.9%]) and DVT/PE (2 [0.7%] vs 2 [0.9%]), respectively. What is new and conclusion: Although edoxaban has a broad therapeutic window that does not require routine monitoring, it should be cautiously used in patients with renal insufficiency (CrCl <50 mL/min) and body weight <60 kg. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self‐reported symptoms in older community‐dwelling persons with and without diabetes. Methods: The basic population was comprised of Finnish community‐dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD‐10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross‐sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire. Results and discussion: The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self‐reported symptoms. What is new and conclusion: There is no difference in anticholinergic drug use in older community‐dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully. [ABSTRACT FROM AUTHOR]

What is known and objectives When considering acute care settings, such as the neonatal intensive care unit ( NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A- PINCH (Anti-infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high-risk medicines list, and determining whether there are any differences in medicine use between countries. Method Quasi-systematic literature review. Search strategy Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. Results A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A- PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off-label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. What is new and conclusion Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off-label and unlicensed medicines. [ABSTRACT FROM AUTHOR]

What is known and objective Antimicrobial resistance is one of the greatest threats to human health. One of the most important factors leading to the emergence of resistant bacteria is overuse of antibiotics. The purpose of this study was to investigate the correlation between antimicrobial usage and bacterial resistance of Pseudomonas aeruginosa ( P. aeruginosa) over a 10-year period in the Clinical Center Niš, one of the biggest tertiary care hospitals in Serbia. We focused on possible relationships between the consumption of carbapenems and beta-lactam antibiotics and the rates of resistance of P. aeruginosa to carbapenems. Methods We recorded utilization of antibiotics expressed as defined daily doses per 100 bed days (DBD). Bacterial resistance was reported as the percentage of resistant isolates (percentage of all resistant and intermediate resistant strains) among all tested isolates. Results and discussion A significant increasing trend in resistance was seen in imipenem ( P < 0·05, Spearman ρ = 0·758) and meropenem ( P < 0·05, ρ = 0·745). We found a significant correlation between aminoglycoside consumption and resistance to amikacin ( P < 0·01, Pearson r = 0·837) and gentamicin ( P < 0·01, Pearson r = 0·827). The correlation between the consumption of carbapenems and resistance to imipenem in P. aeruginosa shows significance ( P < 0·01, Pearson r = 0·795), whereas resistance to meropenem showed a trend towards significance ( P > 0·05, Pearson r = 0·607). We found a very good correlation between the use of all beta-lactam and P. aeruginosa resistance to carbapenems ( P < 0·01, Pearson r = 0·847 for imipenem and P < 0·05, Pearson r = 0·668 for meropenem). What is new and conclusion Our data demonstrated a significant increase in antimicrobial resistance to carbapenems, significant correlations between the consumption of antibiotics, especially carbapenems and beta-lactams, and rates of antimicrobial resistance of P. aeruginosa to imipenem and meropenem. [ABSTRACT FROM AUTHOR]

Summary What is known and Objective: Calcium channel blockers (CCBs), which have been widely used for the treatment of hypertension and angina pectoris, decrease lower oesophageal sphincter pressure and, as a result, can exacerbate gastrointestinal disease. In a previous study, increased risk of exacerbation of gastrointestinal disease among elderly patients following treatment with CCBs was identified. The prevalence of gastrointestinal diseases has increased in elderly patients, and it is possible that treatment with CCBs may have undesirably influenced this increase. The change in risk of gastrointestinal disease can be estimated by analysing changes in the prescription of antisecretory drugs as an outcome of exacerbation of gastrointestinal disease caused by CCBs. Methods: It was hypothesized that patients who were prescribed CCBs would also change their use of antisecretory drugs. From September 2005 to August 2009, a dynamic retrospective cohort study was performed at five community pharmacies in Nagasaki, Japan, to assess alteration of antisecretory drug therapy following treatment with CCBs. Correlations with alterations of antisecretory drug therapy were determined by the Cox proportional hazards model. Results and Discussion: The proposed study included 260 patients who were prescribed CCBs and 155 controls. During the study period, 53 patients were prescribed CCBs and 13 controls altered their antisecretory drug therapy; the hazard ratio was 2·22 (95% CI 1·25-4·26). What is new and Conclusion: Calcium channel blocker treatment of patients with gastrointestinal disease was associated with alteration in frequency of prescription and an increase in dosage of antisecretory drugs. For clinical management of hypertension, alternative antihypertensive drugs may be considered for patients with gastrointestinal diseases. Further studies are required to determine the influence of CCB therapy on gastroesophageal diseases, suggested by the increase in use of antisecretory drugs. [ABSTRACT FROM AUTHOR]

Summary What is known and Objective: The Department of Health (DOH) in Taiwan issued the 'Guidelines for Benzodiazepine Use in Sedation and Hypnosis' in March 2004, which clearly stated that benzodiazepines (BZDs) should not be used alone for the treatment of depression. However, the extent to which clinicians comply with the BZD guidelines was not known. This study aimed to evaluate whether sole prescribing of BZDs for major depression decreased after the implementation of the BZD guidelines. Methods: This was a retrospective longitudinal trend analysis by analyzing the Longitudinal Health Insurance Database (LHID) from September 2002 to September 2005. The LHID contains all claims data from a random sample of 1 000 000 beneficiaries of the universal National Health Insurance programme in Taiwan. The 3-year study period was divided equally into six periods, before and after the implementation of the guidelines respectively. For each period, the proportion of patients with major depression (ICD-9-CM code 296.2x, 296.3x) treated with BZDs without any concomitant antidepressant was calculated in order to conduct a trend analysis. Results and Discussion: A total of 5463 prescriptions of BZDs solely used for major depression were observed in the entire study period. In more than 80% of the BZD prescriptions in which BZDs were used alone for major depression, they were prescribed at doses higher than one prescribed daily dose/defined daily dose and were supplied for more than 7 days. The number of outpatients with major depression ranged from 2137 to 3326 during the 12 periods. The proportion of depressed patients treated with BZDs alone per 3 months (i.e., the non-compliance rate) fluctuated from 6·7% to 9·4% before implementation of the guidelines, and from 8·0% to 9·4% after implementation, in outpatient settings. In addition, the guideline non-adherence rates in inpatient settings varied from 7·0% to 11·8% and from 7·8% to 12·6% before and after the implementation of the BZD guidelines respectively. Further trend analyses indicated that the implementation of the guidelines was not associated with a reduced rate of sole prescribing of BZDs for major depression in either inpatient ( P = 0·083) or outpatient settings ( P = 0·925). What is new and Conclusion: The formulation and implementation of the BZD guidelines appear not to be associated with a reduced rate of sole prescribing of BZDs for major depression, and more comprehensive efforts are required. [ABSTRACT FROM AUTHOR]

Background and Objective: Insomnia is a common complaint in the general population. Interest in the use of alternative treatments for insomnia is increasing exponentially and is fairly common in Taiwan. We undertook a survey to define the drug utilization patterns of Chinese herbal medicines (CM) for insomnia in Taiwan. Methods: The survey was conducted over a period of 4 years, from January 2003 to December 2006. Outpatients with primary insomnia and being treated with CM were studied. Core drug-use indicators were the number of CM items per prescription, the dosing frequency and duration of CM prescriptions, the most common prescribed CM herbs and CM formulae used. Results: Six thousand eight hundred and sixty patients, using 37 046 CM herb items, were screened during the study period. The average CM items per prescription was 5·40. Most of prescriptions (95·23%) were prescribed for administration three times a day. The most often prescribed Chinese herbal products were Hong-Hwa ( Carthamus tinctorius) and Jia-Wey-Shiau-Yau-San, which includes Angelica sinensis, Atractylodes macrocephala, Paeonia lactiflora, Bupleurum chinense, and Poria coco. Conclusion: This is the first extensive survey examining the drug utilization patterns of Chinese herbal medicines in the treatment of insomnia. Although the data were generated in Taiwan, the herbs and practices identified are likely to be widely generalizable wherever Chinese herbal remedies are used for insomnia. Multiple herbs and complex formulae were commonly used. The baseline data generated should be of use in informing subsequent studies, including those aimed at a thorough evaluation of the herbs’ effectiveness. [ABSTRACT FROM AUTHOR]

To evaluate the appropriateness of use of vancomycin in paediatric patients at KK Women's and Children's Hospital, the major paediatric hospital in Singapore to identify potential problems in prescribing practices that may necessitate intervention to optimize vancomycin usage. A retrospective drug utilization evaluation was performed for paediatric patients who received intravenous vancomycin from 1 June 1998 to 31 June 1999. The outcome measures were consistency of vancomycin indication with recommended guidelines, dosing regimens, microbiological data, monitoring of serum drug levels, renal function, clinical outcomes and adverse drug reactions (ADRs). A total of 96 cases was available for evaluation. Sixty-two (64·6%) courses of vancomycin were consistent with guidelines for indication of therapy. Eighty-six (89·6%) of the dosing regimen were consistent. All infusion times that were recorded (56·3%) were consistent with criteria. Of the patients treated with vancomycin for more than 1 day, peak and/or trough serum vancomycin levels were ordered for 70 cases. Of the 56 cases with paired levels ordered, 46 cases had at least one level that fell outside the therapeutic range. Nineteen (19·8%) cases of ADRs were documented. Fifty-eight (60·4%) cases received concurrent nephrotoxic drugs. However, a substantial portion of vancomycin courses were apparently not prescribed for appropriate indications, and there was poor recording of vancomycin administration information and sampling time. The majority of dosing regimens of vancomycin was consistent with guideline criteria. The most evident problem was the sub-optimal use of the monitoring of vancomycin serum levels. The information derived from this study may be used as a for further study and for the development of strategies for optimize vancomycin usage. [ABSTRACT FROM AUTHOR]

People who seek non-pharmaceutical interventions are often motivated by a desire to avoid or reduce orthodox medication. Effectiveness research in these areas needs to measure change in medication as an outcome. We set out to develop a data collection tool that is sensitive to changes in individual drug use over time. A multi-disciplinary team designed, piloted, and revised the Medication Change Questionnaire (MCQ) on two occasions, and used qualitative interviews to understand the patient's perspective and ensure that the final product accurately reflected the medication that patients were taking. Thirty patients in one general practice completed the questionnaire on two occasions and a purposive sample of 14 were interviewed. The design sought to enable patients to record all their ingested medication accurately, both prescription and over-the-counter drugs, over a period of 7 days. It was designed to be administered face-to face on the first occasion, and to be self-completed on subsequent occasions. In considering in detail what medication was taken each day, the interview data fully correlated with the MCQ data in only one of the five people who were interviewed after completing the first draft of the questionnaire, but in eight of the nine people who completed the second draft. Of these eight people all but one had made some change to their medication, either by stopping or starting a drug, varying the dose of a drug or always taking one or more drugs in varying doses. The interviews demonstrated the complex and individual ways that people took their medicines, and the disparity between what was prescribed and what was actually taken. The qualitative data were also useful for reflecting on the potential advantages and disadvantages of other data collection methods, such as single medication questions and pill counts. By involving patients at every level of research, we have developed a questionnaire that enables people to record their medication use accurately over a 7-day period, and to demonstrate changes in medication over time. Further work is required to assess its acceptability by different patient populations and its feasibility in terms of completion rates over longer periods of repeated use. We believe the MCQ to be an improvement over the variety of ad-hoc tools used in the past and it is freely available from the authors. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a major public health problem and often coexists with hypertension and dyslipidaemia. A prescription-based survey was conducted to examine the use of antidiabetic, antihypertensive and lipid lowering drugs in a hospital diabetes clinic. The expenditure incurred was also evaluated. Method: Prescriptions issued from the diabetes clinic were collected for 4 consecutive weeks. Drugs were categorized into three main classes—antidiabetic, antihypertensive and lipid-lowering drugs. The unit cost of each drug and the total amount prescribed were used to estimate the total drug costs. Results: During the 4-week study period, 534 prescriptions were collected, of which 520 contained antidiabetic drugs. Oral hypoglycaemic agents were prescribed in 379 patients (72·9%). Sulphonylurea was used as a single agent in 119 (22·9%) patients, in combination with metformin in 219 (42%) patients and with insulin in 17 patients (3·3%). Among patients treated with sulphonylureas (n=342), glibenclamide (47·7%) and gliclazide (30·7%) were the main drugs prescribed. Metformin monotherapy was prescribed in only 31 patients (6%). Insulin treatment was prescribed in 141 (27%) patients and in combination with oral drugs in 23 patients (4·5%). Of the 534 prescriptions, 225 (42%) contained antihypertensive drugs. Calcium channel blocking agents and angiotensin converting enzyme inhibitors were the most commonly prescribed drugs in both monotherapy (n=155) and combination therapy (n=70). The antidiabetic and antihypertensive drugs accounted for 45% and 39% of the total drug expenditure, respectively. Lipid-lowering drugs were prescribed in 8% of the diabetic patients. Simvastatin and gemfibrozil were the most common drugs prescribed and accounted for 12% of the total drug expenditure. Conclusion: The use of antidiabetic drugs represents a major burden on the health care system. The high proportions of patients requiring... [ABSTRACT FROM AUTHOR]

Summary What is known and Objective: Analgesics are among the most widely used drugs and there is wide intercountry variability in the rates of consumption of different analgesics. Our objective is to determine and compare patterns of analgesic consumption in the Slovak Republic and a number of other European countries. Methods: We undertook a drug utilization study using WHO ATC/defined daily doses (DDD) methodology. Wholesale analgesic data collected by the Slovak State Institute for Drug Control were used. Utilization was calculated as DDD per 1000 inhabitants per day. Comparison with wholesale data from Czech Republic, Estonia, Finland, Norway and Denmark, published on the Internet, was made. Results and Discussion: Paracetamol/acetaminophen consumption varied only a little in Slovak Republic and Czech Republic, whereas consumption in Nordic countries was significantly higher ( P < 0.05) and in Estonia significantly lower. Ibuprofen consumption was significantly higher in Czech Republic and Finland. Significantly lower consumption was in Norway. The lowest consumption of ASA/aspirin was in Denmark and in Norway. The highest consumption was in Finland. What is new and Conclusion: Effective therapy needs good prescribing and well-informed prescribers and patients. Our study highlights wide differences in analgesic consumption even among similar European countries. The basis of these differences and their potential clinical impact require further investigation. [ABSTRACT FROM AUTHOR]